Effectiveness of pancreatic stent placement in pediatric patients with acute recurrent and chronic pancreatitis.

BACKGROUND: The use of pancreatic prostheses in children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) has evolved. The main established indication is the treatment of persistent abdominal pain. This study aimed to evaluate the efficacy of pancreatic stenting for refractory abdominal pain in pediatric patients with ARP and CP. METHODS: We conducted a retrospective case series study. We included patients under 16 years of age diagnosed with ARP and CP in the study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed with the insertion of one and later two pancreatic stents. We evaluated abdominal symptoms before and after treatment, number of changes, duration of treatment, and complications with follow-up at 24 months and after withdrawal. RESULTS: Nine patients with ARP and CP were included in the study: six with undetermined etiology and three with pancreas divisum. The mean age was 12.4 years. Prosthesis placement relieved abdominal pain in 100% of cases, with 3.2 replacement sessions every 6.2 months for 27.4 months, and mild complications (15.7%). One patient experienced pain on removal of the prosthesis and required bypass surgery. CONCLUSION: Pancreatic stent placement in patients with refractory abdominal pain with ARP and CP proved to be effective and safe, providing medium-term symptom relief and minimal complications.

INTRODUCCIÓN: El uso de prótesis pancreáticas en niños con pancreatitis aguda recurrente (PAR) y crónica (PC) ha evolucionado. La principal indicación establecida es el tratamiento del dolor abdominal persistente. El objetivo de este estudio fue evaluar la eficacia del uso prótesis pancreática para el dolor abdominal refractario en pacientes pediátricos con PAR y PC, sin respuesta a manejo conservador. MÉTODOS: Se llevó a cabo un estudio retrospectivo de serie de casos. Se incluyeron pacientes menores de 16 años con diagnóstico de PAR y PC. Se realizó una colangio pancreatografía retrograda endoscópica (CPRE) para introducir inicialmente una y posteriormente dos prótesis pancreáticas. Se evaluaron síntomas abdominales antes y después del tratamiento, número de recambios, duración del tratamiento y complicaciones con seguimiento a 24 meses y posterior a su retiro. RESULTADOS: Se incluyeron 9 pacientes con PAR y PC: seis de etiología no determinada y tres con páncreas divisum. La edad promedio fue de 12.4 años. La colocación de prótesis alivió el dolor abdominal en el 100%, con 3.2 sesiones de recambio cada 6.2 meses en 27.4 meses, y complicaciones leves (15.7%). Un paciente presentó dolor al retirar las prótesis y requirió cirugía derivativa. CONCLUSIONES: El uso de prótesis pancreática en pacientes con dolor abdominal refractario con PAR y PC demostró ser eficaz y seguro al aliviar los síntomas a mediano plazo con mínimas complicaciones.

Effectiveness of pancreatic stent placement in pediatric patients with acute recurrent and chronic pancreatitis / Eficacia de la prótesis pancreática en pacientes pediátricos con pancreatitis aguda recurrente y crónica

Abstract Background: The use of pancreatic prostheses in children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) has evolved. The main established indication is the treatment of persistent abdominal pain. This study aimed to evaluate the efficacy of pancreatic stenting for refractory abdominal pain in pediatric patients with ARP and CP. Methods: We conducted a retrospective case series study. We included patients under 16 years of age diagnosed with ARP and CP in the study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed with the insertion of one and later two pancreatic stents. We evaluated abdominal symptoms before and after treatment, number of changes, duration of treatment, and complications with follow-up at 24 months and after withdrawal. Results: Nine patients with ARP and CP were included in the study: six with undetermined etiology and three with pancreas divisum. The mean age was 12.4 years. Prosthesis placement relieved abdominal pain in 100% of cases, with 3.2 replacement sessions every 6.2 months for 27.4 months, and mild complications (15.7%). One patient experienced pain on removal of the prosthesis and required bypass surgery. Conclusion: Pancreatic stent placement in patients with refractory abdominal pain with ARP and CP proved to be effective and safe, providing medium-term symptom relief and minimal complications.

Resumen Introducción: El uso de prótesis pancreáticas en niños con pancreatitis aguda recurrente (PAR) y crónica (PC) ha evolucionado. La principal indicación establecida es el tratamiento del dolor abdominal persistente. El objetivo de este estudio fue evaluar la eficacia del uso prótesis pancreática para el dolor abdominal refractario en pacientes pediátricos con PAR y PC, sin respuesta a manejo conservador. Métodos: Se llevó a cabo un estudio retrospectivo de serie de casos. Se incluyeron pacientes menores de 16 años con diagnóstico de PAR y PC. Se realizó una colangio pancreatografía retrograda endoscópica (CPRE) para introducir inicialmente una y posteriormente dos prótesis pancreáticas. Se evaluaron síntomas abdominales antes y después del tratamiento, número de recambios, duración del tratamiento y complicaciones con seguimiento a 24 meses y posterior a su retiro. Resultados: Se incluyeron 9 pacientes con PAR y PC: seis de etiología no determinada y tres con páncreas divisum. La edad promedio fue de 12.4 años. La colocación de prótesis alivió el dolor abdominal en el 100%, con 3.2 sesiones de recambio cada 6.2 meses en 27.4 meses, y complicaciones leves (15.7%). Un paciente presentó dolor al retirar las prótesis y requirió cirugía derivativa. Conclusiones: El uso de prótesis pancreática en pacientes con dolor abdominal refractario con PAR y PC demostró ser eficaz y seguro al aliviar los síntomas a mediano plazo con mínimas complicaciones.

