Cribado de cáncer de páncreas en la práctica clínica: es el momento de la prevención

El cribado de cáncer de páncreas en población de alto riesgo puede mejorar la supervivencia. Sin embargo, hay pocas referencias sobre su aplicabilidad y hallazgos en la práctica clínica habitual. Nuestro objetivo es evaluar los hallazgos de las pruebas de cribado de cáncer de páncreas en individuos de alto riesgo en la práctica clínica y describir las variables asociadas a la presencia de lesiones relevantes. Este es un estudio observacional prospectivo en el que se seleccionaron pacientes con alto riesgo de cáncer de páncreas, según los criterios del Consorcio Internacional de Cribado de Cáncer de Páncreas. Se analizaron variables demográficas, presencia de factores de riesgo de cáncer páncreas y los hallazgos de las pruebas. Posteriormente se compararon pacientes que presentan lesiones relevantes con aquellos sin hallazgos. De 70 pacientes de alto riesgo, 25 cumplieron los criterios de cribado. El síndrome hereditario más frecuente fue el cáncer de mama y ovario hereditario (60%). En once individuos (44%) se identificaron hallazgos y en tres (12%) fueron relevantes: dos tumores papilares mucinosos intraductales y un tumor sólido localizado. La mutación en BRCA2 fue la más frecuente en lesiones significativas (66,7% vs 30%, p=0,376) sin encontrar asociación con diabetes ni tabaquismo (0 vs 18 %, p=0,578 y 0 vs 4,5%, p=0,880 respectivamente). En conclusión, las pruebas de cribado permiten detectar lesiones en estadio precoz o resecables en un importante porcentaje de población de alto riesgo seleccionada. Los hallazgos más relevantes fueron en los pacientes pertenecientes al síndrome de cáncer de mama y ovario hereditario.

Pancreatic cancer surveillance can improve outcomes in high-risk individuals. However, little is known about its applicability and findings in routine clinical practice. Our aim was to evaluate findings on screening tests in high-risk individuals in a clinical practice setting and to analyze factors associated with the presence of relevant pancreatic lesions. We developed a prospective observational study of pancreatic cancer high risk patients that meet criteria of surveillance from the International Cancer of the Pancreas Screening Consortium. The demographic variables, other risk factors and imaging findings are collected. Patients with significant findings are compared to those without noteworthy findings. Of 70 high-risk individuals, 25 fitted the criteria for pancreatic cancer surveillance. The most frequent condition was hereditary breast and ovarian cancer syndrome (60%). We identified eleven abnormal imaging findings (44%) and three of them (12%) were relevant: two intraductal papillary mucinous neoplasms and one localized pancreatic neoplasm. BRCA2 mutation was more frequent in patients with significant lesions (66.7% vs 30%, p=0.376) but smoking and diabetes were not associated with relevant findings (0 vs 18 %, p=0.578 and 0 vs 4.5%, p=0.880 respectively). Screening test could detect early-stage or resectable lesions in a significant in a significant percentage of the selected high-risk population. The most relevant findings were in patients belonging to hereditary breast and ovarian cancer syndrome.

[Pancreatic cancer screening in a clinical practice setting: it is the moment of Prevention]. / Cribado de cáncer de páncreas en la práctica clínica: es el momento de la prevención.

Pancreatic cancer surveillance can improve outcomes in high-risk individuals. However, little is known about its applicability and findings in routine clinical practice. Our aim was to evaluate findings on screening tests in high-risk individuals in a clinical practice setting and to analyze factors associated with the presence of relevant pancreatic lesions. We developed a prospective observational study of pancreatic cancer high risk patients that meet criteria of surveillance from the International Cancer of the Pancreas Screening Consortium. The demographic variables, other risk factors and imaging findings are collected. Patients with significant findings are compared to those without noteworthy findings. Of 70 high-risk individuals, 25 fitted the criteria for pancreatic cancer surveillance. The most frequent condition was hereditary breast and ovarian cancer syndrome (60%). We identified eleven abnormal imaging findings (44%) and three of them (12%) were relevant: two intraductal papillary mucinous neoplasms and one localized pancreatic neoplasm. BRCA2 mutation was more frequent in patients with significant lesions (66.7% vs 30%, p=0.376) but smoking and diabetes were not associated with relevant findings (0 vs 18 %, p=0.578 and 0 vs 4.5%, p=0.880 respectively). Screening test could detect early-stage or resectable lesions in a significant in a significant percentage of the selected high-risk population. The most relevant findings were in patients belonging to hereditary breast and ovarian cancer syndrome.

