Capsule endoscopy for the study of small bowel disorders: Experience at a private institution in Mexico. / Cápsula endoscópica para el estudio de patologías de intestino delgado: experiencia en una institución privada en México.

INTRODUCTION AND AIMS: Capsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders. MATERIAL AND METHODS: A retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined. RESULTS: A total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously. CONCLUSIONS: The frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar.

Endoscopic biliary large-balloon dilation after endoscopic sphincterotomy for the treatment of large common bile duct stones. Case report.

Common bile duct (CBD) stones extraction is usually performed by endoscopic sphincterotomy followed by removal by either a Dormia basket or extraction balloon catheter. However, some stones due to their size are not amenable to these procedures and extracorporeal or mechanical lithotripsy devices need to be used. Mechanical lithotripsy involves usage of a basket that will be inevitably destroyed which increases cost to the patient and endoscopy unit. The use of extracorporeal wave shock lithotripsy is an alternative; however it is not available widely. Reports about the use of hydrostatic large caliber balloon dilator (HLCBD) aiding in the extraction of large caliber CBD stones have concluded that is a safe and feasible therapeutic alternative. We present the case of a 25 mm x 30 mm CBD stone that could not be extracted using conventional methods. CBD dilation using HLCBD was performed after endoscopic sphincterotomy in an attempt to avoid mechanical lithotripsy.

[Endoscopic resection of ampullary adenoma.]. / Resección endoscópica de adenoma del ámpula de Vater.

Ampullary adenomas can occur sporadically or as part of familial adenomatous polyposis syndrome. Most of them are asymptomatic. Current standard of management is complete surgical or endoscopic resection, depending on depth of invasion and/or biliary tract involvement. The last can be established by endoscopic ultrasound or endoscopic retrograde colangiopancreatography. Surgical resection has high morbidity (25% to 65%) and mortality (10%) in unexperienced hands compared to endoscopic therapy (12% and 1%, respectively). Complications of endoscopic therapy ranges from 7% to 10%. Recurrence of adenomatous lesions treated endoscopically is 30%. Endoscopic surveillance after resection is mandatory. We present the case of a patient with an ampulla of Vater s adenoma successfully resected endoscopically previous assessment of the lesion by endoscopic ultrasound.

Outcomes of temporary self-expanding plastic stents (SEPS) use for gastrointestinal leaks. A case series.

INTRODUCTION: Gastrointestinal fistulas can develop as a complication of any gastrointestinal surgery, trauma, malignant disease, radiotherapy or because of iatrogenic procedures. The use of self expandable metallic stents (SEMS) has been reported as a feasible and effective therapeutic method. Self expandable plastic stents (SEPS) have been successfully used to treat esophageal malignancies, perforations and leaks but information regarding outcomes of SEPS in gastrointestinal leaks is scarce. OBJECTIVE: To report the outcomes and complications of endotherapy using SEPS in upper gastrointestinal tract fistulas following gastrointestinal surgery. MATERIAL AND METHODS: Retrospective review of 5 cases of upper gastrointestinal leaks treated with SEPS. Medical records were reviewed to obtained patients demographics, procedure success, complications and follow up. RESULTS: We described 2 women and 3 men with an age ranged between 29 and 65 years old. SEPS were left in place for a median period of 90 days (range: 30-279 days). There were no complications related to SEPS placement, replacement or withdrawal. Fistulas closed in 60% of the cases where SEPS were the only therapeutic maneuver and in more than 80% when other therapy (cyanoacrilate, fibrin) was used. CONCLUSIONS: Endotherapy with SEPS appears as a feasible, safe and effective option for sealing gastrointestinal fistulas.

[Endoscopic mucosal resection due to adenocarcinoma of the esophagus caused by Barrett's esophagus.]. / Resección endoscópica de la mucosa debido a adenocarcinoma de esófago originado en un esófago de Barrett.

The endoscopic therapy has been used in the treatment of early stage neoplastic esophageal lesions with great success. The endoscopic ultrasound is a useful tool for the correct staging of these lesions. The staging accuracy of esophageal cancer with endoscopic ultrasound reaches 80% for T stage and 77% for N stage. The endoscopic approach provides complete resection of lesions confined to the mucosal layer, is a safety procedure with complications reported to occur from 3% to 13%. The morbidity and mortality rates after an endoscopic mucosal resection have been reported to be less than those posterior to esophagectomy. We present a case of a patient with high surgical risk, who underwent an upper endoscopy because of long history of gastroesophageal reflux disease and uncontrollable hiccup with successful endoscopic mucosal resection with plastic cap and polipectomy loop of an early stage esophageal adenocarcinoma derived of Barrett s esophagus.

