Laparoscopic Common Bile Duct Exploration Using a Single-Operator Cholangioscope.

Background: Gallbladder stones are a very common disease, with a prevalence of 21.9% in Argentina. The incidence of common bile duct stones (CBDS) varies with age and with the clinical presentation; ∼3%-10% of patients with gallbladder lithiasis have concomitant choledocholithiasis. In the past decades, the development of ultrasound and magnetic resonance cholangiography and endoscopic ultrasound has expanded for the preoperative diagnosis of gallbladder lithiasis. Materials and Methods: We describe the step-by-step technique using the single-operator cholangioscope (pSOC) (SpyGlass™ Discover; Boston Scientific, Natick, MA) under laparoscopic guidance, in a patient with huge stones in the bile duct that was treated with a choledocotomy. Results: The patient underwent the procedure well and the closure of the bile duct was with a primary suture. The current devices, standard cholangioscopes or bronchoscopes, only have a two-way deflection. This problem might be solved with the introduction of a new pSOC device (SpyGlass Discover; Boston Scientific). Conclusion: In conclusion, the combination of laparoscopy and pSOC is a feasible, safe, and effective technique for the treatment of CBDS, and may be considered as an alternative approach in clinical cases where gastrointestinal anatomy is altered or when endoscopic retrograde cholangio-pancreatography (ERCP) failed. pSOC has the potential to reduce peri-procedural adverse events and costs.

Feasibility of using an led-probe in third-space endoscopy: a clinical study.

BACKGROUND: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures. METHODS: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed. RESULTS: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7 ± 14.3 and 43.7 ± 10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males; median procedure times were 50 (interquartile range [IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100 and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3 ± 10.8 to 9.5 ± 4.1 mmHg (p < 0.001); retention percentage at 4 h also improved. LP was successfully placed and adequate myotomy confirmed including 14.2 and 17.8% of POEM and G-POEM difficult patients. CONCLUSIONS: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.

Dispositivo de bajo costo para disminuir el efecto de aerosol durante la endoscopia de vías digestivas altas en COVID-19 / Low cost devices to reduce aerosol effect during upper gastrointestinal endoscopy in COVID-19

Los procedimientos endoscópicos, al estar asociados a la exposición de la vía aérea superior, tienen un mayor riesgo de transmisión del virus SARS-CoV-2; por esta razón, es necesario el planteamiento de in-tervenciones para atenuar o eliminar la exposición a éste. En este artículo nos permitimos presentar una estrategia de mitigación de bajo costo, ya que con el progreso de la pandemia se podría estar en un estado de austeridad de recursos económicos, lo cual haría estos dispositivos totalmente válidos.(AU)

Endoscopic procedures, as they are associated with exposure of the upper airway, have a higher risk of transmission of the SARS-CoV-2 virus; so, it is necessary to consider interventions to mitigate or eliminate ex-posure to it. In this article, we allow ourselves to present a low-cost mitigation strategy, since with the progress of the pandemic it could be in a state of austerity of economic resources, making these devices totally valid.(AU)

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia.

BACKGROUND: Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. METHODS: Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. RESULTS: 45 patients were included, aged 45.5 years (interquartile range [IQR] 22 - 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 - 77) and median myotomy length was 13.5 cm (IQR 6 - 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (P < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg (P < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal (P < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 - 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed. CONCLUSIONS: Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.

The Clinical Utility of Evaluating the Luminal Upper Gastrointestinal Tract During Linear Endoscopic Ultrasonography.

BACKGROUND: The clinical utility of performing esophagogastroduodenoscopy (EGD) before linear endoscopic ultrasonography (L-EUS) to evaluate the luminal upper gastrointestinal (GI) tract is not well established. GOALS: The study was aimed to determine the prevalence of clinically meaningful luminal abnormalities (any luminal finding requiring further evaluation with mucosal biopsy or initiation of treatment) in patients undergoing L-EUS. The study also sought to compare the ability of the gastroscope and the linear echoendoscope in identifying these lesions. STUDY: A prospective, multicenter cohort study enrolled patients undergoing L-EUS for nonluminal indications. All patients underwent EGD followed by L-EUS by 2 different endoscopists. The second endoscopist was blinded to the results of the initial EGD. The identification of clinically meaningful luminal lesions and quality of endoscopic visualization of the upper GI tract were measured. RESULTS: In the cohort of 175 patients, 52 (29.7%) patients had clinically meaningful luminal findings seen in the upper GI tract. There was no significant difference in the number of clinically meaningful lesions identified on EGD and L-EUS (25.1% vs. 22.9%, P=0.39). No significant difference was found in the miss rate of clinically meaningful lesions between the 2 modalities (EGD: 4.5% vs. EUS: 6.9%, P=0.39). CONCLUSIONS: A substantial minority of patients undergoing L-EUS for nonluminal indications will have clinically meaningful luminal findings. The endoscopic evaluation of the luminal upper GI tract can be adequately achieved using the linear echoendoscope.

