Black esophagus.

A 76-year-old man with multiple cardiovascular risk factors (hypertension, DM2, LD, smoker) and severe peripheral arterial disease (iliofemoral bypass, supracondylar amputation) came to the emergency with coffee ground emesis and mild anemia. Urgent gastroscopy showed diffuse circumferential black mucosa covered by fibrin affecting the middle and distal esophageal third. Acute esophageal necrosis is a rare cause of gastrointestinal bleeding that should be suspected in patients with cardiovascular risk factors with an image of a black esophagus that is abruptly interrupted at the EGJ.

Metaplasia epidermoide de esófago: una entidad infrecuente / Esophageal epidermoid metaplasia: an unusual condition

Un varón de 66 años con antecedente de consumo de tabaco y alcohol fue diagnosticado de esofagitis péptica grave. Tras el tratamiento, la gastroscopia mostró resolución de la esofagitis, con la presencia de unas placas blanquecinas multinodulares extensas cuya biopsia demostró una metaplasia epidermoide de esófago. Se trata de una entidad infrecuente que se ha asociado a la aparición de carcinoma epidermoide de esófago, por lo que se considera de gran importancia su diagnóstico y seguimiento endoscópico. (AU)

Esophageal epidermoid metaplasia: an unusual condition.

A 66-year-old man with a history of tobacco and alcohol consumption was diagnosed with a severe peptic esophagitis. After treatment, an endoscopy showed the resolution of esophagitis, but revealed white multinodular plaques with a diffuse distribution. Histology showed esophageal mucosa with a prominent granular layer and hyperorthokeratotis, in keeping with epidermoid metaplasia. This unusual condition has been linked to esophageal squamous cell carcinoma. Therefore, diagnosis and endoscopic surveillance should be considered.

Colorectal penetration by two intrauterine devices

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Colorectal penetration by two intrauterine devices.

A colonoscopy was performed as part of a colorectal screening program on a 77-year-old female with positive fecal occult blood test. During withdrawal, two metallic elongated foreign bodies, around 20 mm in length were found pinned into the transverse colon and rectal wall. A computed tomography with multiplanar reconstruction showed two metallic density T-shaped foreign bodies that resembled intrauterine devices (IUDs) that penetrated the intestinal wall , which ruled out other complications. The patient confirmed a previous loss of an IUD device 35 years previously and underwent a second IUD insertion a few years later. She refused another colonoscopy for endoscopic removal as she did not have any symptoms in the past.

Hepatitis aguda como manifestación de sífilis secundaria / Acute hepatitis as a manifestation of secondary syphilis

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Factors associated with complications during endoscopic esophageal dilation.

BACKGROUND: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. OBJECTIVE: to assess the safety of esophageal dilation and the factors associated with the development of complications. MATERIALS AND METHODS: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. RESULTS: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. CONCLUSIONS: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.

Factores asociados a complicaciones en las dilataciones esofágicas endoscópicas / Factors associated with complications during endoscopic esophageal dilation

Antecedentes: las dilataciones endoscópicas se consideran el tratamiento de elección para las estenosis esofágicas, sin embargo, no se cuenta en nuestra región con estudios en los que se evalúe la seguridad de este procedimiento. Objetivo: evaluar la seguridad de las dilataciones esofágicas y los factores asociados a las complicaciones. Material y métodos: cohorte retrospectiva. Se incluyeron todos los pacientes referidos para dilatación esofágica entre enero de 2015 y junio de 2017. Se obtuvo la tasa de complicaciones y se determinó la asociación entre la no adherencia a la "regla de los tres" y el desarrollo de complicaciones. Se analizaron otros factores predictivos asociados al desarrollo de complicaciones. Resultados: se incluyeron 164 pacientes en los que se realizaron 474 dilataciones. La etiología más prevalente fue la estenosis de anastomosis quirúrgica. Se presentaron seis complicaciones: tres perforaciones (0,63%), dos sangrados (0,42%) y un episodio de dolor significativo que requirió observación posprocedimiento (0,21%). La dilatación endoscópica esofágica fuera de la "regla de los tres" no se encontró asociada a un mayor riesgo de complicaciones. La dilatación con balón fue el único factor predictivo para el desarrollo de complicaciones. Conclusiones: la dilatación esofágica es un procedimiento seguro. La no adherencia a la "regla de los tres" no parece estar asociada a un mayor riesgo de complicaciones, incluyendo la perforación esofágica

Background: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. Objective: to assess the safety of esophageal dilation and the factors associated with the development of complications. Materials and methods: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. Results: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. Conclusions: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation

Esofagitis eosinofílica y esofagitis herpética: ¿causa o consecuencia? / Eosinophilic esophagitis and herpetic esophagitis: cause or consequence?

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Eosinophilic esophagitis and herpetic esophagitis: cause or consequence?

Association between eosinophilic esophagitis and herpetic esophagitis has been suggested in some studies but it continues been so controversial. We present two clinical cases of two immunocompetent patients who did not have any previous predisposing treatment and who present both diseases; that is the reason we suggest that they may have any relation.

Extracción endoscópica de paquete de hachís / Endoscopic removal of a hashish packet

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Endoscopic removal of a hashish packet.

Illicit drug trafficking within the body ("body packers") represents a medical-legal problem currently on the rise. Endoscopic removal of drug packets is not generally recommended because of the risk of packet rupture and subsequent overdose on the spilled substance. A 40-year-old male presented with abdominal pain and diaphoresis following the ingestion of 30 g of hashish as a means of illegal trafficking, remaining in police custody during his hospital stay.

Brote psicótico agudo secundario a tratamiento erradicador de Helicobacter pylori / Acute psychotic episode secondary to Helicobacter pylori eradication treatment

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Acute psychotic episode secondary to Helicobacter pylori eradication treatment.

The side effects of Helicobacter pylori (H. pylori) eradication treatment are few, usually in the form of gastrointestinal or allergic complaints. However, occasionally, some antibiotics including clarithromycin, included in the classic eradication regimen, may result in reversible psychosis, a condition called "antibiomania" or "Hoigne syndrome".

Perforación múltiple de divertículos de intestino delgado en paciente con síndrome de Ehlers-Danlos / Multiple perforation of small-intestine diverticula in a patient with Ehlers-Danlos syndrome

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Multiple perforation of small-intestine diverticula in a patient with Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome represents a group of hereditary connective tissue disorders characterized by ligamentous hyperlaxity, fragile skin and joint hypermobility. Gastrointestinal complications in this syndrome are less well known.

Intubación con fibrobroncoscopio en paciente diagnosticado de síndrome de Prader Willi para extracción de cuerpo extraño gástrico / Fiber-optic intubation in a Prader Willi syndrome diagnosed patient to take out a gastric strange object

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Endoscopic management of esophageal varices.

The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis.