[Endoscopic retrieval of migrated gastric band]. / Extracción endoscópica de banda gástrica migrada.

This is a case report of a 47-year-old woman, carrier of an adjustable gastric band since 2018, that developed abdominal pain due to partial migration into the stomach. which was successfully removed endoscopically using Sohendra's lithotriptor.

Unmasked immune reconstitution inflammatory syndrome towards B-cell non-Hodgkin lymphoma during treatment of esophageal actinomycosis in a patient with advanced HIV: a case report.

BACKGROUND: Actinomycosis is an unusual chronic bacterial infection, even rarer in people living with HIV. It is not considered an AIDS-defining disease. However, the role in co-presentation or overlap with other opportunistic conditions of advanced HIV is unknown. CASE PRESENTATION: A 49-year-old Peruvian male presented with a 4-month history of dysphagia, odynophagia, hyporexia and wasting. He underwent an upper digestive endoscopy, in which ulcers with a necrotic center were observed, therefore, the initial diagnostic assumption was esophageal cancer. Subsequent pathology report excluded neoplasms and confirmed the diagnosis of actinomycosis. Serology for human immunodeficiency virus was requested, yielding a positive result. Antimicrobial treatment with amoxicillin and antiretroviral therapy were indicated, with slow clinical improvement. After 4 months, epigastric discomfort presented, for which a new upper digestive endoscopy was performed, revealing a deep gastric ulcer, which was compatible with diffuse large B-cell non-Hodgkin lymphoma. CONCLUSION: Esophageal actinomycosis in people living with HIV is very rare. We suggest HIV-associated immunosuppression is not enough to allow for actinomycosis to develop, and masked underlying entities should be sought. The existence of such entities in people living with HIV should raise awareness of the possibility of unmasked immune reconstitution inflammatory syndrome once treatment has started.

Extracción endoscópica de banda gástrica migrada

Se reporta el caso de una paciente mujer de 47 años, portadora de una banda gástrica ajustable desde el año 2018, quien presenta dolor abdominal por migración intragástrica de la misma, pudiendo extraerla exitosamente via endoscópica con ayuda de litotriptor de Sohendra.

This is a case report of a 47-year-old woman, carrier of an adjustable gastric band since 2018, that developed abdominal pain due to partial migration into the stomach. which was successfully removed endoscopically using Sohendra's lithotriptor.

Pancreatitis aguda asociada a balón intragástrico

Presentamos el caso de una mujer joven con el hábito de dormir en posición decúbito ventral, quien refiere que, tras la colocación de balón intragástrico, inició cuadros repetitivos de dolor abdominal en epigastrio, de aparición nocturna. El más reciente se caracterizó por dolor abdominal súbito e intenso, elevación de enzimas pancreáticas y hallazgos imagenológicos compatibles con pancreatitis aguda. Tras realizar un estudio etiológico sistemático, se descartan otras causas, retirándose el balón intragástrico con inmediato cese de los dolores nocturnos. Se atribuyó la etiología a fenómenos de compresión mecánica provocados por el balón sobre el cuerpo pancreático durante el descanso en decúbito prono. Hacemos notar que el hábito de reposo en la posición decúbito ventral constituiría un potencial factor de riesgo para pancreatitis post-colocación de balón intragástrico, por lo que este factor debe ser tomado en cuenta en la orientación de los candidatos a esta técnica.

We present a clinical case of a young woman with the habit of sleeping in the prone position. She reports that after intragastric balloon placement, she begins with nocturnal episodes of epigastric abdominal pain. The most recent episode was characterized by sudden and intense abdominal pain, elevation of pancreatic enzymes, and imaging findings compatible with acute pancreatitis. After carrying out a systematic approach, other potential causes were ruled out. After removing the intragastric balloon, immediate cessation of the nocturnal episodes of pain was obtained. The etiology was attributed to the mechanical compression phenomena caused by the balloon on the pancreatic body during rest in the prone position. We note that the habit of resting in the prone position would constitute a potential risk factor for acute pancreatitis after intragastric balloon placement, so this factor should be considered when counselling candidates for this technique.

[Intra-gastric balloon associated with acute pancreatitis]. / Pancreatitis aguda asociada a balón intragástrico.

