Concordancia de la cápsula endoscópica y la enteroscopia asistida por dispositivos en lesiones del intestino delgado / No disponible

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Concordance between capsule endoscopy and device-assisted enteroscopy in small-bowel lesions.

The agreement between capsule endoscopy (CE) and device-assisted enteroscopy (DAE) in tumors of the small-bowel (SB) may be high. However, other SB lesions such as ulcers and angioectasias seem to have more agreement between both procedures, compared to tumors or polyps. In the article published by Alventosa-Mateu C et al., an interesting case was presented of a patient with iron deficiency anemia secondary to two carcinoid ileum tumors, identified by CE and later biopsied and tattooed by DAE.

Comparison in the Diagnostic Yield between "Pillcam SB3" Capsule Endoscopy and "OMOM Smart Capsule 2" in Small Bowel Bleeding: A Randomized Head-to-Head Study.

INTRODUCTION: Capsule endoscopy (CE) is the first-line tool for diagnosis of small bowel bleeding. There are some studies that have compared different types of CE. OMOM CE is one of the newest in the market and has not been compared with other types of CE. The objective of this study was to compare the diagnostic yield of the Pillcam SB3 and OMOM CE in small bowel bleeding. MATERIALS AND METHODS: This is a prospective, comparative, randomized, and blinded study. Patients with suspected small bowel bleeding were included. All the patients were given both types of CE in random order. Diagnostic yield and functionality between the 2 types of CE were analyzed. RESULTS: We included 44 patients, 54.5% were female with a median age of 63.5 years. Battery time was significantly longer with SB3 (816.5 vs. 700.5 min, p < 0.001), and the download time was shorter with OMOM (33 vs. 132 min, p < 0.001). Both CEs presented 1 failure. The cause of the bleeding was identified in 39 SB3 (88.6%) and in 34 OMOM CE (77.3%) (p = 0.256). P2 lesions were observed in 32 SB3 (72.7%) and in 29 OMOM CE (65.9%) (p = 0.784). The agreement between both CEs for P2 lesions was moderate (κ = 0.628). CONCLUSIONS: Pillcam SB3 and OMOM devices are safe procedures and have a similar diagnostic yield. Significant differences were observed in the battery life and download time with both CEs.

Seguridad y eficacia de la enteroscopia con intercambio de agua en comparación con la enteroscopia con dióxido de carbono / No disponible

INTRODUCCIÓN: la insuflación de dióxido de carbono (CO2) durante la enteroscopia reduce el tiempo del procedimiento y los síntomas posteriores al mismo e incrementa la profundidad de inserción comparado con aire ambiente. En colonoscopia, la técnica de intercambio de agua (IA) se asocia a menor dolor en comparación con la insuflación de CO2. La técnica IA no está bien estudiada en enteroscopia. El objetivo de este estudio es comparar la seguridad y eficacia de la enteroscopia con IA y la enteroscopia con CO2. MÉTODOS: estudio prospectivo, comparativo y observacional, que incluyó enteroscopias de doble balón (EDB) que fueron aleatorizadas en dos grupos: el primero con IA y el segundo con insuflación de CO2. Los datos recopilados se evaluaron mediante análisis univariado y una regresión logística múltiple (variables con p ≤ 0.10 en análisis univariado). RESULTADOS: se incluyeron 46 EDB (23 por brazo; mediana de edad 63,5 años, 37% mujeres). No hubo diferencias estadísticas en la vía de acceso, los hallazgos, la terapéutica y las complicaciones entre grupos. Cuatro pacientes (20%) en el grupo de CO2 tuvieron eventos adversos (distensión abdominal y dolor) y uno en el grupo IA (náuseas) sin diferencia estadística. La mediana de profundidad de inserción fue mayor en el grupo de CO2 (260 cm vs. 160 cm; p = 0,048). La regresión logística múltiple mostró una diferencia estadística en la profundidad de inserción utilizando insuflación de CO2 (OR 1,009, 1,001-1,017; p = 0,034). CONCLUSIONES: las EDB con técnica de insuflación de CO2 y con IA son seguras con una mayor profundidad de inserción con CO2

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Predictores para identificar lesiones en intestino delgado por enteroscopia posterior a una cápsula endoscópica positiva / No disponible