[Endoscopic dilation of the gastrointestinal tract]. / Dilataciones endoscópicas del tracto gastrointestinal.

The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation indications, benefits and risks for each of the existing systems of dilations.

Endoscopic retrograde cholangiopancreatography with per oral pancreatoscopy for calcific chronic pancreatitis using endoscope and catheter-based pancreatoscopes: a 10-year single-center experience.

OBJECTIVES: Per oral pancreatoscopy (POP) with electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) permits stone fragmentation and removal during endoscopic retrograde cholangiopancreatography. Our study evaluates the safety and efficacy of POP in patients with main pancreatic duct (PD) stones. METHODS: This was a cohort study of patients undergoing POP with EHL/LL for PD stones between January 2000 and March 2011. Technical success was defined as complete or partial stone clearance, and clinical success as greater than 50% reduction in opiate use, pain, or hospitalizations. RESULTS: Forty-six patients underwent POP for PD stones using a 10F cholangioscope (POP-Endo) (n = 31) or catheter-based system (POP-Cath, n = 15). Electrohydraulic lithotripsy/LL was performed in 39 (85%) of 46 patients. Stone extraction without EHL or LL was performed in 7 (15%) of 46 patients. Technical success for POP-Endo versus POP-Cath was 27 (87%) of 31 versus 15 (100%) of 15 patients (P = 0.29). Complete clearance was achieved in 21 (68%) of 31 versus 11 (73%) of 15 patients, respectively (P = 0.519). Per oral pancreatoscopy-related complications were found in 10%. Follow-up in 43 (93%) of 46 patients was a median of 18 months (range, 1-60 months). Overall clinical success was 74%. CONCLUSIONS: Per oral pancreatoscopy-guided endotherapy leads to partial or complete stone clearance in most patients with PD stones. The technical success rates between POP-Endo versus POP-Cath systems appear similar and are associated with clinical improvement in most patients.

Linitis plástica gástrica. A propósito de un caso / Gastric-plastic letinitis. A case report

Fundamento: el cáncer gástrico es una de las principales causas de muerte. En Cuba la mayoría son diagnosticados en fases avanzadas ensombreciendo el pronóstico. La linitis plástica es una forma de crecimiento submucoso del adenocarcinoma. Objetivo: ofrecer lección a médicos sobre los signos endoscópicos de sospecha y complementarios a utilizar para diagnosticarlo rápidamente. Presentación de caso: paciente que refería epigastralgia, vómitos y pérdida de peso. La radiografía contrastada de estómago evidenció rigidez y defecto de lleno en curvatura mayor y menor. La esofagogastroduodenoscopía mostró ausencia de peristalsis y estenosis de la luz del estómago. En el examen laparoscópico se observó exteriorización del tumor. El diagnóstico definitivo se realizó por macrobiopsia después de la cirugía. Conclusiones: se ha de sospechar la entidad ante un paciente con la clínica sugestiva de tumor y hallazgos endoscópicos como la disminución de la peristalsis y la reducción de la luz del órgano.

Background: gastric cancer is one of the main causes of death. In Cuba most of the cases are diagnosed in advanced stages clouding the outlook. The plastic linitis is a form of submucosal growth adenocarcinoma. Objective: to provide medical lesson on endoscopic signs of suspicion and complementary use to diagnose it quickly. Case Presentation: a patient referred epigastralgia, vomiting and weight loss. The stomach contrasted radiography showed stiffness and squarely defect in major and minor curvature. The esophagogastroduodenoscopy showed absence of peristalsis and stenosis of the light of the stomach. In the laparoscopic exam the tumor externalization was observed. The final diagnosis was carried out by macrobiopsy after surgery. Conclusions: doctors have to suspect the disease in a patient with clinical suggestive features of tumor and endoscopic findings as decreased peristalsis and reduced organ light.

Analgesia y sedación para endoscopia digestiva superior diagnóstica e intervencionista en pediatría / Analgesia and sedation for diagnostic and interventional upper gastrointestinal endoscopy in pediatrics

La endoscopia digestiva superior es parte integrante fundamental de la práctica de la gastroenterologíapediátrica. Debe ser realizada por personas con experiencia en este tipo de procedimiento. La posibilidad de brindar una adecuada sedación y analgesia de forma segura y efectiva garantiza la estabilidad y comodidad del paciente por lo que se considera como un componente importante del procedimiento. En los últimos años hay un mayor uso de la sedación para este tipo de procederes. En Cuba, se realizan a diario más de mil endoscopías semanales, alrededor del 19% corresponde a pacientes pediátricos. Llevarlos a cabo con éxito, no es solo obtener resultados valiosos para el diagnóstico y la investigación; sino también, es tener al paciente sedado, sin dolor, dispuesto a incorporarse con rapidez a su tarea de jugar y estudiar.