We present a clinical case of a young woman with the habit of sleeping in the prone position. She reports that after intragastric balloon placement, she begins with nocturnal episodes of epigastric abdominal pain. The most recent episode was characterized by sudden and intense abdominal pain, elevation of pancreatic enzymes, and imaging findings compatible with acute pancreatitis. After carrying out a systematic approach, other potential causes were ruled out. After removing the intragastric balloon, immediate cessation of the nocturnal episodes of pain was obtained. The etiology was attributed to the mechanical compression phenomena caused by the balloon on the pancreatic body during rest in the prone position. We note that the habit of resting in the prone position would constitute a potential risk factor for acute pancreatitis after intragastric balloon placement, so this factor should be considered when counselling candidates for this technique.diseases.

[Retrograde cholangiography performed with simple balloon-assisted enteroscopy in patients with altered anatomy by surgery in a private level III clinic]. / Colangiografía retrógrada realizada con enteroscopia asistida por balón simple en pacientes con anatomía alterada por cirugía en una clínica privada nivel III.

OBJECTIVE: To evaluate the usefulness of retrograde cholangiography performed with simple balloon-assisted enteroscopy for the management of bile duct pathology in patients with altered anatomy by surgery at the Anglo American Clinic. MATERIALS AND METHODS: This is a retrospective descriptive study where all patients with altered anatomy who came for bile duct problems to undergo a retrograde cholangiography assisted by simple balloon enteroscopy at the Anglo American Clinic during the January period from 2014 to January 2020. RESULTS: We performed 10 studies of retrograde cholangiography assisted by simple balloon enteroscopy. Cannulation of the bile duct was successful in 80% of our cases, in two cases the bile duct could not be located. The findings of the retrograde cholangiography were biliary stones in 7 cases, stenosis of the biliodigestive anastomosis in 5 cases, and an ampuloma. The most frequent therapeutic procedures were CRE progressive balloon dilation of the bilioenteric anastomosis and extraction of stones with a Dormia basket. There were no complications associated with the procedure. CONCLUSION: Retrograde cholangiography assisted by simple balloon enteroscopy is a safe and effective method to resolve biliary pathology in our patients with altered anatomy.

Colangiografía retrógrada realizada con enteroscopia asistida por balón simple en pacientes con anatomía alterada por cirugía en una clínica privada nivel III / Retrograde cholangiography performed with simple balloon-assisted enteroscopy in patients with altered anatomy by surgery in a private level III clinic

RESUMEN Objetivo : Evaluar la utilidad de la colangiografía retrógrada realizada con enteroscopia asistida por balón simple para el manejo de la patología de la via biliar en pacientes con anatomía alterada por cirugía en la Clínica Anglo Americana. Materiales y métodos : El presente es un estudio descriptivo retrospectivo donde se evalúan a todos los pacientes con anatomía alterada que acudieron por problemas de la via biliar para realizarse una colangiografía retrógrada asistida por enteroscopia con balón simple en la Clínica Anglo Americana durante el periodo de enero del 2014 a enero del 2020. Resultados : Realizamos 10 estudios de colangiografía retrógrada asistida por enteroscopia con balón simple. La canulación de la vía biliar fue exitosa en el 80% de nuestros casos, en dos casos no se pudo localizar la via biliar. Los hallazgos de la colangiografía retrógrada fueron litiasis de via biliar en 7 casos, estenosis de la anastomosis biliodigestiva en 5 casos y un ampuloma. Los procedimientos terapeúticos más frecuentes fueron dilatación con balón progresivo CRE de la anastomosis bilioentérica y extracción de litos con canastilla de Dormia. No se presentaron complicaciones asociadas al procedimiento. Conclusión : La colangiografía retrógrada asistida por enteroscopia con balón simple es un método seguro y eficaz para resolver la patología biliar en nuestros pacientes con anatomía alterada.

