Protocol for acquisition of images and measurement of transabdominal ultrasound pancreatic two-dimensional shear wave elastography (2D-SWE). / Protocolo de adquisición de imágenes y medición de la elasticidad pancreática mediante elastografía por onda de cizallamiento bidimensional (2D-SWE) transabdominal.

INTRODUCTION: Transabdominal ultrasound (TU) pancreatic 2D-SWE elastography is a developing technique that needs to be protocolized. OBJECTIVES: Establish a protocol for image acquisition and measurement of TU pancreatic - 2D-SWE elastography and estimate the minimum number of measurements to be performed. MATERIALS AND METHODS: Ten measurements of pancreatic elasticity were taken in healthy volunteers using TU-2D-SWE, following a strict protocol for image acquisition and measurement. RESULTS: The 70% of the participants were women, with an average age, weight, and BMI of 49.5±15.7 years, 65.9±11.9kg, and 24.5±4.2kg/m2, respectively. Measurements were taken from the body (70%), tail (16.7%), and pancreatic head (13.3%). The median mean velocity and elasticity were 1.46±0.25cm/sec and 6.46±2.87KPa, respectively. The ROI depth was 4.12±1cm and the SP-ROI distance was 5.2mm on average. There were no statistically significant differences between the 10 measurements. The reliability analysis of the measurements showed high internal consistency and repeatability. Taking 5-6 measurements ensured high concordance with the ten reference measurements. The measurements were significantly lower when the SP-ROI values were intermediate (0.3-0.6cm). The measurement accuracy was higher when performed at a depth less than 4.8cm. CONCLUSION: To measure pancreatic elasticity using TU-2D-SWE, we propose a strict protocol for image acquisition and measurement, taking a minimum of 5 measurements in the best visualized and accessible pancreatic portion, and preferably at a depth of less than 4.8cm.

Cambios hemodinámicos posligadura con bandas de varices esofágicas: un estudio de cohortes / No disponible

INTRODUCCIÓN: existe controversia sobre la necesidad de mantener el tratamiento vasoconstrictor tras lograr una adecuada hemostasia mediante ligadura endoscópica, en la hemorragia aguda por varices esofágicas. Dado que es muy complejo hacer un gradiente "pre y posligadura urgente" en el sangrante por varices, nuestro objetivo es conocer las variaciones hemodinámicas tras la terapia endoscópica, midiendo un gradiente venoso hepático "pre" y otro 24 horas "posprocedimiento" en los cirróticos con ligadura programada como profilaxis de la hemorragia varicosa. MATERIAL Y MÉTODOS: estudio prospectivo, de cohorte, unicéntrico. Los pacientes, en protocolo de erradicación endoscópica, fueron sometidos a un gradiente de presión venosa hepática basal (GPVH PRE), sin modificar su tratamiento habitual con beta-bloqueantes. Después, se procedió a ligadura endoscópica, según guías de práctica clínica. Tras 24 horas del procedimiento, se realizó una segunda medida de presiones (GPVH POST). RESULTADOS: 30 pacientes. Las medianas de los GPVH PRE y POST ligadura fueron 16,5 mmHg (14-20) y 19,5 mmHg (17-21) respectivamente, con un aumento significativo tras el procedimiento (p < 0,001). Las variaciones porcentuales de presión portal, según cifra de gradiente basal (12, 16 y 20 mmHg), eran mayores en pacientes con menor GVPH frente a mayor GPVH basal en cualquiera de las categorías comparadas (p = 0,087, p = 0,016 y p < 0,001, respectivamente). En nuestra serie, el 36,7 % de los pacientes presentó un incremento de gradiente ≥ 20 % tras la ligadura. CONCLUSIÓN: la ligadura con bandas de varices esofágicas condiciona un aumento de presión portal, al menos transitorio, objetivado mediante gradiente de presión venosa hepática

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Hemodynamic changes after endoscopic variceal ligation: a cohort study.