INTRODUCCIÓN Y OBJETIVO: estudios han evaluado la concordancia entre la cápsula endoscópica y la enteroscopia doble-balón con resultados diversos. El objetivo de este estudio es identificar factores que predicen la visualización de las lesiones en el intestino delgado por enteroscopia doble-balón después de una cápsula endoscópica positiva. MÉTODOS: estudio retrospectivo, observacional y comparativo que evaluó a pacientes con enteroscopia doble balón después de un cápsula endoscópica positiva entre enero de 2017 y agosto de 2019. Los datos estudiados fueron demográficos, indicaciones, comorbilidades y resultados de cápsula endoscópica y enteroscopia doble-balón. Se evaluaron mediante una regresión logística múltiple. RESULTADOS: se incluyeron 91 pacientes (edad 58 ± 16,5 años, 53 mujeres). Sesenta y dos enteroscopia doble-balón (68,1 %) encontraron las mismas lesiones que la cápsula endoscópica. Los factores predictivos para enteroscopia doble-balón positiva fueron lesiones múltiples (OR 8,10, 1,50-43,78; p = 0,015) y < 15 días ambos estudios (OR 5,31, 1,19-23,66; p = 0,029). En el subgrupo de pacientes con hemorragia de intestino delgado (70 pacientes), 46 enteroscopia doble-balón (65,7 %) coincidieron con la cápsula endoscópica. Los factores predictivos en este grupo fueron lesiones múltiples (OR 10,42, 1,37-79,30; p = 0,024), < 15 días entre ambos estudios (OR 13,51, 1,78-102,22; p = 0,012), > 60 años (OR 7,45, 1,51-36,75; p = 0,014) y úlceras (OR 4,67, 1,08-20,22; p = 0,039). CONCLUSIONES: los factores predictivos para enteroscopia doble-balón positiva después de cápsula endoscópica positiva son lesiones múltiples y < 15 días entre ambos procedimientos. En pacientes con hemorragia de intestino delgado, edad mayor a 60 años y presencia de úlceras también son

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Predictors for finding lesions in the small bowel by enteroscopy after a positive capsule endoscopy.

INTRODUCTION: studies have examined the agreement between capsule endoscopy and double-balloon enteroscopy, with varying results. The aim of this study was to identify factors that predict the visualization of lesions in the small bowel by double-balloon enteroscopy after a positive capsule endoscopy. METHODS: a retrospective, observational and comparative study was performed that evaluated patients that underwent double-balloon enteroscopy after a positive capsule endoscopy, between January 2017 and August 2019. The data studied included demographics, indications, comorbidities and the results of capsule endoscopy and double-balloon enteroscopy, which were evaluated by multiple logistic regression. RESULTS: 91 patients were included (age 58 ± 16.5 years, 53 female). Sixty-two double-balloon enteroscopy (68.1 %) found the same lesions as capsule endoscopy. Predictive factors for a positive double-balloon enteroscopy were multiple lesions (OR 8.10, 1.50-43.78; p = 0.015) and < 15 days between both studies (OR 5.31, 1.19-23.66; p=0.029). In the subgroup of patients with small bowel bleeding (70 patients), the results of 46 double-balloon enteroscopies (65.7 %) agreed with the capsule endoscopy. Predictive factors in this group were multiple lesions (OR 13.51, 1.78-102.22; p = 0.012), < 15 days between both studies (OR 13.51, 1.78-102.22; p = 0.012), > 60 years of age (OR 7.45, 1.51-36.75; p = 0.014) and ulcers (OR 4.67, 1.08-20.22; p = 0.039). CONCLUSIONS: predictive factors for a positive double-balloon enteroscopy after a positive capsule endoscopy were multiple lesions and < 15 days between both procedures. In patients with small bowel bleeding, age over 60 years and the presence of ulcers were also predictive factors.

Efficacy and safety of water-exchange enteroscopy compared to carbon dioxide insufflation during enteroscopy.

