Utilidad de la ecoendoscopia para la resección endoscópica de los tumores carcinoides duodenales / Utility of echoendoscopy for endoscopic resection of duodenal carcinoid tumors

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Role of stationary esophageal manometry in clinical practice. Manometric results in patients with gastroesophageal reflux, dysphagia or non-cardiac chest pain.

The present study was carried out to evaluate the diagnostic usefulness of stationary esophageal manometry in 263 patients divided into three groups: 150 patients with reflux symptoms, 68 with dysphagia, and 45 with non-cardiac chest pain. Patients with endoscopic abnormalities were excluded. Standard manometry was performed following the station pull-through technique. In the group of patients with reflux symptoms 40.7% had a normal manometry and 57.3% had abnormalities, being the most frequent (43%) hypotensive lower esophageal sphincter. In the dysphagia group, 20.6% of manometries were normal and 79.4% were abnormal, of which achalasia was the most frequent disorder (53.7%). In the case of non-cardiac chest pain, 42.2% of patients had a normal manometry and 57.8% an abnormal one, of which hypotensive lower esophageal sphincter was the most frequent abnormality. A significant higher proportion of manometric alterations were found in the dysphagia group compared to reflux symptoms and non-cardiac chest pain (p < 0.05). No statistical differences were found between the reflux and the non-cardiac chest pain groups. Manometry yields a higher diagnostic value in patients with dysphagia, and therefore manometry should be performed routinely after the exclusion of any organic esophageal disease. Manometry is not a first-choice functional diagnostic test in the study of patirnts with gastroesophageal reflux or non-cardiac chest pain.

Papel de la manometría esofágica estacionaria en la práctica clínica. Resultados manométricos en pacientes con reflujo gastroesofágico, disfagia y dolor torácico no cardiaco / Role of stationary esophageal manometry in clinical practice. Manometric results in patients with gastroesophageal reflux, dysphagia or non-cardiac chest pain

El presente estudio ha sido realizado para evaluar la utilidad diagnóstica de la manometría esofágica estacionaria en 263 pacientes divididos en 3 grupos: 150 pacientes con síntomas de reflujo gastroesofágico, 68 con disfagia y 45 con dolor torácico no cardiaco. Se excluyeron los pacientes con alteraciones endoscópicas. La manometría se realizó según la técnica de retirada estacionaria. Entre los pacientes con síntomas de reflujo gastroesofágico, el 40,7 por ciento tuvieron una manometría normal y el 57,3 por ciento presentaron alteraciones, siendo la presencia de un esfínter esofágico inferior hipotenso la alteración más frecuente (43 por ciento). En el grupo de disfagia, el 20,6 por ciento de las manometrías fueron normales y el 79,4 por ciento anormales, siendo la achalasia el trastorno motor más frecuente (53,7 por ciento). En el grupo con dolor torácico no cardiaco, el 42,2 por ciento de los pacientes tuvieron manometría normal y el 57,8 por ciento anormal, siendo esfínter esofágico inferior hipotenso la alteración más frecuente. Se encontró mayor proporción de alteraciones manométricas en el grupo de disfagia comparado con el de reflujo y con el de dolor torácico no cardiaco (p < 0,05). No se encontraron diferencias estadísticamente significativas entre el grupo con reflujo y dolor torácico no cardiaco. La manometría tiene un mayor valor diagnóstico en el grupo de pacientes con disfagia y, por lo tanto, debería de realizarse de forma rutinaria tras excluir una enfermedad orgánica esofágica. La manometría no es la primera opción diagnóstica funcional para estudiar reflujo gastroesofágico o dolor torácico no cardiaco (AU)

[Angina-like chest pain due to gastric anisakiasis]. / Dolor torácico como manifestación inicial de anisakiasis gástrica.

The chest pain is one of the most common reasons for consultation of the patients seen in the emergency services of hospitals. Still being the acute coronary syndrome one of the first causes to confirmed by its important repercussions, we do not have to forget other reasons. We report a case of acute anginalike chest pain due to gastric anisakiasis. The larvae of Anisakis in the gastric mucosa were found and extracted endoscopically. Gastric anisakiasis should be included in the differential diagnosis of acute chest pain.

Dolor torácico anginoso como manifestación inicial de anisakiasis gástrica / Anginalike chest pain due to gastric anisakiasis

El dolor torácico es una de las patologías que con mayor frecuencia se atienden en los servicios de urgencia hospitalarios. Aún siendo el síndrome coronario agudo una de las primeras causas a descartar por sus importantes repercusiones, no debemos descuidar otras etiologías. Presentamos un caso de un dolor torácico de características anginosas secundario a anisakiasis gástrica. La larva del anisakis en la mucosa gástrica fue encontrada y extraída endoscópicamente. La anisakiasis gástrica debería ser incluido en el diagnóstico diferencial de un dolor torácico (AU)

[Recurrent ascites in peritoneal mesothelioma. Its diagnostic and therapeutic management]. / Ascitis recidivante en el mesotelioma peritoneal. Manejo diagnóstico y terapéutico.

Peritoneal mesothelioma is an uncommon neoplasm often related to previous asbestos exposure. It is necessary to exclude other secondary peritoneal neoplasm. The application of immunohistochemical analysis in the biopsy sample is important for establishing an accurate diagnosis. We report the case of a peritoneal mesothelioma that started as a haemorrhagic ascites. After laparotomy, the initial diagnosis was peritoneal carcinomatosis from adenocarcinoma of unknown origin. The diagnosis was obtained by using immunohistochemical analysis: vimentin and keratine antibodies were positive and leu M1, antibodies were negative. The interest of our case resides in the difficulty for obtaining the diagnosis and the complicate management of refractory ascites. Our patient required intraperitoneal 5-fluorouracil for controlling the ascites.

[Digestive hemorrhage caused by duodenal ectopic pancreas and diffuse angiodysplasia of the colon]. / Hemorragia digestiva por páncreas ectópico duodenal y angiodisplasia difusa de colon.

We present the case of a 79-years-old male with episodes of digestive bleeding in the form of melenas in which two pathological findings were observed as potential causes: ectopic pancreas in subpyloric position and diffuse colon angiodysplasia. The difficult management of the digestive bleeding when two lesions are associated as potential causes is stressed.