Coledocoduodenostomía guiada por ultrasonografía endoscópica ante fallo o imposibilidad de CPRE / Endoscopic ultrasound-guided choledochoduodenostomy after a failed or impossible ERCP

Introducción: el drenaje biliar endoscópico guiado por ultrasonografía (DBUSE) es una alternativa al drenaje biliar percutáneo transhepático (CTPH) ante fallo de la colangiografía retrógrada endoscópica (CPRE). Métodos: descripción retrospectiva de seis casos de drenaje biliar guiado por ultrasonografía endoscópica, mediante coledocoduodenostomía (USE-CDS), así como de sus características clínicas, procedimiento endoscópico, complicaciones y posterior seguimiento. Resultados: todos nuestros casos presentaban obstrucción biliar distal de etiología maligna. En cuatro de los seis pacientes se concluyó el procedimiento con buen drenaje posterior. Registramos dos complicaciones tardías por migración de prótesis, sin muertes relacionadas con el procedimiento. El tiempo medio de seguimiento fue de seis meses. Conclusión: la USE-CDS se plantea como una opción terapéutica válida, no exenta de complicaciones, en casos seleccionados y en manos de un equipo de endoscopistas expertos ante fallos del drenaje por CPRE, y como alternativa al CTPH

Introduction: endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to percutaneous trans-hepatic biliary drainage (PTBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). Methods: this is a retrospective description of six cases of endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy (EUCD), as well as the clinical characteristics, endoscopic procedure, complications and monitoring. Results: all cases had malignant distal biliary obstruction. The procedure was concluded with good drainage in four out of six patients. Two late complications were recorded that were caused by stent migration and there were no deaths related with the procedure. The average monitoring period was six months. Conclusions: EUCD can be considered as a valid therapeutic choice in some selected cases and when performed by a team of expert endoscopists in cases of failed ERCP drainage or as an alternative to PTBD. However, the procedure has some associated complications

Endoscopic ultrasound-guided choledochoduodenostomy after a failed or impossible ERCP.

INTRODUCTION: endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to percutaneous trans-hepatic biliary drainage (PTBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). METHODS: this is a retrospective description of six cases of endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy (EUCD), as well as the clinical characteristics, endoscopic procedure, complications and monitoring. RESULTS: all cases had malignant distal biliary obstruction. The procedure was concluded with good drainage in four out of six patients. Two late complications were recorded that were caused by stent migration and there were no deaths related with the procedure. The average monitoring period was six months. CONCLUSIONS: EUCD can be considered as a valid therapeutic choice in some selected cases and when performed by a team of expert endoscopists in cases of failed ERCP drainage or as an alternative to PTBD. However, the procedure has some associated complications.

Hepatitis crónica por virus de la hepatitis E tratada con ribavirina / Chronic hepatitis caused by hepatitis E virus and treated with ribavirin

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Tumor de células epitelioides perivasculares de íleon. Descripción de un caso / Perivascular epithelioid cell tumor of the ileum. A case report

Los tumores de células epiteliodes perivasculares son tumores de células epiteliales vasculares con características inmunohistoquímicas de músculo liso y células melanocíticas. Los gastrointestinales son infrecuentes. El tratamiento es quirúrgico aunque existen datos que indican buena respuesta a la rapamicina (AU)

Perivascular epithelioid cell tumors (PEComa) are tumors of perivascular epithelioid cells with immunohistochemical features of smooth muscle and melanocytic tumors. The PEComa of the gastrointestinal tract is rare. The treatment is surgical, although there are data that suggest a good response to rapamycin (AU)

Pancreatitis aguda secundaria a déficit parcial de multidrug resistance 3 p-glycoprotein / Acute pancreatitis secondary to partial multidrug resistance 3 p-glycoprotein deficit

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Aumento de la incidencia de cáncer colorrectal en la provincia de Salamanca. Comparación de dos periodos: 2004-2006 y 2010-2012 / Increasing incidence of colorectal cancer in the province of Salamanca. Comparison of two periods: 2004-2006 and 2010-2012

Objetivos: comparar incidencia, mortalidad y características epidemiológicas de los pacientes diagnosticados de cáncer colorrectal (CCR) en la provincia de Salamanca entre dos periodos: 2010-2012 y 2004-2006. Métodos: estudio observacional retrospectivo. Incluimos todos los CCR diagnosticados según criterios histopatológicos del 01/01/2004 al 31/12/2006 y del 01/01/2010 al 31/12/2012. Las variables estudiadas fueron género, edad, fecha de diagnóstico y localización del tumor. Se han calculado incidencia acumulada e incidencia específica por grupos de edad comparando los resultados entre periodos. Hemos ajustado las tasas por edad a la población mundial estándar para poder compararla con otras poblaciones. Resultados: detectamos un 38% más de CCR en el periodo de 2010 a 2012 que en el de 2004 a 2006. Las variables (sexo, edad de diagnóstico y localización) han sido similares en ambos grupos. En el periodo de 2010-2012 se realizaron más del doble de colonoscopias que en el de 2004-2006. La mortalidad poblacional por CCR también aumentó, aunque de manera mucho menos importante que la incidencia. Conclusiones: existe un claro aumento de la incidencia del CCR en la provincia de Salamanca entre los años 2004-2006 y 2010-2012 no relacionado con el envejecimiento. El aumento considerable de colonoscopias puede haber sido un factor importante para el aumento en la detección (AU)