Clinical and paraclinical characteristics in pediatric patients with acute recurrent and chronic pancreatitis: a cohort in Mexico.

BACKGROUND: Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are infrequent clinical entities in pediatric patients, as less than 8% of the literature mentions this population. This study aimed to describe the clinical and paraclinical profile, and the etiology related to patients with ARP and CP attended at a tertiary-level healthcare institute in Mexico. METHODS: We conducted a retrospective study from medical records of patients with ARP and CP attended between 2010 and 2020, analyzing the clinical characteristics, imaging studies, and the etiology associated with each patient. RESULTS: We analyzed 25 patients: 17 were diagnosed with ARP, and eight with CP. The main etiology identified was an anatomical alteration of the pancreatic duct (32%); pancreas divisum was the most prevalent condition. In 48% of the population, the etiology was not identified. The group with CP was higher in frequency for calcifications and dilation of the pancreatic duct (p < 0.005) compared to the ARP group. CONCLUSIONS: The main etiology for ARP and CP was an anatomical alteration of the pancreatic duct; however, in almost half of the cases, no established cause was identified. Although comparing our results with those offered by large cohorts such as the INSPPIRE group can be complex, we found relevant similarities. Currently, the data obtained from this first descriptive study are the foundation for future research in the field of Mexican pediatric pancreatology.

INTRODUCCIÓN: La pancreatitis aguda recurrente (PAR) y crónica (PC) son entidades poco frecuentes en la edad pediátrica; sin embargo, menos del 8% de la literatura hace referencia a esta población. El objetivo de este estudio fue describir el perfil clínico, paraclínico y etiologías vinculadas en los pacientes con PAR y PC atendidos en una institución de tercer nivel de atención en México. MÉTODOS: Se realizó un estudio retrospectivo de los expedientes de los pacientes con PAR y PC atendidos entre 2010 a 2020, analizando las características clínicas, estudios de imagen y etiologías asociadas en cada uno de los pacientes. RESULTADOS: Se analizaron 25 pacientes, 17 con diagnóstico de PAR y ocho con PC. La principal etiología identificada correspondió a las alteraciones anatómicas del conducto pancreático (32%); el páncreas divisum fue la entidad más prevalente. En el 48% de la población no se pudo identificar una etiología. El grupo con PC presentó mayor frecuencia de calcificaciones y dilatación ductal pancreática (p < 0.005) en comparación al grupo de PAR. CONCLUSIONES: La principal etiología de PAR y PC identificada en nuestro estudio corresponde a las alteraciones anatómicas del conducto pancreático; sin embargo, en casi la mitad de los casos, no se tiene una causa establecida. Aunque es complicado comparar nuestros resultados con los ofrecidos por las grandes cohortes del grupo INSPPIRE, sí encontramos similitudes relevantes. Los datos obtenidos en este primer estudio descriptivo son la base para futuras investigaciones en el ámbito de la pancreatología pediátrica mexicana.

Clinical and paraclinical characteristics in pediatric patients with acute recurrent and chronic pancreatitis: a cohort in Mexico / Características clínicas y paraclínicas en pacientes pediátricos con pancreatitis aguda recurrente y crónica: una cohorte en México

Abstract Background: Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are infrequent clinical entities in pediatric patients, as less than 8% of the literature mentions this population. This study aimed to describe the clinical and paraclinical profile, and the etiology related to patients with ARP and CP attended at a tertiary-level healthcare institute in Mexico. Methods: We conducted a retrospective study from medical records of patients with ARP and CP attended between 2010 and 2020, analyzing the clinical characteristics, imaging studies, and the etiology associated with each patient. Results: We analyzed 25 patients: 17 were diagnosed with ARP, and eight with CP. The main etiology identified was an anatomical alteration of the pancreatic duct (32%); pancreas divisum was the most prevalent condition. In 48% of the population, the etiology was not identified. The group with CP was higher in frequency for calcifications and dilation of the pancreatic duct (p < 0.005) compared to the ARP group. Conclusions: The main etiology for ARP and CP was an anatomical alteration of the pancreatic duct; however, in almost half of the cases, no established cause was identified. Although comparing our results with those offered by large cohorts such as the INSPPIRE group can be complex, we found relevant similarities. Currently, the data obtained from this first descriptive study are the foundation for future research in the field of Mexican pediatric pancreatology.

Resumen Introducción: La pancreatitis aguda recurrente (PAR) y crónica (PC) son entidades poco frecuentes en la edad pediátrica; sin embargo, menos del 8% de la literatura hace referencia a esta población. El objetivo de este estudio fue describir el perfil clínico, paraclínico y etiologías vinculadas en los pacientes con PAR y PC atendidos en una institución de tercer nivel de atención en México. Métodos: Se realizó un estudio retrospectivo de los expedientes de los pacientes con PAR y PC atendidos entre 2010 a 2020, analizando las características clínicas, estudios de imagen y etiologías asociadas en cada uno de los pacientes. Resultados: Se analizaron 25 pacientes, 17 con diagnóstico de PAR y ocho con PC. La principal etiología identificada correspondió a las alteraciones anatómicas del conducto pancreático (32%); el páncreas divisum fue la entidad más prevalente. En el 48% de la población no se pudo identificar una etiología. El grupo con PC presentó mayor frecuencia de calcificaciones y dilatación ductal pancreática (p < 0.005) en comparación al grupo de PAR. Conclusiones: La principal etiología de PAR y PC identificada en nuestro estudio corresponde a las alteraciones anatómicas del conducto pancreático; sin embargo, en casi la mitad de los casos, no se tiene una causa establecida. Aunque es complicado comparar nuestros resultados con los ofrecidos por las grandes cohortes del grupo INSPPIRE, sí encontramos similitudes relevantes. Los datos obtenidos en este primer estudio descriptivo son la base para futuras investigaciones en el ámbito de la pancreatología pediátrica mexicana.