Digestive endoscopy is an important tool in the practice of pediatric gastroenterology. It should be realized by experienced endoscopist. The possibility of a proper sedation and analgesia in a safe and effective waygarantees the stability and and comfort of the patient. It is considered an important component of the procedure. In the recent past years there is an increase in the sedation for endoscopy. In Cuba, more than athousand endoscopies are done dayli. 19% of them are done in pediatric patients. To do the procedure successfully is not only to have a proper diagnosis; it is also to have the patient properly sedated, without pain and ready to play and to go back to school.

Benign biliary strictures: current endoscopic management.

Endoscopic treatment is the mainstay of therapy for benign billiary strictures, and surgery is reserved for selected patients in whom endoscopic treatment fails or is not feasible. The endoscopic approach depends mainly on stricture etiology and location, and generally involves the placement of one or multiple plastic stents, dilation of the stricture(s), or a combination of these approaches. Knowledge of biliary anatomy, endoscopy experience and a well-equipped endoscopy unit are necessary for the success of endoscopic treatment. This Review discusses the etiologies of benign biliary strictures and different endoscopic therapies and their respective outcomes. Data on newer therapies, such as the placement of self-expandable metal stents, and the treatment of biliary-enteric anastomotic strictures is also reviewed.

Atuação do enfermeiro na limpeza e desinfecção de materiais de endoscopia digestiva alta / Role of nurse in the cleaning and disinfection of materials for upper endoscopy

Visando descrever a atuação do enfermeiro na Endoscopia Digestiva Alta e no Centro de Material e Esterilização frente ao processo de limpeza e desinfecção de aparelhos endoscópicos, este estudo utilizou-se da visão teórica do enfermeiro, comparando-a com a sua experiência profissional...

Clinical and fiberoptic endoscopic evaluation of swallowing in Robin sequence treated with nasopharyngeal intubation: the importance of feeding facilitating techniques.

OBJECTIVE: To evaluate oral feeding capacity, the swallowing process, and risk for aspiration, both clinically and during fiberoptic endoscopic evaluation of swallowing, in infants with isolated Robin sequence treated exclusively with nasopharyngeal intubation and feeding facilitating techniques. DESIGN: Longitudinal and prospective study. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, Brazil. PATIENTS: Eleven infants with isolated Robin sequence, under 2 months of age, treated with nasopharyngeal intubation. INTERVENTIONS: Feeding facilitating techniques were applied in all infants throughout the study period. The infants were evaluated clinically and through fiberoptic endoscopic evaluation of swallowing at first, second, and, if necessary, third week of hospitalization (T1, T2, T3). The mean volume of ingested milk was registered during clinical evaluation, and events were registered during feeding. RESULTS: The respiratory status of all infants was improved after nasopharyngeal intubation; 72% of them presented risk for aspiration during fiberoptic endoscopic evaluation of swallowing at T1. This risk was less frequent when thickened milk was given to the infants and at subsequent evaluations (T2 and T3). CONCLUSIONS: Nasopharyngeal intubation aids in stabilizing the airway in isolated Robin sequence, but it does not relate directly to feeding. The risk for aspiration was present in most of the infants, mainly during the first week of hospitalization, and improved within a few weeks, after the use of feeding facilitating techniques.

Colocación endoscópica del tubo de derivación salival de Montgomery en fistulas y estenosis esofágicas / Endoscopic experience with the montgomery salivary bypass tube in esophageal stenosis and fistulae