ABSTRACT Objective : To evaluate the usefulness of retrograde cholangiography performed with simple balloon-assisted enteroscopy for the management of bile duct pathology in patients with altered anatomy by surgery at the Anglo American Clinic. Materials and methods : This is a retrospective descriptive study where all patients with altered anatomy who came for bile duct problems to undergo a retrograde cholangiography assisted by simple balloon enteroscopy at the Anglo American Clinic during the January period from 2014 to January 2020. Results : We performed 10 studies of retrograde cholangiography assisted by simple balloon enteroscopy. Cannulation of the bile duct was successful in 80% of our cases, in two cases the bile duct could not be located. The findings of the retrograde cholangiography were biliary stones in 7 cases, stenosis of the biliodigestive anastomosis in 5 cases, and an ampuloma. The most frequent therapeutic procedures were CRE progressive balloon dilation of the bilioenteric anastomosis and extraction of stones with a Dormia basket. There were no complications associated with the procedure. Conclusion : Retrograde cholangiography assisted by simple balloon enteroscopy is a safe and effective method to resolve biliary pathology in our patients with altered anatomy.

[Single balloon enteroscopy in the management of small bowel pathology. Experience of the Small Bowel Unit - British American Hospital from December 2012 to December 2018]. / Enteroscopia asistida por balón simple en el manejo de la patología del intestino delgado. Experiencia de la Unidad de Intestino Delgado de la Clínica Anglo Americana durante el periodo de diciembre del 2012 a diciembre del 2018.

Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. MATERIAL AND METHODS: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. RESULTS: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. CONCLUSION: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure.

Enteroscopia asistida por balón simple en el manejo de la patología del intestino delgado: Experiencia de la Unidad de Intestino Delgado de la Clínica Anglo Americana durante el periodo de diciembre del 2012 a diciembre del 2018 / Single balloon enteroscopy in the management of small bowel pathology: Experience of the Small Bowel Unit - British American Hospital from December 2012 to December 2018

Objetivo: Describir la experiencia en el uso de la enteroscopia asistida por balón simple para el diagnóstico y manejo de la patología del intestino delgado en pacientes con anatomía normal y alterada por cirugía en la Clínica Anglo Americana. Material y método: El presente es un estudio descriptivo - retrospectivo que incluye a todos los pacientes que acudieron a la Unidad de Intestino Delgado de la Clínica Anglo Americana, para realizarse una enteroscopia asistida por balón durante el periodo comprendido entre diciembre del 2012 a diciembre del 2018. Resultados: Se realizaron 80 procedimientos de enteroscopia asistida por balón simple, 49 fueron realizados por via anterógrada y 31 por vía retrógrada. La edad promedio fue 60,78 años (20 a 88 años). 48 pacientes (60%) eran varones. El tiempo de inserción media fue 80 minutos para la vía anterógrada (55 - 141 minutos) y 110 minutos para la vía retrógrada (55 -180 minutos). La principal indicación para realizar la enteroscopia por balón simple fue hemorragia digestiva oscura, 45 casos (56,25%). Se realizaron 6 estudios de enteroscopias asistida por balón en pacientes con anatomía alterada (7,5%). Setenta de los ochenta procedimientos (87,5%) fueron realizados con sedación administrada por enfermería supervisada por gastroenterólogo en base a midazolam, petidina y propofol, no se presentó ninguna complicación respiratoria o hemodinámica. Los diagnósticos obtenidos más frecuentes por enteroscopia fueron: angiodisplasias de intestino delgado (20%), úlceras yeyuno ileales (17,5%) y neoplasias a nivel del intestino delgado (7,5%). La complicación que se presentó con más frecuencia posterior a la enteroscopia fue el íleo paralítico, 2 casos, y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento. Conclusiones: La hemorragia digestiva oscura fue la principal indicación para realizar una enteroscopia asistida por balón simple. Los diagnósticos más frecuentes fueron angiodisplasias, úlceras yeyuno ileales y neoplasias a nivel del intestino delgado. La complicación más frecuente fue el íleo paralítico y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento.

Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. Material and methods: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. Results: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. Conclusion: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure

[Endoscopic submucosal dissection of a transpyloric early gastric cáncer. A case report and literature review]. / Disección submucosa endoscópica de cáncer gástrico tempranotranspilórico. Reporte de caso y revisión de la literatura.