Peutz-Jeghers syndrome in pediatric patients: experience in a tertiary care institution in Mexico.

BACKGROUND: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disease characterized by the development of polyps in the gastrointestinal tract, mucocutaneous pigmentation, and the risk of developing malignant neoplasms. This study aimed to analyze the epidemiological, clinical, and histopathological data of patients with PJS treated in a tertiary pediatric hospital. METHODS: We conducted a retrospective observational study to describe the epidemiological, clinical, endoscopic, and histological characterization of patients with PJS treated in a tertiary pediatric hospital in Mexico. RESULTS: We included 13 cases with a male-female ratio of 1.16:1. Abdominal pain was the main reason for consultation, followed by rectorrhagia. Patients showed mucocutaneous pigmentation and polyps in the gastrointestinal tract, frequently of the hamartomatous type, although inflammatory polyps, follicular hyperplasia, and adenomatous polyps were also found. Among the complications, there was a high prevalence of emergency surgery secondary to abdominal obstructive processes, the main reason for first-time consultation in these patients. CONCLUSIONS: The main clinical manifestations were mucocutaneous pigmentation, abdominal pain, and rectorrhagia. PJS should be included in the differential diagnosis in the presence of intestinal obstruction. The diagnosis of PJS should not be excluded if hamartomatous polyps are not evident on the first endoscopy. Nutritional assessment should be included due to the risk of presenting some degree of malnutrition.

INTRODUCCIÓN: El síndrome de Peutz-Jeghers es una enfermedad hereditaria autosómica dominante poco frecuente, caracterizada por el desarrollo de pólipos en el tubo digestivo, pigmentación mucocutánea y riesgo de desarrollar neoplasias malignas. El objetivo de este estudio fue analizar los datos epidemiológicos, clínicos e histopatológicos de los pacientes con SPJ atendidos en un hospital pediátrico de tercer nivel. MÉTODOS: Se llevó a cabo un estudio observacional retrospectivo, para describir las características epidemiológicas, clínicas, endoscópicas e histopatológicas de los pacientes con SPJ atendidos en un hospital pediátrico de tercer nivel de atención en México. RESULTADOS: Se recopilaron 13 casos con una relación masculino-femenino de 1.16:1. El dolor abdominal fue el principal motivo de consulta, seguido por rectorragia. Los pacientes presentaban pigmentación mucocutánea y pólipos en el tubo digestivo, la mayoría del tipo hamartomatoso, aunque también se hallaron pólipos inflamatorios, hiperplasia folicular y adenomatosos. Dentro de las complicaciones se encontró una alta prevalencia de cirugías de emergencia secundarias a procesos obstructivos abdominales, motivo principal de consulta de primera vez en estos pacientes. CONCLUSIONES: Las principales manifestaciones clínicas fueron pigmentación mucocutánea, dolor abdominal y rectorragia. Ante un cuadro de obstrucción intestinal se debe considerar el SPJ en el diagnóstico diferencial. No se debe excluir el diagnóstico de SPJ si no se evidencian pólipos hamartomatosos en la primera endoscopia. Se debe incluir la valoración nutricional por el riesgo de presentar algún grado de desnutrición.

Peutz-Jeghers syndrome in pediatric patients: experience in a tertiary care institution in Mexico / Síndrome de Peutz-Jeghers en pacientes pediátricos: experiencia en una institución de tercer nivel de atención en México

Abstract Background: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disease characterized by the development of polyps in the gastrointestinal tract, mucocutaneous pigmentation, and the risk of developing malignant neoplasms. This study aimed to analyze the epidemiological, clinical, and histopathological data of patients with PJS treated in a tertiary pediatric hospital. Methods: We conducted a retrospective observational study to describe the epidemiological, clinical, endoscopic, and histological characterization of patients with PJS treated in a tertiary pediatric hospital in Mexico. Results: We included 13 cases with a male-female ratio of 1.16:1. Abdominal pain was the main reason for consultation, followed by rectorrhagia. Patients showed mucocutaneous pigmentation and polyps in the gastrointestinal tract, frequently of the hamartomatous type, although inflammatory polyps, follicular hyperplasia, and adenomatous polyps were also found. Among the complications, there was a high prevalence of emergency surgery secondary to abdominal obstructive processes, the main reason for first-time consultation in these patients. Conclusions: The main clinical manifestations were mucocutaneous pigmentation, abdominal pain, and rectorrhagia. PJS should be included in the differential diagnosis in the presence of intestinal obstruction. The diagnosis of PJS should not be excluded if hamartomatous polyps are not evident on the first endoscopy. Nutritional assessment should be included due to the risk of presenting some degree of malnutrition.

Resumen Introducción: El síndrome de Peutz-Jeghers es una enfermedad hereditaria autosómica dominante poco frecuente, caracterizada por el desarrollo de pólipos en el tubo digestivo, pigmentación mucocutánea y riesgo de desarrollar neoplasias malignas. El objetivo de este estudio fue analizar los datos epidemiológicos, clínicos e histopatológicos de los pacientes con SPJ atendidos en un hospital pediátrico de tercer nivel. Métodos: Se llevó a cabo un estudio observacional retrospectivo, para describir las características epidemiológicas, clínicas, endoscópicas e histopatológicas de los pacientes con SPJ atendidos en un hospital pediátrico de tercer nivel de atención en México. Resultados: Se recopilaron 13 casos con una relación masculino-femenino de 1.16:1. El dolor abdominal fue el principal motivo de consulta, seguido por rectorragia. Los pacientes presentaban pigmentación mucocutánea y pólipos en el tubo digestivo, la mayoría del tipo hamartomatoso, aunque también se hallaron pólipos inflamatorios, hiperplasia folicular y adenomatosos. Dentro de las complicaciones se encontró una alta prevalencia de cirugías de emergencia secundarias a procesos obstructivos abdominales, motivo principal de consulta de primera vez en estos pacientes. Conclusiones: Las principales manifestaciones clínicas fueron pigmentación mucocutánea, dolor abdominal y rectorragia. Ante un cuadro de obstrucción intestinal se debe considerar el SPJ en el diagnóstico diferencial. No se debe excluir el diagnóstico de SPJ si no se evidencian pólipos hamartomatosos en la primera endoscopia. Se debe incluir la valoración nutricional por el riesgo de presentar algún grado de desnutrición.

Screening for COVID-19 in Children Undergoing Elective Invasive Procedures.

OBJECTIVE: To report the frequency of asymptomatic infection with SARS-CoV-2 in pediatric patients undergoing invasive medical procedures in a tertiary pediatric hospital. METHODS: From June to October 2020, a SARS-CoV-2 real-time reverse-transcription polymerase chain reaction (rRT-PCR) test was performed for all pediatric patients scheduled to undergo an elective invasive procedure. None of the patients was symptomatic. The cycle threshold (Ct) values of the ORF1ab gene were recorded for all patients. RESULTS: A total of 700 patients were screened for SARS-CoV-2 infection. The median age was 5.7 y old. In total, 46.6% (n = 326) of the patients were male, and 53.4% (n = 374) were female. The most common underlying diseases were hemato-oncological (25.3%), gastrointestinal (24.9%), and genitourinary (10.3%). The main scheduled surgical-medical procedures were surgical treatment for acquired congenital diseases, biopsy sampling, local therapy administration, organ transplantation, and the placement of central venous catheters, among others. The SARS-CoV-2 rRT-PCR test was positive in 9.4% (66), and the median Ct value was 35.8. None of the patients developed COVID-19. CONCLUSIONS: The frequency of asymptomatic SARS-CoV-2 infection was detected in less than 10% of pediatric patients scheduled to undergo an elective invasive procedure in a tertiary hospital. This frequency is higher than those in reports from different countries.

Importance of early endoscopic and clinical evaluation of children with caustics ingestion.

BACKGROUND: Accidental ingestion of caustics in pediatrics continues to be a frequent problem that can lead to severe injuries and permanent sequelae that require esophageal rehabilitation programs. This study aimed to describe the medical care experience of children who ingested caustic substances in a tertiary hospital in Mexico City. METHODS: We conducted a descriptive and analytical study. We described age, sex, type of caustics, clinical and endoscopic findings, and the radiological evolution of 284 patients who arrived during the acute phase. RESULTS: The records of 336 children with a history of caustic ingestion were reviewed. The median age was 1.7 years, and the predominant sex was male. Caustic soda was the most accidentally ingested substance. We found an association between the severity of the esophageal injury with the presence of more than four symptoms at diagnosis (χ², p < 0.001) and with the finding of oral lesions, sialorrhea, and vomiting (χ², p < 0.05). Forty percent (n = 114) showed normal gastrointestinal endoscopy. CONCLUSIONS: In children with caustic ingestion, upper gastrointestinal endoscopy should be performed within 72 hours to evaluate the extent of the lesions. In this study, we found that more than four symptoms at admission, and oral lesions, sialorrhea, and vomiting are associated with the severity of the esophageal injury.

INTRODUCCIÓN: La ingesta accidental de cáusticos continúa siendo un problema frecuente en pediatría que puede llegar a producir lesiones graves y secuelas permanentes que ameritarán programas de rehabilitación esofágica. El objetivo de este estudio es describir la experiencia en la atención médica de niños con ingesta de sustancias cáusticas en un hospital de tercer nivel en la Ciudad de México. MÉTODOS: Se llevó a cabo un estudio descriptivo y analítico. Se describieron la edad, el sexo, el tipo de cáustico, los hallazgos clínicos y endoscópicos, así como la evolución radiológica, de 284 pacientes que llegaron en la fase aguda. RESULTADOS: Se revisaron los expedientes de 336 niños con antecedente de ingesta de cáusticos. La mediana de edad fue de 1.7 años, con predominio del sexo masculino. La sosa cáustica fue la sustancia más ingerida y de tipo accidental. Encontramos asociación entre la gravedad de la lesión esofágica y la presencia de más de cuatro síntomas en el momento del diagnóstico (χ2, p < 0.001,), y con el hallazgo de lesiones orales, sialorrea y vómito (χ2, p < 0.05). El 40% de los niños (n = 114) tuvieron una endoscopia digestiva normal. CONCLUSIONES: En los niños con ingesta de cáusticos debe realizarse una endoscopia digestiva alta en las primeras 72 horas para evaluar la extensión de las lesiones. En este estudio se encontró que tener más de cuatro síntomas al ingreso, así como la presencia de lesiones orales, sialorrea y vómito, se asocian con la gravedad de la lesión esofágica.