BACKGROUND: there is controversy about the need to maintain vasoconstrictor treatment after adequate haemostasis is achieved through endoscopic band ligation (EBL) in bleeding esophageal varices (BEV). Measuring a "before and after urgent-EBL" hepatic venous pressure gradient (HVPG) in acute variceal hemorrhage is very difficult. Thus, the goal of this study was to determine hemodynamic variations after an EBL session. A "before" HVPG (PRE) was performed and another one 24 hours "after-ligation" (POST), in cirrhotic patients undergoing endoscopic band ligation as BEV prophylaxis. PATIENTS AND METHODS: this was a single-center, cohort, prospective study. Patients followed a program of repeated sessions of EBL until eradication of their varices and underwent a basal hepatic venous pressure gradient (PRE HVPG), without changing their usual treatment with beta-blockers. Subsequently, an endoscopic ligation session was performed, following the clinical practices guidelines. A second pressure measurement (POST HVPG) was taken 24 hours after the endoscopic treatment. RESULTS: 30 patients were included. PRE and POST HVPG median results were 16.5 mmHg (14-20) and 19.5 mmHg (17-21), respectively, with a significant increase after the procedure (p < 0.001). Percentage variations in portal pressure, based on the baseline gradient values (12, 16 and 20 mmHg), were higher for patients with a lower basal HVPG versus a higher HVPG for any of the categories compared (p = 0.087, p = 0.016 and p < 0.001, respectively). In our series, 36.7 % of patients showed a ≥ 20 % gradient increase after ligation. CONCLUSION: endoscopic band ligation causes an increase in portal pressure, at least for a transitional period, determined by the hepatic venous pressure gradient.

Utilidad de la calprotectina sérica como biomarcador de actividad inflamatoria en la enfermedad inflamatoria intestinal / The use of serum calprotectin as a biomarker for inflammatory activity in inflammatory bowel disease

Introducción: para el correcto manejo de la enfermedad inflamatoria intestinal (EII) precisamos de marcadores no invasivos, fiables y sencillos que permitan detectar la actividad inflamatoria de forma precoz. Uno de estos marcadores biológicos podría ser la calprotectina sérica (CS). Material y métodos: inclusión prospectiva de pacientes con EII que iban a realizarse una colonoscopia por práctica clínica habitual. Se determinaron: CS, calprotectina fecal (CF) y parámetros analíticos convencionales. Se realizaron los índices clínicos (Harvey y Walmsley) así como los endoscópicos correspondientes en cada escenario (Simple Endoscopic Score Crohn Disease [SES-CD] y Mayo). Resultados: se incluyeron 53 pacientes; el 51% (27 pacientes) con colitis ulcerosa (CU) y el 49% (26 pacientes) con enfermedad de Crohn (EC). En CU los valores de CS fueron significativamente superiores con actividad endoscópica Mayo 2/3 (mediana 10,39 mg/ml [IQR: 7,4-12,2]) frente aquellos con Mayo 0/1 (mediana 4,07mg/ml [IQR: 2,9-7,2]) (p = 0,01). El área bajo la curva ROC (AUCROC) fue 0,85, obteniendo para un punto de corte de CS de 4,4 mg/dl una sensibilidad y especificidad del 83,3% y 81,25%, respectivamente. Además, al comparar con otros marcadores serológicos de actividad (proteína C reactiva [PCR], velocidad de sedimentación globular [VSG], hemoglobina [Hb] y plaquetas) se obtuvo un AUCROC superior. Cuando comparamos la CS con los hallazgos endoscópicos en EC, no hubo diferencias estadísticamente significativas (SES CD > 3: 20,1 [IQR: 16,8-23,4] vs. SESC ≤ 3:6,25 [IQR: 5,4-7,1]) (p = 0,8). Conclusiones: la CS es un buen marcador indirecto de la actividad inflamatoria y existe correlación con los hallazgos endoscópicos en CU, aunque sin diferencias estadísticamente significativas en EC

Introduction: simple, reliable and non-invasive biomarkers are needed to enable the early detection of inflammatory activity for the correct management of inflammatory bowel disease (IBD). One of these biomarkers may be serum calprotectin (SC). Material and methods: a prospective study was performed of patients with IBD due to undergo a colonoscopy as part of the common clinical practice. The study parameters included SC, fecal calprotectin (FC) and conventional blood test parameters. Clinical indices (Harvey and Walmsley) and relevant endoscopic scores were completed for each scenario (Simple Endoscopic Score Crohn Disease [SES-CD] and Mayo). Results: fifty-three patients were included in the study, 51% (27 patients) with ulcerative colitis (UC) and 49% (26 patients) with Crohn's disease (CD). The CS values in UC were significantly higher with an endoscopic Mayo score 2/3 (median score 10.39 mg/ml [IQR: 7.4-12.2]) compared to those with a Mayo score of 0/1 (median 4.07 mg/ml [IQR: 2.9-7.2]) (p = 0.01). The area under the ROC curve (AUCROC) was 0.85 and the sensitivity and specificity were 83.3% and 81.25%, respectively, for a SC cut-off point of 4.4 mg/dl. Furthermore, a higher AUCROC was obtained in comparison with other serological markers for activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin [Hb] and platelets). There were no statistically significant differences in the comparison between SC and endoscopic findings in CD (SES CD > 3: 20.1 [IQR: 16.8-23.4] vs SESC ≤ 3:6.25 [IQR: 5.4-7.1]) (p = 0.8). Conclusions: SC is a good indirect marker of inflammatory activity and there was a correlation with endoscopic findings in UC. However, there were no statistically significant differences in the case of CD

