Rectal ultrasound as unique diagnostic option in obstructive colorectal metastasis from breast adenocarcinoma.

We present the case of an uncommon manifestation of metastatic breast cancer as an occlusive colorectal stenosis with submucosal location. The endoscopic rectal ultrasound allowed to confirm the diagnosis with transmural biopsies.

Endoscopic ultrasound-guided resolution of right hydronephrosis secondary to local compression by an inflammatory pancreatic mass.

We present the case of 67 years-old man with unremarkable medical history. He was admitted to our department for abdominal pain compatible with choledocholithiasis associated with acute cholecystitis. ERCP was performed but direct papillary canulation attempts failed by means of conventional sphincterotome. So, pre- cut papillotomy was successfully attempted getting free access to distal choledochus and retrieving a small lithiasis. Unfortunately, the patient developed severe post-ERCP acute pancreatitis.

Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy.

INTRODUCTION: The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. METHODS: A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. RESULTS: 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. CONCLUSION: Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients' satisfaction.

Prospective cohort study to evaluate premedication with simethicone and n-acetilcysteine for upper diagnostic gastrointestinal endoscopy

Introduction: The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim of the study was to compare gastric visibility according to the total visibility score (TVS). The secondary aim was to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient satisfaction. Methods: A single center prospective cohort study was performed of consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water >15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire. Results: 205 patients were included in the study, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p<0.001) and excellent gastric visibility (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although the median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups. Conclusion: Patients receiving premedication with simethicone and N-acetylcysteine had a better gastric visibility score, without any increase in adverse events or affecting the patients’ satisfaction (AU)

Diarrhea secondary to intestinal infiltration secondary to renal epidermoid carcinoma.

Renal squamous cell carcinoma is a rare neoplasm in adults, but with an aggressive behavior. It is diagnosed in most cases in advanced stages. The invasion of the digestive tract by this type of tumor is rare, due to the anatomical arrangement of the colon, however, when it occurs, it carries a poor prognosis for the patient. Digestive endoscopy allows us to reach a definitive diagnosis since these patients usually present digestive manifestations, such as diarrhoea, digestive bleeding or abdominal pain.

Esophageal hyperkeratosis as an uncommon manifestation of gastroesophageal reflux disease.

We present the case of a 66-year-old woman with intermittent dysphagia and esophageal food impaction. The endoscopic examination showed an upper and middle esophagus with a diffuse circumferential, white, crackleware epithelium. Esophageal biopsies revealed acanthosis and papillomatosis with diffuse hyperkeratosis. High dose of Proton pump inhibitors was initiated with improvement of all symptoms 6 weeks later.

Endoscopic treatment of a cecal Dieulafoy's lesion. An uncommon cause of massive lower gastrointestinal bleeding.

We present the case of a 71-year-old male with a history of pulmonary adenocarcinoma under palliative treatment. He was admitted to our hospital with hematochezia and anemia (hemoglobin 10.6 g/dl).

Primary synchronous rectal squamous-cell carcinoma and its exceptional response to chemoradiotherapy.

We present the case of a 51-year-old female with a 2-month history of intense anal pain and rectal bleeding. A digital rectal exam revealed a possible lower rectal mass. A colonoscopy was then performed that showed a 5 x 6-cm lesion in the middle rectum and a second 3-cm lesion in the lower rectum, without affecting the anal canal. Multiple biopsies were taken and the histopathologic analysis revealed a moderately differentiated squamous-cell proliferation invading beyond the lamina propria. The CT scan confirmed a middle rectum T4N2bM0 and a lower rectum T3N0M0 synchronous neoplasia. These findings were compatible with a synchronous squamous-cell carcinoma (SCC).

Chronic diarrhea due to autoimmune enteropathy.

Chronic diarrhea is a common symptom seen in the Gastroenterology clinic. Occasionally, the diagnosis is a real challenge as there are multiple entities with unremitting diarrhea as a symptom. Herein, we present a patient affected with intractable diarrhea who was transferred to our department. After many laboratory, endoscopy and radiological tests, she was diagnosed with autoimmune enteropathy (AE) and achieved clinical remission with corticosteroids and azathioprine.

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.

El linfograma duodenal como herramienta complementaria en el diagnóstico de la enfermedad celiaca del adulto / Duodenal lymphogram as a complementary tool in the diagnosis of celiac disease in adults

INTRODUCCIÓN: la enfermedad celiaca (EC) presenta un determinado patrón de infiltrado linfocitario en la mucosa duodenal. Gracias a la citometría de flujo como herramienta complementaria al diagnóstico de la EC, se pueden cuantificar y caracterizar los linfocitos intraepiteliales (LIE) a través de lo que comúnmente denominamos linfograma. Con este estudio, pretendemos describir nuestra experiencia con la técnica en el diagnóstico del paciente celiaco adulto. MÉTODOS: se han analizado retrospectivamente los linfogramas realizados en nuestro centro entre 2009 y 2017, que fueron en total 157. Catorce de ellos tenían un diagnóstico previo de EC y seguían una dieta sin gluten, 21 tuvieron un diagnóstico nuevo de EC y el resto fueron considerados no celiacos. Se ha estudiado la asociación de los valores del linfograma (LIE totales, linfocitos CD3- y linfocitos TcRγδ) con el diagnóstico de EC, el cumplimiento de la dieta sin gluten (DSG), el tiempo desde el diagnóstico y el título de inmunoglobulina A antitransglutaminasa tisular. RESULTADOS: el valor de área bajo la curva ROC de los linfocitos TcRγδ para el diagnóstico de EC varía entre 0,86 y 0,86. El porcentaje de linfocitos TcRγδ en pacientes celiacos en DSG es menor 12 (8,5) vs. 20,5 (8,7), p = 0,0153, aunque permanece elevado frente a los no celiacos 12 (8,5) vs. 6,7 (6), p = 0,135. El tiempo desde el diagnóstico y el título de IgA antitransglutaminasa tisular (anti-Tgt) se correlacionan con los valores del linfograma en el paciente celiaco. La infección por Helicobacter pylori y el tratamiento con antagonistas de receptores de angiotensina 2 (ARA2) se asocia a diferencias en el linfograma. CONCLUSIONES: el linfograma duodenal es una herramienta complementaria fiable en el diagnóstico del celiaco adulto. Sin embargo, el cumplimiento y la duración de la DSG, así como otros factores, pueden condicionar su capacidad diagnóstica

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Concurrent hepatic and renal angiomyolipomas in tuberous sclerosis complex

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Concurrent hepatic and renal angiomyolipomas in tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is a rare disease which is characterized by widespread of a variety of benign tumors in multiple organs. Renal angiomyolipomas (AMLs) are the primary cause of morbidity in TSC due to anemia, renal failure or spontaneous bleeding. In contrast, the hepatic involvement is unusual and it is infrequently described in literature.