Rituximab in the Treatment of Interstitial Lung Disease Associated with Autoimmune Diseases: Experience from a Single Referral Center and Literature Review.

In the present study, we aimed to report our experience with rituximab (RTX) in the treatment of patients with ILD associated with AD (AD-ILD) at a single center. For this purpose, clinical characteristics, radiological findings, and pulmonary function tests (PFTs) of RTX-treated AD-ILD-patients seen from May 2016 until March 2020 at a referral center for individuals with ILD were retrospectively reviewed. Additionally, an updated literature review was conducted. A total of 26 patients (mean age 58.3 ± 11.1 years at ILD diagnosis) was included. The most common ADs related to ILD were systemic sclerosis, idiopathic inflammatory myositis (including anti-synthetase syndrome) and rheumatoid arthritis. Non-specific interstitial pneumonia (n = 12) and usual interstitial pneumonia (n = 11) were the predominant radiological patterns. The sustained improvement in PFTs was observed from the start of RTX, with a statistically significant increase in DLCO from basal to one year after RTX (mean + 4.2%, p = 0.024). Overall, there were no differences when comparing PFT outcome according to the radiological pattern or the specific type of AD. In conclusion, RTX constitutes a good therapeutic option to preserve lung function in patients with AD-ILD, regardless of the radiological pattern or the underlying AD.

The Spectrum of Interstitial Lung Disease Associated with Autoimmune Diseases: Data of a 3.6-Year Prospective Study from a Referral Center of Interstitial Lung Disease and Lung Transplantation.

Interstitial lung disease (ILD) may occur in patients with a rheumatic autoimmune disease (AD), increasing their risk of morbidity and mortality. However, little is known about the prevalence of AD in patients diagnosed with an ILD. In this prospective study, we determined the spectrum of ILD associated with AD (AD-ILD) among patients sent for assessment to a single clinic of ILD and lung transplantation from a referral center between May 2016 and December 2019. ILD diagnosis was made by pneumologists based on clinical and radiological findings and pulmonary function test abnormalities. All patients with ILD were also assessed by experienced rheumatologists. During the period of assessment, 338 patients were diagnosed with ILD. Among them, 32.8% fulfilled definitions for an AD. Most cases with AD-ILD had a diagnosis of rheumatoid arthritis (27.0%), systemic sclerosis (26.1%) or anti-synthetase syndrome (17.1%). Interestingly, 18% of the patients with AD-ILD were diagnosed as having an interstitial pneumonia with autoimmune features. Antinuclear antibodies and non-specific interstitial pneumonia were the most frequent positive autoantibodies and radiological pattern found in AD-ILD patients, respectively. In conclusion, our study indicates that a high number of ILD patients have a related AD. Consequently, close collaboration among rheumatologists and pneumologists is needed.

Características y resultados de la ingestión de cuerpos extraños en niños / Characteristics and outcomes of foreign body ingestion in children

Introducción: La ingestión de un cuerpo extraño (CE) es un accidente frecuente en el hogar en la edad pediátrica; su manejo oportuno por especialistas puede evitar complicaciones a corto y largo plazo. Objetivo: Describir características y complicaciones de los CE en el tubo digestivo en población pediátrica. Material y métodos: Estudio transversal, retrospectivo y prospectivo. Se incluyeron pacientes con diagnóstico de ingestión de un CE desde enero de 1971 a diciembre de 2016. Se recabaron características generales de los pacientes, tipo de objeto, métodos de extracción y complicaciones. Se realizó análisis descriptivo. Resultados: Durante 45 años, se extrajeron 2637 CE localizados en faringe (n= 118), esófago (n= 2410), estómago (n= 103) e intestino (n= 6). Predominaron en el sexo masculino (50,9%); 74% fueron en menores de 5 años. El 57% llegó en las primeras 24 horas; sialorrea, disfagia y vómito fueron los principales síntomas y un 16% estaba asintomático. La radiografía permitió localizar el CE en el 93%; el más ingerido fue la moneda (78%); la localización más común fue el tercio superior del esófago (79%); el 86% se extrajo con endoscopio rígido y las complicaciones se presentaron en el 7,8% de los casos. Conclusiones: La ingestión de un CE predomina en menores de 5 años, y los metales son los más frecuentes. La radiografía simple es el estudio de elección, que permite realizar el diagnóstico y la extracción es por vía endoscópica con endoscopio rígido o flexible según la experiencia del endoscopista.

Introduction: Foreign body (FB) ingestion is a common home accident during childhood; a timely management by the specialists may help prevent complications in the short and long term. Objective: To describe the characteristics and complications of FB ingestion located in the gastrointestinal tract in the pediatric population. Material and methods: Two phases, retrospective, and prospective study. Patients diagnosed with FB ingestion between January 1971 and December 2016 were included. The general characteristics of patients, FB type, removal method, and complications were registered. A descriptive analysis was performed. Results: Over 45 years, 2637 FBs were removed from the pharynx (n= 118), the esophagus (n= 2410), the stomach (n= 103), and the intestines (n= 6). Male patients predominated (50.9%); 74% were younger than 5 years. Besides, 57% arrived within the first 24 hours; ptyalism, dysphagia, and vomiting were the main symptoms; 16% of patients had no symptoms. It was possible to locate the FB using an X-ray in 93% of cases; the most common FBs were coins (78%); the most frequent location was the upper third of the esophagus (79%); 86% of FBs were removed using a rigid endoscope, and complications were observed in 7.8% of patients. Conclusions: FB ingestion predominated among children younger than 5 years; metal objects were the most common ones. A plain X-ray is the test of choice for diagnosis; removal is usually done with a rigid or flexible endoscope, depending on the endoscopist's experience.