INTRODUCTION: carbon dioxide (CO2) insufflation during enteroscopy reduces procedure time and subsequent symptoms and increases the insertion depth compared with room air. In colonoscopy, the water-exchange (WE) technique is associated with less pain compared with CO2 insufflation. The WE technique is not well studied in enteroscopy. The aim of this study was to compare the efficacy and safety of enteroscopy with WE and CO2. METHODS: a prospective, comparative and observational study was performed of double balloon enteroscopies (DBE) that were randomized in two groups. The first group used WE while the second group used CO2 insufflation. The data collected was evaluated via univariate analysis and multiple logistic regression (variables with p ≤ 0.10 according to the univariate analysis). RESULTS: forty-six DBE were included; 23 in each arm. The median age of cases was 63.5 years and 37% were female. There were no statistical differences between the groups with regard to the access route, findings, therapy and complications. Four patients (20%) in the CO2 group had adverse events (abdominal distension and pain) and one in the WE group (nausea), which was not statistically significant. The median insertion depth was greater in the CO2 group; 260 cm vs 160 cm (p = 0.048). Multiple logistic regression showed a statistically significant difference in the insertion depth using CO2 insufflation (OR 1.009, 1.001-1.017; p = 0.034). CONCLUSIONS: DBE with a CO2 insufflation technique and WE are safe with a greater insertion depth with CO2.

Esophageal candidiasis in patients from a specialty hospital / Candidiasis esofágica en pacientes de un hospital de especialidades

Background: Esophageal candidiasis (EC) is the most common cause of infectious esophagitis. So far, its main risk factor has been HIV infection; in recent years, EC has been favoured by the increasing of diabetes mellitus, wide-spread use of acid-lowering agents, broad-spectrum antibiotics, and inhaled steroids. In Mexico EC has been poorly studied. Objectives: To determine the clinical and epidemiological characteristics of EC, and to identify its etiological agents as well as its antifungal susceptibility. Methods: Patients who revealed the presence of scattered white spots through an upper gastrointestinal system endoscopy, in a period of one year, in a tertiary care hospital, were included. Samples from patches were collected for microscopic examination, culture, and susceptibility tests. Results: Out of 1763 patients studied, 23 had scattered white spots, and most of them presented Kodsi grade I; 13 were men; half of the patients were between the ages 20 to 40; main comorbidity was liver cirrhosis; use of omeprazole was significant. 22 isolates were obtained from 17 patients. The most frequent species were C. albicans (14) and C. parapsilosis (3). In five cases we found a two-species association v. g. Candida famata with Trichosporon mucoides. Half of the isolates showed resistance to one or several antifungal drugs. Conclusions: EC frequency in this study was similar to other studies' results. Obtained isolates showed high resistance to azolic compounds and to caspofungin, which is relevant information to take a therapeutic decision.

Introducción: la candidiasis esofágica (CE) es la causa más común de esofagitis infecciosa. Su principal factor de riesgo ha sido la infección por VIH. En México ha sido poco estudiada. Objetivos: determinar las características clínico-epidemiológicas de la CE e identificar sus agentes etiológicos y su sensibilidad a antifúngicos. Métodos: se incluyeron pacientes a quienes se les detectaron placas blanquecinas durante una endoscopía esofágica, en un periodo de un año, en un hospital de tercer nivel de atención. Se tomó muestra de las placas para examen microscópico, cultivo, y estudios de sensibilidad. Resultados: de 1763 pacientes estudiados, 23 presentaron placas blanquecinas; 13 fueron hombres; la mitad tenía de 20 a 40 años de edad; la principal comorbilidad fue cirrosis hepática; el uso de omeprazol fue significativo. Se obtuvieron 22 aislados de 17 pacientes; predominaron Candida albicans (14) y Candida parapsilosis (3). En cinco casos se encontró asociación de dos especies v. g. Candida famata con Trichosporon mucoides. La mitad de los aislados mostró resistencia a antimicóticos. Conclusiones: la frecuencia de CE fue similar a la de otras casuísticas. Los aislados obtenidos mostraron resistencia elevada a compuestos azólicos y a caspofungina, información relevante para tomar una decisión terapéutica.

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.

Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report.

Is a case report of a patient with overt obscure gastrointestinal bleeding due to a mesenteric hemolymphangioma with infiltration to jejunum. Diagnosed by capsule endoscopy and treated with double-balloon enteroscopy and surgery.

Hemolinfangioma como causa de hemorragia de origen obscura evidente. Presentación de un caso / Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report

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Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet?