The endoscopic sumucosal disection (ESD) is an advanced endoscopic technique that achieves the curative resection of superficial neoplasms of the gastrointestinal tract, getting block exeresis with margins free of neoplasia avoiding surgery. However, tumors located in the esophagogastric junction, or pylorus, are technically more complex to resect by ESD. When a neoplasm settles in the pylorus, the anatomical characteristics of this region can affect the adequate assessment of the margins and the performance of the procedure. We present the case of a 70-year-old male patient who, in a high digestive endoscopy, showed a flat multilobulated lesion of 18 mm x 10 mm, located mostly in the lower 2 quadrants of the pyloric canal and minimal compromise of the upper-posterior quadrant, it mainly covers the gastric side of the pyloric channel and extends into the duodenum. Therefore, it was decided to perform en bloc resection of the lesion with the endoscopic submucosal dissection technique. The ERBEJET system was used with a knife type Hybrid knife, saline injection with methylene blue diluted 0.04% on the distal margin, submucosal injection being complemented with 0.4% hyaluronic acid. A "capsule" or straight transparent distal plastic device was used to be able to pull the lesion and allow anterograde visualization of the margins of resection, including the intraduodenal portion, allowing adequate submucosal dissection. Histopathology showed a moderately differentiated tubular adenocarcinoma with surgical edges free of injury. Thanks to the DSE strategy used, our patient could benefit from the curative resection of his gastric cancer with preservation of the organ and with perfect functionality. This case, the first described in the country, shows the progress of national therapeutic endoscopy.

Disección submucosa endoscópica de cáncer gástrico temprano transpilórico: Reporte de caso y revisión de la literatura / Endoscopic submucosal dissection of a transpyloric early gastric cáncer: A case report and literature review

La disección submucosa endoscópica (DSE) es una técnica endoscópica avanzada que logra la resección curativa de neoplasias superficiales del tracto gastrointestinal, consiguiendo exéresis en bloque con márgenes libres de neoplasia evitando una cirugía. Sin embargo, los tumores localizados en la unión esófago gástrica, o pilórica son técnicamente más complejos para resecar por DSE. Cuando una neoplasia asienta en el píloro las características anatómicas de esta región pueden afectar la adecuada valoración de los márgenes y la realización del procedimiento. Presentamos el caso de un paciente varón de 70 años a quien en una endoscopia digestiva alta se le evidencia una lesión plana elevada multilobulada de 18 mm x 10 mm, situada mayoritariamente en los 2 cuadrantes inferiores del canal pilórico y compromiso mínimo del cuadrante supero-posterior, abarca principalmente la vertiente gástrica del canal pilórico y se extiende hacia el duodeno. Por todo ello se decide realizar resección en bloque de la lesión con la técnica de disección submucosa endoscópica. Se empleó el sistema ERBEJET con una cuchilla de tipo Hybrid knife, inyección salina con azul de metileno diluido al 0,04% sobre el margen distal, complementándose la inyección submucosa con ácido hialurónico al 0,4%. Se utilizó un "capuchón" o dispositivo plástico distal transparente recto para poder traccionar la lesión y permitir visualizar anterógradamente los márgenes de resección, incluso de la porción intraduodenal, permitiendo una adecuada disección submucosa. Luego de comprobar hemostasia se constató la resección en bloque. La histopatología mostró un adenocarcinoma tubular medianamente diferenciado con bordes quirúrgicos libres de lesión. Gracias a la estrategia de DSE utilizada, nuestro paciente pudo beneficiarse de la resección curativa de su cáncer gástrico con preservación del órgano y con perfecta funcionalidad. Este caso, el primero descrito en el país, muestra el avance de la endoscopía terapéutica nacional.