INTRODUCCIÓN: El manejo de las fistulas y estenosis del esófago son un problema; el tubo deriva la saliva al esofago distal y facilita la solución del problema. OBJETIVO: Proporcionar la experiencia endoscópica inicial en la colocación del tubo de derivación salival de Montgomery (TDSM) en pacientes con patología esofágica. PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo de 7 pacientes en el Departamento del Aparato Digestivo del Hospital Edgardo Rebagliati Martins (EsSALUD) de Lima-Perú, desde Noviembre de 2003 a Enero del 2006. RESULTADOS: La edad promedio de los pacientes fue de 34.68 años (2 años 8 meses-de 76 años), 85.1 por ciento correspondió a sexo masculino, 71.4 por ciento requirieron hospitalización en Unidad de Cuidados Intensivos. Las indicaciones del TDSM fueron en 5 pacientes algún tipo de fístula en el esófago y en 2 pacientes estenosis, uno del cricofaringeo y el otro de anastomosis de transposición gástrica en esófago cervical. La ayuda endoscópica para la colocación del TDSM se requirió en 81.8 por ciento, y para el retiro en 77.7 por ciento. En los 6 pacientes adultos, la sedación, el procedimiento endoscópico y colocación del TDSM fueron bien tolerados. El tiempo promedio de permanencia del TDSM fue de 70.5 días. En 2 pacientes (28.6 por ciento) se presentaron complicaciones asociadas al TDSM, en uno se presentó odinofagia que requirió retiro a los 7 días y en otro migración anterógrada del TDSM con perforación fatal del intestino delgado. En 57.1 por ciento se presentó curación de la fístula o estenosis, en 28.6 por ceinto hubo mejoría parcial. CONCLUSIONES: La técnica endoscópica para la colocación del TDSM sirve de alternativa, permite el diagnóstico, confirmación, comparación de fístulas o estenosis en el esófago cervical y es bien tolerada.

OBJECTIVE: Provide the initial endoscopic experience in the placing of the Montgomery salivary bypass tube (MSBT). Patients and Methods: Descriptive, retrospective study in 7 patients in the Digestive System Unit of EsSALUD Hospital Edgardo Rebagliati Martins in Lima-Peru from November 2003 to Jnuary 2006. Results: The average age of the patients was 34.68 years (2 years, 8 months - 76 years); 85.1% were male, 71.4% required hospitalization in the IntensiveCare Unit. In 5 patients, the MSBT indications were some kind of fistula in the esophagus, and stenosis in 2 patients, one crichopharyngeal and the other gastric transposition with anastomosis in the cervical esophagus. The endoscopic help for the placing of the MSBT was required in 81.8% and for withdrawal in 77.7%. In the six (6) adult patients, sedation, the endoscopicprocedure and the placing of the MSBT were well-tolerated. The average time that the MSBT was in place was70.5 days. In two (2) patients (28.6%), there were complications associatedwith the MSBT: one had odinophagia which required withdrawal on the seventh day and another patient had anterograde migration of the MSBT with fatal perforation of the small intestine. In57.1% of the cases, the fistula or stenosis was cured; in 28.6%, there was partial improvement. CONCLUSIONS: The endoscopic technique for the insertion of the MSBT serves as an alternative,allows the diagnosis, confirmation, comparison of fistulas or stenosis in the cervical esophagus and is well-tolerated.

Sedación consciente en procedimientos colonoscópico ambulatorios junio 2003 a enero 2002, Hospital Escuela Oscar Danilo Rosales Arguello / Conscious sedation in procedures colonoscópico ambulatory June 2003 to January 2002, School Hospital Oscar Danilo Rosales Arguello

Presenta estudio ensayo controlado aleatorizado, en pacientes atendidos en el servicio de endoscopia digestiva del Hospital Escuela Oscar Danilo Rosales. El estudio se baso en pacientes sometidos a colonoscopía bajo sedación consciente. De los participantes 24 (54 porciento) se incluyeron en el grupo 1; y 20 (45 porciento) en el grupo 2.En la distribución genérica se distribuyeron 28 (63.6 porciento) con el sexo femenino y 16 (36.4 porciento) con el masculino. Encontrándose dolor moderado en el 41.6 porciento del sexo femenino y 30 porciento en el sexo masculino. El grupo etáreo predominante fue de 35-49 años (36.4 porciento), 22-34 años 10 pacientes (22.7 porciento) y el 20.5 porciento en grupos 50-64 años y 65-90 años. El grupo etáreo que refirió mayor intensidad del dolor fue de 50-64 años, quienes aquejaron dolor moderado. En la intensidad del dolor se encontró que 24 pacientes presentaban dolor leve (54.5 porciento) y moderado 20 pacientes (45.5porciento). Siendo leve 13 casos (54 porciento) Se encontraron 27 pacientes ASA 1(61 porciento), 13 ASA 11(29.5 porceinto) y 4 ASA III (9 porciento); de los cuales el 22.7 porciento presentaban antecedentes patológicos y 15 (34 porciento) tomaban medicación al momento del procedimiento. La saturación de oxígeno al final mostró una variación que se considera no significativa con respecto a la inicial. Las variaciones de presión arterial media mantuvieron modificaciones no significativas que promedian menos de los 10 milímetros de mercurio. Las diferencias entre el pulso inicial y final mostraron una variación del 16.8 porciento en el grupo 1; y del 30 porciento en el grupo 2 para el intervalo de pulso de 60-79