[Characteristics and outcomes of foreign body ingestion in children] / Características y resultados de la ingestión de cuerpos extraños en niños

INTRODUCTION: Foreign body (FB) ingestion is a common home accident during childhood; a timely management by the specialists may help prevent complications in the short and long term. OBJECTIVE: To describe the characteristics and complications of FB ingestion located in the gastrointestinal tract in the pediatric population. MATERIAL AND METHODS: Two phases, retrospective, and prospective study. Patients diagnosed with FB ingestion between January 1971 and December 2016 were included. The general characteristics of patients, FB type, removal method, and complications were registered. A descriptive analysis was performed. RESULTS: Over 45 years, 2637 FBs were removed from the pharynx (n= 118), the esophagus (n= 2410), the stomach (n= 103), and the intestines (n= 6). Male patients predominated (50.9%); 74% were younger than 5 years. Besides, 57% arrived within the first 24 hours; ptyalism, dysphagia, and vomiting were the main symptoms; 16% of patients had no symptoms. It was possible to locate the FB using an X-ray in 93% of cases; the most common FBs were coins (78%); the most frequent location was the upper third of the esophagus (79%); 86% of FBs were removed using a rigid endoscope, and complications were observed in 7.8% of patients. CONCLUSIONS: FB ingestion predominated among children younger than 5 years; metal objects were the most common ones. A plain X-ray is the test of choice for diagnosis; removal is usually done with a rigid or flexible endoscope, depending on the endoscopist's experience.

Introducción: La ingestión de un cuerpo extraño (CE) es un accidente frecuente en el hogar en la edad pediátrica; su manejo oportuno por especialistas puede evitar complicaciones a corto y largo plazo. Objetivo: Describir características y complicaciones de los CE en el tubo digestivo en población pediátrica. Material y métodos: Estudio transversal, retrospectivo y prospectivo. Se incluyeron pacientes con diagnóstico de ingestión de un CE desde enero de 1971 a diciembre de 2016. Se recabaron características generales de los pacientes, tipo de objeto, métodos de extracción y complicaciones. Se realizó análisis descriptivo. Resultados: Durante 45 años, se extrajeron 2637 CE localizados en faringe (n= 118), esófago (n= 2410), estómago (n= 103) e intestino (n= 6). Predominaron en el sexo masculino (50,9%); 74% fueron en menores de 5 años. El 57% llegó en las primeras 24 horas; sialorrea, disfagia y vómito fueron los principales síntomas y un 16% estaba asintomático. La radiografía permitió localizar el CE en el 93%; el más ingerido fue la moneda (78%); la localización más común fue el tercio superior del esófago (79%); el 86% se extrajo con endoscopio rígido y las complicaciones se presentaron en el 7,8% de los casos. Conclusiones: La ingestión de un CE predomina en menores de 5 años, y los metales son los más frecuentes. La radiografía simple es el estudio de elección, que permite realizar el diagnóstico y la extracción es por vía endoscópica con endoscopio rígido o flexible según la experiencia del endoscopista.

Tolerancia, seguridad y eficacia de la preparación intestinal con un día de PEG3350 + bisacodilo en comparación con 2 días de PEG3350 + bisacodilo en pacientes pediátricos / Tolerance, safety and efficacy of the one-day preparation of PEG3350 + bisacodyl compared to 2 days of PEG3350 + bisacodyl in pediatric patients

Resumen: Introducción: Múltiples preparaciones intestinales se han utilizado en niños sometidos a una colonoscopia, con limitación variable debido a la aceptación, tolerancia y la limpieza adecuada. El objetivo del estudio fue comparar la tolerancia seguridad y eficacia de la preparación intestinal para colonoscopia de 1 día con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo y el tratamiento con 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo en pacientes pediátricos. Métodos: Se realizó un ensayo clínico, aleatorizado y ciego. Se incluyeron pacientes de 2 a 18 años, que ameritaron colonoscopia en forma programada. Los pacientes se asignaron de manera aleatoria en dos grupos: 1 día de preparación con PEG 3350 4 g/kg/día + bisacodilo y 2 días de preparación con PEG 3350 2 g/kg/día + bisacodilo. Por medio de un cuestionario, exploración física y valoración endoscópica (escala de Boston), se determinó la tolerancia, seguridad y eficacia de las 2 preparaciones a evaluar. Se realizó una prueba t de Student para variables cuantitativas y χ2 para variables cualitativas. Resultados: No hubo diferencias significativas en las tasas de cumplimiento, los efectos adversos y la extensión de la evaluación colonoscópica. Conclusiones: La tolerancia y seguridad entre la preparación intestinal para colonoscopia de 1 día con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo y la preparación de 2 días con PEG 3350 (2 g/kg/día) + bisacodilo fue semejante. La calidad de la limpieza fue buena en ambos grupos, siendo parcialmente más eficaz en el grupo de 1 día con PEG 3350 (polietilenglicol) (4 g/kg/día).

