Hemangioma de esófago superior tratado con éxito mediante láser / Upper esophageal hemangioma succesfully treated by laser

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[A review of the clinical application of dyes in gastrointestinal chromoendoscopy, and their magistral formulation]. / Revisión de la aplicación clínica de los colorantes en cromoendoscopia digestiva y su formulación magistral.

OBJECTIVE: To review the drug compounding of dyes employed in chromoendoscopy, and their clinical effectiveness. METHOD: A literature search in Medline, Cochrane Library, and Micromedex was carried out with the term chromoendoscopy as a keyword, and the search was then repeated for each dye found in association with the term endoscopy. A number of monographs, scientific journals, and references quoted in selected papers were also reviewed. Papers collected were then classified according to their methodology. RESULTS: Ninety-six references were found, their original article being recovered for only 57 of these - 13 clinical trials, 21 case series, and 11 reviews. References were found for 7 dyes. Main indications, evidence of effectiveness, administration route, and drug formulation are described for each dye. CONCLUSIONS: The number of papers involved is high, but their accessibility is limited. Evidence is overall scarce, but high in cases such as methylene blue for Barrett s esophagus, lugol in the detection of esophageal carcinoma, and indigo carmine for colonic hyperplastic polyp differentiation. Drug compounding is rather simple, but scarcely developed.

Revisión de la aplicación clínica de los colorantes en cromoendoscopia digestiva y su formulación magistral / review of the clinical application of dyes in gastrointestinal chromoendoscopy, and their magistral formulation

Objetivo: El objetivo del presente trabajo es revisar la formulación magistral de los colorantes empleados y su efectividad clínica. Método: Se realizó una búsqueda bibliográfica en Medline, Cochrane Library y Micromedex, utilizando el término cromoendoscopia y repitiendo la búsqueda con los colorantes localizados asociados al término endoscopia. Se revisaron también diversas monografías, revistas científicas y las citas de los trabajos seleccionados. Los trabajos recuperados se clasificaron en función de su metodología. Resultados: Se localizaron 96 referencias, recuperándose el artículo original sólo en 57 de ellas correspondientes a 13 ensayos clínicos, 21 series de casos y 11 revisiones. Se encontraron referencias para 7 colorantes. Se describen las principales indicaciones, las evidencias de efectividad, la forma de administración y la fórmula magistral para cada uno de los colorantes. Conclusiones: El número de trabajos es elevado aunque la accesibilidad a los mismos es limitada. La evidencia es escasa en conjunto aunque en determinados casos como el azul de metileno en esófago de Barrett, el lugol en la detección de carcinomas esofágicos y el índigo carmín en la diferenciación de pólipos hiperplásicosa nivel colónico es alta. La formulación magistral es bastante simple aunque está poco desarrollada

Objective: To review the drug compounding of dyesemployed in chromoendoscopy, and their clinical effectiveness. Method: A literature search in Medline, Cochrane Library, and Micromedex was carried out with the term chromoendoscopy as a keyword, and the search was then repeated for each dye found in association with the term endoscopy. A number of monographs, scientific journals, and references quoted in selected papers were also reviewed. Papers collected were then classifiedaccording to their methodology. Results: Ninety-six references were found, their original article being recovered for only 57 of these – 13 clinical trials, 21case series, and 11 reviews. References were found for 7 dyes. Main indications, evidence of effectiveness, administration route, and drug formulation are described for each dye. Conclusions: The number of papers involved is high, but their accessibility is limited. Evidence is overall scarce, but high in cases such as methylene blue for Barrett's esophagus, lugol in the detection of esophageal carcinoma, and indigo carmine for colonic hyperplastic polyp differentiation. Drug compounding is rather simple, but scarcely developed

[Percutaneous endoscopic gastrostomy. Reality in the intra- and extra-community clinical nutritional practice]. / La gastrostomía endoscópica percutánea. Realidad en la práctica nutricional clínica intra y extrahospitalaria.

BACKGROUND: This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). MATERIAL: We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. RESULTS: Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 +/- 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. CONCLUSION: Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortality.

