What Is the Value of the Learning Curve in Endoscopic Balloon Dilatation of the Major Papilla?

INTRODUCTION: Endoscopic papillary large balloon dilatation (EPLBD) is an alternative for the treatment of common bile duct (CBD) stones. Existing evidence of factors associated with its outcomes is contradictory. OBJECTIVE: To identify predictors (including the experience of an endoscopist) of success and adverse events in EPLBD. METHODS: We reviewed the first 200 EPLBD with endoscopic sphincterotomy (EST) performed at our center. Demographic, clinical, and anatomic variables were studied, as well as the performance characteristics, correlating them with individual and group experience. RESULTS: Global success was obtained in 87% of cases, and adverse events occurred in 16% of cases. Success was associated with stone size, CBD diameter, and the need to perform mechanical lithotripsy (ML). Despite that adverse events were not univariately associated with any factor, severe adverse events were more likely to occur in stones > 13.5 mm. Multivariate analysis which disclosed success was higher when ML was not required and stones were < 13.5 mm. It also showed that no factor was associated with adverse events or their severity. No differences were found on success or adverse events that could be directly related to experience. CONCLUSIONS: Success of EPLBD-EST is higher in stones < 13.5 mm and when ML is not required. Experience does not appear to play a major role.

Ulcerated submucosal gastric tumor. Could it be a benign condition?

In this article we present the case and images of an infrequent submucosal gastric tumor: an inflammatory fibroid polyp or Vanek´s tumor. When the tumor size exceeds the centimeter, it may be difficult to differentiate from malignant lesions. Endoscopic removal may be feasible and curative.

Tumoración gástrica submucosa ulcerada. ¿Puede ser algo benigno? / Ulcerated submucosal gastric tumor. Could it be a benign condition?

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Una causa infrecuente de obstrucción gástrica: síndrome de Bouveret / An uncommon cause of gastric outlet obstruction: Bouveret's syndrome

El síndrome de Bouveret (SB) es un tipo infrecuente de íleo biliar consistente en una obstrucción gastroduodenal secundaria al paso de cálculos desde la vesícula biliar al duodeno, a través de una fístula colecisto o coledocogastroduodenal. La primera descripción de este síndrome la realizó en 1896 León Bouveret. Desde esta época se han descrito en la literatura médica poco más de 200 casos. Si bien la mortalidad del cuadro se establece en un 25%, el pronóstico viene determinado por la comorbilidad, la edad avanzada y el retraso en el diagnóstico. Para llegar al diagnóstico suelen precisarse tanto técnicas radiológicas (radiografía simple, ecografía, tomografía computarizada o resonancia magnética) como endoscópicas. Se debe intentar siempre el tratamiento endoscópico, aunque es muy frecuente que éste sea fallido y sea preciso recurrir al tratamiento quirúrgico. Presentamos el caso de un paciente que consultó por la aparición de vómitos pospandriales y epigastralgia. A continuación discutimos el manejo diagnóstico y terapéutico de esta infrecuente causa de obstrucción gástrica

Bouveret’s syndrome is a rare type of gallstone ileus inwhich a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, aswell as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopictechniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed (AU)

[A rare cause of gastric outlet obstruction: Bouveret's syndrome]. / Una causa infrecuente de obstrucción gástrica: síndrome de Bouveret.

Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.