[Comparative study of the use of sennoside A and B vs polyethylene glycol and electrolytes in anterograde preparation of the colon]. / Estudio comparativo del uso de senósidos A y B vs solución de polietilenglicol y electrólitos en la preparación anterógrada de colon.

OBJECTIVE: Compare effectiveness of antegrade bowel preparation by liquid diet, polyethylenglycol (PEG) and electrolytes solution plus sennosides A and B, vs. liquid diet plus sennosides A and B only. BACKGROUND DATA: Preparation for colonoscopy with a balanced solution (PEG and electrolytes) has some physiological advantages. Nonetheless, drawbacks of such preparation include nasty flavor, large volumes and low availability in our country. METHOD: A randomized, comparative, prospective, transversal and blind trial that included 200 patients scheduled for colonoscopy were randomly assigned (one hundred each group) to receive: group 1: liquid diet, sennosides A and B and a two litter of solution with PEG and electrolytes; and group 2: liquid diet plus sennosides A and B. Compliance, tolerance and effectiveness of both preparations were evaluated blindly. The results were assessed by Student's T test. RESULTS: The effectiveness of group 2 preparation proved superior (p < 0.05) to group 1. Tolerance and side effects were similar for both groups with no related complications.

[Long-term usefulness and late complications of percutaneous endoscopic gastrostomy]. / Utilidad a largo plazo y complicaciones tardías de la gastrostomía endoscópica percutánea.

OBJECTIVE: To investigate the usefulness of endoscopic gastrostomy and long-term complications. BACKGROUND DATA: Endoscopic gastrostomy is well established as the procedure of choice for long-term feeding, given the low morbidity-mortality and ease of placement. METHOD: We evaluated retrospectively one hundred endoscopically placed gastrostomy feeding tubes and complications occurring more than 30 days after placement were recorded. RESULTS: Gastrostomy feeding tubes remained in place for a mean of 92 days (range 30-547 days). Fifteen percent developed evident gastroesophageal reflux, two patients developed aspiration pneumonia and one presented with infection at the site of gastrostomy. Our long-term complications rate thus was 3.0% and 0% mortality. CONCLUSIONS: Our experience suggests that endoscopic gastrostomy is a relatively simple procedure, associated with very low morbidity and mortality. It is the procedure of choice in patients requiring long-term enteral nutrition.

[Early detection of adenomas in asymptomatic subjects: flexible sigmoidoscopy or colonoscopy]. / Detección temprana de adenomas en sujetos asintomáticos: sigmoidoscopia flexible o colonoscopia?

OBJECTIVE: The aim of this study was to determine the frequency of adenomas as well as sensitivity, specificity, positive and negative predictive values of FS for polyp screening in two groups of asymptomatic individuals using colonoscopy (CP) as the gold standard. BACKGROUND: Flexible sigmoidoscopy (FS) is the screening procedure of choice for polyps and colorectal carcinoma (CRC) in asymptomatic individuals. However, the validity of this approach has been questioned, specially in subjects with a family history of CRC. METHODS: A total of 92 asymptomatic individuals were included in two groups: group A: with a family history (1st or 2nd degree relatives) of polyps or CRC (fifty-eight), and group B: without a family history and > 50 years (thirty-four). FS was simulated with the videocolonoscope until 60 cm, and was continued into the cecum. The number, type and localization of polyps were noted for each, FS and CP. The values mentioned previously were calculated according to established formulas. Comparisons were performed using Chi square test. RESULTS: Adenomas were found in twenty individuals in group A (34.4%) and 7 in group B (20.5%), p = NS. Sensitivity for FS in group A was 42% vs 71% in group B, with a negative predictive value of 44.5 and 93%, respectively. CONCLUSION: Colonoscopy is probably the screening procedure of choice in individuals with a family history of polyps or CRC. The utility of FS for screening purposes in asymptomatic individuals without a family history seems adequate, although more studies are required in different populations in our country.

[Endoscopic resolution of acute dilatation of the colon secondary to edema of colonic anastomosis]. / Resolución endoscópia de la dilatación aguda de colon secudaria a edema de anastomosis colónica.

Acute colonic dilation due to anastomotic edema is rare and is not always solved with conservative treatment. Endoscopic colonic decompression was carried out in 3 patients completing the procedure with a transrectal drainage. No complications resulted from the procedure and all 3 patients did well, once motility was re-established.

[Endoscopic decompression of the biliary tract]. / Descompresión endoscópica de la vía biliar.

A technical review is done about different approaches in endoscopic management of biliary tract decompression, with emphasis in the state of the art points who allows this goal. Mention is done in nasobiliary drainage, endoprosthesis and pneumatic dilation.