La gastrostomía endoscópica percutánea. Realidad en la práctica nutricional clínica intra y extrahospitalaria / Percutaneous endoscopic gastrostomy. Reality in the intra- and extra-community clinical nutritional practice

Objetivo. El objetivo de este trabajo ha sido revisar nuestra experiencia durante 8 años de la utilización de la gastrostomía endoscópica percutánea (GEP) y su aplicación en nutrición enteral domiciliaria (NED). Material y métodos. Estudiamos 207 pacientes (56 mujeres y 151 hombres) a los que se le ha realizado GEP desde 1994 al 2002 inclusive, al requerir nutrición enteral de forma prolongada (> 4 semanas). En aquellos casos en los que se programó NED los pacientes/familiares fueron adiestrados en las técnicas y cuidados de la GEP y de la NE, y el control se hizo a través de la consulta externa de Nutrición. Resultados. El tiempo medio de duración de la GEP fue de 640 días y 175 pacientes (84,6%) necesitaron la GEP más de 60 días, mientras que 135 la requirieron más de 6 meses. El aporte calórico medio fue de 1.730 ± 288 Kcal/día; el modo de administración fue mediante infusión intermitente por gravedad en 162 casos y por infusión continua a través de bomba volumétrica en 45 pacientes. En dos pacientes con hiperémesis gravídica se realizó gastroyeyunostomía endoscópica percutánea (GYEP) en el tercer y cuarto mes de embarazo, terminándose con éxito la gestación mediante parto por vía vaginal. La realización de la GEP facilitó el alta hospitalaria y la programación de la NED en 195 pacientes (94%). Las complicaciones más frecuentes fueron la infección de la gastrostomía, que ocurrió en 41 pacientes, y la aparición de granuloma en la ostomía en 34 casos. Sólo hubo un paciente que falleció en relación directa con una peritonitis tras la GEP. Conclusión. De nuestro trabajo se infieren las ventajas de la GEP como técnica de nutrición enteral, permitiendo la instauración de un programa de NED con escasa incidencia de complicaciones y muy baja mortalidad

Background. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortalityBackground. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortalityBackground. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortality

Results of an upper endoscopy protocol in liver transplant candidates.

OBJECTIVE: our aims is to understand endoscopic findings from a preoperative systematic study of patients with hepatic cirrhosis who were candidates for transplantation and their impact on a protocol for primary and secondary prophylaxis of variceal haemorrhage. PATIENTS AND METHODS: this study involves a retrospective evaluation of upper digestive tract lesions detected before inclusion and a prospective evaluation of new episodes of variceal haemorrhage, associated mortality rates, and factors that are likely to be involved in the development of this condition. Primary prophylaxis with beta-blockers was considered indicated in cases of varices of grande II or greater or with signs associated with increased risk. Secondary prophylaxis was essentially always associated with medical and endoscopic treatment. RESULTS: of 134 patients, there were 9 deaths, with a median time on the waiting list of 3 months. Of all patients, 33.6% presented with high risk oesophageal varices, 11.2 % with gastric varices, 42.6% with portal hypertensive gastropathy, and 26.9% with peptic lesions. Primary prophylaxis was indicated in 33 of 90 patients, and was initiated in almost half of the cases as a results of the study. Optimum fulfiment of the pre-established objectives was 75.3%. The incidence of new haemorrhagic events due to varices was 10.4% and accounted for almost half of the deaths during the monitoring period. The only statistically significant predictive factors were the presence of gastrict varices and previous history. CONCLUSION: upper endoscopy should play a role in the preoperative examination of liver transplant candidates due to the significant impact it has on subsequent management.

[A multicenter clinical trial. Zinc acexamate versus famotidine in the treatment of acute duodenal ulcer. Study Group of Zinc acexamate (new UP doses)]. / Ensayo clínico multicéntrico. Acexamato de zinc versus Famotidina en el tratamiento de la úlcera duodenal aguda. Grupo de estudio del Acexamato de zinc (nueva dosis UP).

A multicentric double-blind trial comparing 600 mg/d of Zinc Acexamate (ACZ) and 40 mg/d of Famotidine (FMT) in the short term treatment of acute duodenal ulcer included 199 patients, diagnosed by endoscopy. One-hundred and five patients received ACZ and 94 FMT, during four weeks. A clinical control took place at two weeks and a second clinical and endoscopic control at the end of the treatment (4 weeks). Complete cicatrization of the ulcer was observed in 56.5% of patients on ACZ and in 69.5% of patients of FMT (N.S.). A reduction of more than 50% of the ulcer diameter was recorded in 78.8% of the ACZ group and in 79.9% of the FMT group. Alcohol and smoking did not influence the results. Both treatments were equally effective in the disappearance of symptoms. The incidence of adverse reactions was very low in both groups (< 5%) and no patient dropped from the trial for this reason. In conclusion, a dosage of 600 mg/d of ACZ has shown to be as effective as 40 mg/d of FMT in the healing of duodenal ulcer.