Abstract: Background: Multiple intestinal preparations have been used in children undergoing colonoscopy, with variable limitation due to acceptance, tolerance, and proper cleaning. The objective of this study was to compare the tolerability, safety and efficacy of the colonoscopy preparation with 1 day with PEG 3350 (poliethylenglycol) (4 g/kg/day) + bisacodyl compared to 2 days of preparation with PEG 3350 (2 g/kg/day) + bisacodyl in pediatric patients. Methods: A clinical, randomized, and blind trial was performed. Patients aged 2 to 18 years scheduled for colonoscopy were included. Patients were randomized into two groups: 1 day of preparation with PEG 3350 4 g/kg/day + bisacodyl and 2 days of preparation with PEG 3350 2 g/kg/day + bisacodyl. Through a questionnaire, physical examination and endoscopic evaluation (Boston scale), the tolerance, safety and efficacy of the 2 preparations to be evaluated were determined. Student's t test was performed for quantitative variables and χ2 for qualitative variables. Results: There were no significant differences in compliance rates, adverse effects, and extent of colonoscopic evaluation. Conclusions: Tolerance and safety between the intestinal preparation for 1-day colonoscopy with PEG 3350 (4 g/kg/day) + bisacodyl and the 2-day preparation with PEG 3350 (2 g/kg/day) + bisacodyl were similar. The quality of cleanliness was good in both groups, being partially more effective in the 1-day group with PEG 3350 (4 g/kg/day).

[Tolerance, safety and efficacy of the one-day preparation of PEG3350 + bisacodyl compared to 2 days of PEG3350 + bisacodyl in pediatric patients]. / Tolerancia, seguridad y eficacia de la preparación intestinal con un día de PEG3350 + bisacodilo en comparación con 2 días de PEG3350 + bisacodilo en pacientes pediátricos.

BACKGROUND: Multiple intestinal preparations have been used in children undergoing colonoscopy, with variable limitation due to acceptance, tolerance, and proper cleaning. The objective of this study was to compare the tolerability, safety and efficacy of the colonoscopy preparation with 1 day with PEG 3350 (poliethylenglycol) (4g/kg/day) + bisacodyl compared to 2 days of preparation with PEG 3350 (2g/kg/day) + bisacodyl in pediatric patients. METHODS: A clinical, randomized, and blind trial was performed. Patients aged 2 to 18 years scheduled for colonoscopy were included. Patients were randomized into two groups: 1 day of preparation with PEG 3350 4g/kg/day + bisacodyl and 2 days of preparation with PEG 3350 2g/kg/day + bisacodyl. Through a questionnaire, physical examination and endoscopic evaluation (Boston scale), the tolerance, safety and efficacy of the 2 preparations to be evaluated were determined. Student's t test was performed for quantitative variables and χ2 for qualitative variables. RESULTS: There were no significant differences in compliance rates, adverse effects, and extent of colonoscopic evaluation. CONCLUSIONS: Tolerance and safety between the intestinal preparation for 1-day colonoscopy with PEG 3350 (4g/kg/day) + bisacodyl and the 2-day preparation with PEG 3350 (2g/kg/day) + bisacodyl were similar. The quality of cleanliness was good in both groups, being partially more effective in the 1-day group with PEG 3350 (4g/kg/day).

Tratamiento quirúrgico de los quistes subglóticos adquiridos / Surgical management of acquired subglottic cysts

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¿Qué tan urgente es extraer una pila de disco alojada en el esófago? / How urgent is the extraction of a button disk battery located into the esophagus?

Introducción. La ingestión de cuerpo extraño (CE) es frecuente observarla en la consulta pediátrica; aunque el mayor porcentaje son monedas, la ingestión de pilas de disco o botón son un problema serio. Objetivos: conocer las principales lesiones esofágicas ocasionadas por la ingesta de pilas de disco (IPD), así como la respuesta al manejo y su evolución. Métodos. En un estudio retrospectivo, donde se revisaron los expedientes de pacientes con diagnóstico de IPD de diciembre 1996 a 2007, se analizó: sexo, edad, síntomas, tiempo de evolución, hallazgos radiológicos y endoscópicos, manejo, complicaciones y secuelas. Resultados. Se encontraron 21 casos de IPD; predominó el sexo masculino en relación 4:1, con edades de 3 meses a 12 años. El síntoma principal fue sialorrea. El tiempo de evolución fue en promedio de 39.6 horas. En 14 pacientes la extracción del CE se realizó con laringoscopio tipo Jackson, con esofagoscopio rígido en 2 y con panendoscopio en 4, y en 1 se utilizó red de recuperación de Roth. La mayoría de los CE estaban alojados en el tercio superior de esófago. A la endoscopia se encontraron úlceras en 8 pacientes, necrosis en 6, úlcera y necrosis en 1, perforación parcial en 1, perforación con fístula traqueoesofágica en 2, y en 3 pacientes no hubo evidencia de lesión. Sólo 5 pacientes evolucionaron a estenosis esofágica, que se resolvió con dilataciones. Dos pacientes con perforación y fístula traqueoesofágica recibieron manejo quirúrgico, falleciendo uno de ellos. Otro paciente con perforación solicitó alta voluntaria. Conclusiones. La IPD es cada vez más frecuente, su extracción en el esófago debe ser urgente para evitar complicaciones graves como la estenosis y fístula traqueoesofágica.