The endoscopic sumucosal disection (ESD) is an advanced endoscopic technique that achieves the curative resection of superficial neoplasms of the gastrointestinal tract, getting block exeresis with margins free of neoplasia avoiding surgery. However, tumors located in the esophagogastric junction, or pylorus, are technically more complex to resect by ESD. When a neoplasm settles in the pylorus, the anatomical characteristics of this region can affect the adequate assessment of the margins and the performance of the procedure. We present the case of a 70-year-old male patient who, in a high digestive endoscopy, showed a flat multilobulated lesion of 18 mm x 10 mm, located mostly in the lower 2 quadrants of the pyloric canal and minimal compromise of the upper-posterior quadrant, it mainly covers the gastric side of the pyloric channel and extends into the duodenum. Therefore, it was decided to perform en bloc resection of the lesion with the endoscopic submucosal dissection technique. The ERBEJET system was used with a knife type Hybrid knife, saline injection with methylene blue diluted 0.04% on the distal margin, submucosal injection being complemented with 0.4% hyaluronic acid. A "capsule" or straight transparent distal plastic device was used to be able to pull the lesion and allow anterograde visualization of the margins of resection, including the intraduodenal portion, allowing adequate submucosal dissection. Histopathology showed a moderately differentiated tubular adenocarcinoma with surgical edges free of injury. Thanks to the DSE strategy used, our patient could benefit from the curative resection of his gastric cancer with preservation of the organ and with perfect functionality. This case, the first described in the country, shows the progress of national therapeutic endoscopy.

[Endoscopic ultrasound drainage of a postoperative pancreatic fluid collection, a case report]. / Drenaje por endosonografía de colecciones pancreáticas, revisión de la literatura, a propósito de un caso clinico.

Postoperative pancreatic fluid collections (PPFC) occur in up to 30% of patients after they have undergone pancreatic resection. We report a case in which we used endoscopic ultrasound for drainage of a PPFC in a post Whipple surgery patient. A 48 year old man, who underwent a Whipple surgery for suspected pancreatic adenocarcinoma, after a torpid evolution in the postoperative period, is evaluated due to abdominal epigastric pain, evidencing on MRI a 10 x 7 cm fluid collection near the tail of the pancreas. Three weeks later he was admitted in the emergency department due to an increase in abdominal pain. He underwent an endoscopic ultrasound procedure for drainage of the collection into the gastric cavity. Endoscopic drainage of PPFCs is a therapeutic alternative that is new in our settings, safe, effective, and presents a lower morbi-mortality and a lower complication rate than that of conventional surgical drainage, as well as a faster recovery.

Drenaje por endosonografía de colecciones pancreáticas, revisión de la literatura, a propósito de un caso clínico / Endoscopic ultrasound drainage of a postoperative pancreatic fluid collection, a case report

Las colecciones de fluido pancreático postoperatorio (CPFP) ocurren en hasta un 30% de pacientes luego de haber sido sometidos a una resección quirúrgica pancreática. Nosotros reportamos un caso en el que se hizo uso del ultrasonido endoscópico para el drenaje de una CPFP en un paciente post operado de una cirugía de Whipple. Paciente hombre de 48 años pos operado de cirugía de Whipple por sospecha de adenocarcinoma pancreático, quien tras una evolución tórpida en su postoperatorio es evaluado por dolor abdominal epigástrico, evidenciándose en la resonancia magnética una colección de 10 x 7 cm ubicada cerca de la cola del páncreas. Tres semanas después ingresa por emergencia presentando dolor abdominal incrementado. Se decide realizar una eco-endoscopía para el drenaje de la colección hacia la cavidad gástrica. El drenaje endoscópico de las CPFP es una alternativa terapéutica nueva en nuestro medio, segura, eficaz, y que presenta una menor morbi-mortalidad y menor tasa de complicaciones que el drenaje quirúrgico convencional, además de una recuperación más rápida...

Postoperative pancreatic fluid collections (PPFC) occur in up to 30% of patients after they have undergone pancreatic resection. We report a case in which we used endoscopic ultrasound for drainage of a PPFC in a post Whipple surgery patient. A 48 year old man, who underwent a Whipple surgery for suspected pancreatic adenocarcinoma, after a torpid evolution in the postoperative period, is evaluated due to abdominal epigastric pain, evidencing on MRI a 10 x 7 cm fluid collection near the tail of the pancreas. Three weeks later he was admitted in the emergency department due to an increase in abdominal pain. He underwent an endoscopic ultrasound procedure for drainage of the collection into the gastric cavity. Endoscopic drainage of PPFCs is a therapeutic alternative that is new in our settings, safe, effective, and presents a lower morbi-mortality and a lower complication rate than that of conventional surgical drainage, as well as a faster recovery...