The use of serum calprotectin as a biomarker for inflammatory activity in inflammatory bowel disease.

INTRODUCTION: simple, reliable and non-invasive biomarkers are needed to enable the early detection of inflammatory activity for the correct management of inflammatory bowel disease (IBD). One of these biomarkers may be serum calprotectin (SC). MATERIAL AND METHODS: a prospective study was performed of patients with IBD due to undergo a colonoscopy as part of the common clinical practice. The study parameters included SC, fecal calprotectin (FC) and conventional blood test parameters. Clinical indices (Harvey and Walmsley) and relevant endoscopic scores were completed for each scenario (Simple Endoscopic Score Crohn Disease [SES-CD] and Mayo). RESULTS: fifty-three patients were included in the study, 51% (27 patients) with ulcerative colitis (UC) and 49% (26 patients) with Crohn's disease (CD). The CS values in UC were significantly higher with an endoscopic Mayo score 2/3 (median score 10.39 mg/ml [IQR: 7.4-12.2]) compared to those with a Mayo score of 0/1 (median 4.07 mg/ml [IQR: 2.9-7.2]) (p = 0.01). The area under the ROC curve (AUCROC) was 0.85 and the sensitivity and specificity were 83.3% and 81.25%, respectively, for a SC cut-off point of 4.4 mg/dl. Furthermore, a higher AUCROC was obtained in comparison with other serological markers for activity (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin [Hb] and platelets). There were no statistically significant differences in the comparison between SC and endoscopic findings in CD (SES CD > 3: 20.1 [IQR: 16.8-23.4] vs SESC ≤ 3:6.25 [IQR: 5.4-7.1]) (p = 0.8). CONCLUSIONS: SC is a good indirect marker of inflammatory activity and there was a correlation with endoscopic findings in UC. However, there were no statistically significant differences in the case of CD.

Ileal ulcers due to gastrointestinal amyloidosis as an unusual cause of severe lower gastrointestinal bleeding.

Amyloidosis is a chronic multisystem disease that could show multitude of nonspecific symptoms. Gastrointestinal amyloidosis is a very unusual cause of lower gastrointestinal bleeding and it does not usually lead the patient to death. We report a case of a 73-year-old woman who presented a severe, refractory lower gastrointestinal bleeding secondary to ileal ulcers due to amyloid deposit.

Úlceras ileales secundarias a amiloidosis gastrointestinal como causa infrecuente de hemorragia digestiva baja severa / Ileal ulcers due to gastrointestinal amyloidosis as an unusual cause of severe lower gastrointestinal bleeding

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Utilidad de la ecografía abdominal doppler en el diagnóstico del síndrome de obstrucción sinusoidal (SOS) en un paciente receptor de trasplante de progenitores hematopoyéticos / Use of abdominal ultrasound in the diagnosis of hepatic sinusoidal obstruction syndrome (SOS) in a patient receiving a hematopoietic-cell transplant

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Use of abdominal ultrasound in the diagnosis of hepatic sinusoidal obstruction syndrome (SOS) in a patient receiving a hematopoietic-cell transplant.

The sinusoidal obstruction syndrome (SOS) is an uncommon form of portal hypertension that occurs in hematopoietic-cell transplant recipients who receive intense conditioning treatments. The diagnosis is clinical and it is usually delayed, because in these patients there are many causes that can damage the liver and can delay its detection. We present the case of a 47-year-old man, whose diagnosis was made with clinical and analytical data supported by ultrasound signs that showed hepatic congestion. After treatment with defibrotide the patient improved clinically and analytically. Hepatic vascularization and perfusion also improved. Therefore, abdominal doppler ultrasound is shown as a noninvasive exploration useful for the clinical management of SOS and as an early marker of good clinical evolution.