Introduction. Foreign body ingestion is a common cause of consultation in the pediatric practice. Even though the most frequent ingested objects are coins, the button disk batteries are becoming a serious problem. Objectives: To describe the main esophageal lesions caused by the ingestion of button disk batteries, their response to treatment and clinical evolution. Methods. Files from patients admitted to our hospital with diagnosis of button disk battery ingestion between December 1996 to December 2007 were reviewed. We analyzed sex, age, symptoms, evolution time, radiological and endoscopical findings, management, complications and long term sequels. Results. We found 21 cases, male preponderance 4:1, age rank from 3 months to 12 years. Sialorrhea was the main symptom. Average time to treatment was 39.6 hours. Battery removal was accomplished with direct esophagoscopy using Jackson laryngoscope in 14 patients, rigid esophagoscope in 2 patients, and flexible esophagoscopy in 4. In most of the cases the battery was lodged in the proximal third of the esophagus. At endoscopic exploration, esophageal ulcers were found in 8 patients, necrosis in 6, ulcers and necrosis in 1, partial perforation in 1, perforation with traqueoesophageal fistula in 2, and no injury in 3 patients. Only 5 patients evolved to esophageal stenosis that resolved with dilatations. Two patients with perforation and traqueoesophageal fistula underwent surgical treatment, one of them died. Another patient with perforation was lost to follow up because of voluntary discharge. Conclusions. Button disk battery ingestion is becoming a more frequent event; removal from the esophagus should be an urgent procedure to avoid severe complications such as stenosis and traqueoesophageal fistula.

Transluminal endoscopic electrosurgical incision of fenestrated duodenal membranes.

Duodenal fenestrated membranes are traditionally treated by side-to-side diamond-shaped duodenoduodenostomy, or duodenotomy and resection. We describe an alternative endoscopic approach for its resolution. A flexible panendoscopy reaching the duodenal membrane was performed. A balloon was inserted to dilate its orifice. Traction was applied to the balloon to differentiate the border of the membrane forming the duodenal wall. After visualizing the ampulla, the membrane was incised using a sphincterotome or needle knife on two sites opposite to the bile duct. From May 2001 to August 2007, ten patients with a fenestrated duodenal membrane underwent transluminal endoscopic electrosurgical incision (TEEI). Mean patient age was 3.4 years (range 1 month to 15 years). The endoscopic procedure lasted from 30 to 60 min. Oral intake began 24 h postsurgery in eight patients and at 48 h postsurgery in two patients. Hospital stay lasted for 2-5 days. After 1 year of follow-up, eight patients were asymptomatic and thriving at present, and one had a double membrane, required a second endoscopy with TEEI, and has experienced occasional vomiting. An additional asymptomatic patient was lost after 3 months of follow-up. TEEI of fenestrated duodenal membranes is a feasible and effective procedure in children.

A randomized trial comparing laryngeal mask airway to endotracheal tube in children undergoing upper gastrointestinal endoscopy.

Although the efficacy of laryngeal mask airway (LMA) has been demonstrated for securing patency of the airway in children, it has not yet been compared to endotracheal tube (ET) in this population. This study aimed to compare the safety and efficacy of LMA vs. ET in children undergoing elective diagnostic upper gastrointestinal endoscopies. Sixty ASA I-III patients were randomly allocated to ET (Group I) or LMA (Group II). A set of cardiovascular and respiratory parameters were obtained before, during and after the endoscopic procedure. The recovery time and the time to discharge were also registered. The cardiovascular and respiratory parameters evaluated in the study varied across the different evaluation periods. However, they remained within physiological ranges and were not different between groups. The median (range) recovery time was 4 (2-10) min and the time to discharge was 58 (36-88) min in the ET group and 3 (1-7) min and 50 (35-67) min in the LMA group (P > 0.10), respectively. In a 16 month-old, 80 cm and 10 kg girl, we failed to secure the patency of the airway with LMA. In conclusion, the LMA was as effective and safe as ET for securing the airway of children undergoing diagnostic upper endoscopies. However, the 3% failure rate occurred with LMA.

Primary cricotracheal resection with thyrotracheal anastomosis for the treatment of severe subglottic stenosis in children and adolescents.

Severe subglottic stenosis in children is best managed by laryngotracheal reconstruction or cricotracheal resection (CTR). We describe clinical outcomes with CTR and end-to-end anastomosis in pediatric patients with severe subglottic stenosis in a tertiary-care pediatric teaching hospital in Mexico City. We prospectively followed up all consecutive patients younger than 18 years of age with a Myer-Cotton grade 3 or 4 subglottic stenosis who underwent CTR between May 1, 2000, and March 31, 2003. The frequency of each clinical outcome was calculated. Twenty-two patients (16 boys [72.7%] and 6 girls [27.3%]) were included. The mean age at operation was 4.6 years (range, 11 months to 16 years). Eighteen patients (81.8%) required primary CTR, and 4 (18.2%) required extended CTR. Seventeen (77.3%) had grade 3 stenosis, and 5 (22.7%) had grade 4 stenosis. Six (27.3%) had associated clinical conditions, and 3 (13.6%) had associated vocal cord mobility defects. All were tracheostomy-dependent at presentation, and none had undergone previous airway surgery. Ten (45.5%) underwent one-stage surgery, and 12 (54.5%) had a concomitant temporary tracheotomy. No intraoperative complications occurred. Seventeen patients (77.3%) developed postoperative granulation tissue requiring endoscopic resection. The mean follow-up was 1.2 years (range, 2 months to 2.8 years). No deaths occurred. Fifteen children (88.2%) with grade 3 stenosis and 5 (100%) with grade 4 stenosis were decannulated, for an overall decannulation rate of 90.9%. Partial cricoid resection with end-to-end anastomosis has been a feasible procedure with reproducible successful results among our patients. We conclude that CTR performed as a primary procedure is an effective treatment for the management of severe subglottic stenosis in children.