As we know, the frequency of diverticular disease (DD) increases according to age, being less than 5% in patients under 40 years of age and up to 60% after 80 years of age. The most common distribution of diverticula is in the left colon, except for the Asian population, where diverticular disease of the right colon is more frequent.

Colonic diverticular bleeding. Have we identified the risk factors for massive bleeding yet?

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Per-oral Endoscopic Myotomy (POEM): A safe and effective treatment for achalasia in geriatric patients / Miotomía endoscópica a través de la boca (POEM): una alternativa endoscópica segura y efectiva para el tratamiento de la acalasia en pacientes geriátricos

Background: Esophageal achalasia is a primary motor disorder of the esophagus characterized by impair relaxation of the lower esophageal sphincter and absent of esophageal peristalsis. Per-oral endoscopic myotomy is an alternative treatment to surgical Heller myotomy in patients over 65 years old. The aim of this paper was to describe the results of peroral endoscopic myotomy (POEM) or the treatment of achalasia in geriatric patients. Methods: We included patients over 65 years old with POEM, from retrospective cohort review, in which POEM was performed with a standardized technique in our department. Results: 12 patients were included, the procedure was successful in 98% of patients, minor adverse events occurred without mortality. Conclusions: POEM is a safe and effective technique for the treatment of achalasia, the results of the study are similar to those reported in the literature.

Introducción: La acalasia es un trastorno motor primario del esófago caracterizado por falla en la relajación del esfínter esofágico inferior y ausencia de peristalsis esofágica sin una causa identificable de obstrucción en el esófago distal. La miotomía endoscópica a través de la boca es un tratamiento alternativo a la cardiomiotomía de Heller laparoscópica en pacientes mayores de 65 años. El objetivo de este trabajo fue describir los resultados la miotomía endoscópica a través de la boca (POEM), en pacientes mayores de 65 años. Métodos: Estudio retrospectivo con diagnóstico manométrico de acalasia, de pacientes mayores de 65 años de edad. Resultados: Se incluyeron 12 pacientes, se consideró tratamiento exitoso cuando el paciente alcanza un índice de Eckardt < 3. El procedimiento fue exitoso en el 98% de los pacientes, se presentaron eventos adversos menores en la mayoría de los pacientes. Conclusiones: La miotomía endoscópica a través de la boca es una técnica segura y efectiva para el tratamiento de acalasia en adultos mayores, los resultados del estudio son similares a los reportados en la literatura.

The Per Oral Endoscopic Myotomy (POEM) technique: how many preclinical procedures are needed to master it?

BACKGROUND AND STUDY AIM: Per oral endoscopic myotomy (POEM) is a complex technique used in achalasia. Preclinical training is essential but little is known about the number of procedures needed. The aim of this study was to determine the number of procedures required to master POEM in an animal model. PATIENTS AND METHODS: This prospective comparative study was conducted in two swine models at a single institution in Mexico City between November 2012 and October 2014: Group 1 (G1) = 30 ex vivo and Group 2 (G2) = 20 live swine models. POEM was mastered after finishing the five steps without complications. Time, characteristics, and complications were recorded. Velocity of tunnelization and myotomy (VTM) was determined. Ex vivo analysis was done in G1 immediately after finishing POEM and at day 30 in G2. RESULTS: A total of 50 POEM were done in both groups (G1 = 30, G2 = 20). The mean times were 90.17 min (G1) and 89.50 min (G2) (P = 0.92). Myotomy was faster in G2 (21.10 vs 27.97 min; P = 0.009) with a slightly slower tunnelization (40.35 vs 41.13 min; P = 0.86). Myotomy was longer in G2 (9.25 vs 8.83 cm; P = 0.26). VTM between the groups was similar (G1 = 0.159 vs G2 = 0.157 cm/min; P = 0.925). Complications were: mucosotomy (G1 = 18 %, G2 = 8 %; P = 0.430), mediastinal perforation (G1 = 12 %, G2 = 8 %; P = 1.0), and perforation at the gastroesophageal junction (GEJ) level (G1 = 16 %, G2 = 4 %; P = 0.149). Seven models in G2 presented minor bleeding and there was one death not attributed to the procedure. Mastery was obtained after 26 cases. CONCLUSIONS: We suggest that centers interested in learning POEM consider 26 procedures in animal models to master it before performing it in patients with achalasia.