Objectives: To compare incidence, mortality and epidemiological characteristics of patients diagnosed with colorectal cancer (CRC) in the province of Salamanca over two different periods: 2010-2012 and 2004-2006. Methods: Retrospective observational study. We include all diagnosed cases of CRC according to histopathological criteria from 01/01/2004 to 31/12/2006 and from 01/01/2010 to 31/12/2012. The studied variables were sex, age, date of diagnosis and tumor location. Cumulative incidence and specific incidence in different age groups were measured and compared between the two periods. The age rates were adjusted to the standard world population so that the results could be compared with those of other populations. Results: We detected 38% more cases of CRC in the 2010-2012 period than in 2004-2006. Variables distribution (sex, age at diagnosis and location) was similar in both groups. More than twice as many colonoscopies were performed in 2010-2012 than in 2004-2006. Population mortality due to CRC also increased, although much less importantly than the incidence of this condition. Conclusions: There has been a clear increase in CRC incidence in the province of Salamanca from 2004-2006 to 2010-2012 which is not related to the ageing of the population. The remarkable increase in colonoscopies may have been an important factor for the increased detection (AU)

Increasing incidence of colorectal cancer in the province of Salamanca. Comparison of two periods: 2004-2006 and 2010-2012.

OBJECTIVES: To compare incidence, mortality and epidemiological characteristics of patients diagnosed with colorectal cancer (CRC) in the province of Salamanca over two different periods: 2010-2012 and 2004-2006. METHODS: Retrospective observational study. We include all diagnosed cases of CRC according to histopathological criteria from 01/01/2004 to 31/12/2006 and from 01/01/2010 to 31/12/2012. The studied variables were sex, age, date of diagnosis and tumor location. Cumulative incidence and specific incidence in different age groups were measured and compared between the two periods. The age rates were adjusted to the standard world population so that the results could be compared with those of other populations. RESULTS: We detected 38% more cases of CRC in the 2010-2012 period than in 2004-2006. Variables distribution (sex, age at diagnosis and location) was similar in both groups. More than twice as many colonoscopies were performed in 2010-2012 than in 2004-2006. Population mortality due to CRC also increased, although much less importantly than the incidence of this condition. CONCLUSIONS: There has been a clear increase in CRC incidence in the province of Salamanca from 2004-2006 to 2010-2012 which is not related to the ageing of the population. The remarkable increase in colonoscopies may have been an important factor for the increased detection.

Perivascular epithelioid cell tumor of the ileum. A case report.

Perivascular epithelioid cell tumors (PEComa) are tumors of perivascular epithelioid cells with immunohistochemical features of smooth muscle and melanocytic tumors. The PEComa of the gastrointestinal tract is rare. The treatment is surgical, although there are data that suggest a good response to rapamycin.

Melanoma maligno primario esofágico: una causa infrecuente de disfagia / Primary malignant melanoma of the esophagus: A rare cause of dysphagia

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Hemorragia digestiva secundaria a enteritis por herpes virus en paciente inmunodeprimido / Gastrointestinal bleeding secondary to enteritis due to herpes virus in an immunosuppressed man

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Tratamiento endoscópico de varices duodenales con cianoacrilato / Endoscopic treatment of duodenal varices with cyanoacrylate

Introducción: el duodeno es la localización más frecuente de varices ectópicas. Su sangrado es poco frecuente, pero cuando ocurre, es masivo y de difícil control. Material y métodos: descripción retrospectiva de cinco casos clínicos de hemorragia digestiva secundaria a varices duodenales en los años 2011 y 2012, sus características clínicas, diagnóstico endoscópico, tratamiento endoscópico con inyección de cianoacrilato y posterior seguimiento y valoración de resangrado. Resultados: los cinco pacientes fueron tratados con inyección endoscópica de cianoacrilato de los cuales, dos pacientes experimentaron resangrado. Tres de nuestros pacientes fallecieron durante el seguimiento, uno de ellos por hemorragia digestiva. Conclusión: podemos afirmar que el tratamiento endoscópico de las varices duodenales con cianoacrilato es técnicamente factible, y puede ser de ayuda para controlar el episodio inicial de sangrado de este modo ganar tiempo de cara a otros tratamientos definitivos, siempre y cuando el estado del paciente lo permita (AU)

Background: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control. Material and methods: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. Results: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding. Conclusion: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it (AU)

Endoscopic treatment of duodenal varices with cyanoacrylate.

BACKGROUND: the duodenum is the most common location for ectopic varices. Bleeding is rare, but when it appears, it is massive and difficult to control. MATERIAL AND METHODS: retrospective description of five clinical cases of digestive bleeding secondary to duodenal varices that we observed between the years 2011 and 2012, together with their clinical characteristics, endoscopic diagnosis, endoscopic treatment with cyanoacrylate injection and the posterior follow-up and assessment of new bleeding. RESULTS: all five patients were treated with an endoscopic cyanoacrylate injection and two of the patients experienced a digestive rebleeding. Three of the patients died during the follow-up period, only one due to cause digestive bleeding. CONCLUSION: in conclusion we can state that endoscopic treatment of duodenal varices with cyanoacrylate is technically possible, and it permits us to control the first bleeding before doing other definitive treatments, if the patient condition allows it.