Gastric ischemia due to critical stenosis of the celiac trunk / Isquemia gástrica secundaria a estenosis crítica del tronco celíaco

Gastric ischemia (GI) results from diffuse or localized vascular insufficiency caused by different aetiologies such as systemic hypotension, vasculitis, disseminated thromboembolism and celiac or mesenteric stenosis. We present a case of gastric ischemia due to critical stenosis of the celiac artery treated using endovascular therapy. The celiac artery is the first major branch of the abdominal aorta and provides some of the blood supply to the stomach through the left gastric artery and other organs like the spleen (splenic artery branch) and the liver. Although the collateral blood supply to the stomach is protective, systemic hypotension or occlusion of the main arteries, as in the case of our patient, may result in gastric ischemia. The stent placement is an alternative to surgery in patients with high comorbidity and with good outcomes. The clinical awareness of this syndrome will allow gastroenterologists and radiologists to appropriately diagnose and manage affected patients (AU)

La isquemia gástrica resulta de la insuficiencia vascular difusa o localizada causada por diferentes etiologías como la hipotensión sistémica, la vasculitis, el tromboembolismo diseminado y la estenosis mesentérica o celíaca. Presentamos un caso de isquemia gástrica secundaria a estenosis crítica del tronco celíaco tratada endovascularmente. El tronco celíaco es la primera rama de la aorta abdominal y aporta gran parte del flujo de sangre al estómago a través de la arteria gástrica izquierda y de otros órganos como el bazo (a través de la rama esplénica) y el hígado. Aunque las colaterales que irrigan el estómago son protectoras, la hipotensión sistémica o la oclusión de las principales ramas como en el caso que presentamos, pueden llevar a la isquemia gástrica. La colocación de stents endovasculares es una alterativa terapéutica a la cirugía en pacientes con gran comorbilidad y con buenos resultados. La sospecha clínica de este síndrome puede llevar tanto a gastroenterólogos como a radiólogos a un correcto diagnóstico y tratamiento de los pacientes afectos (AU)

Gastric ischemia due to critical stenosis of the celiac trunk.

Gastric ischemia (GI) results from diffuse or localized vascular insufficiency caused by different aetiologies such as systemic hypotension, vasculitis, disseminated thromboembolism and celiac or mesenteric stenosis. We present a case of gastric ischemia due to critical stenosis of the celiac artery treated using endovascular therapy. The celiac artery is the first major branch of the abdominal aorta and provides some of the blood supply to the stomach through the left gastric artery and other organs like the spleen (splenic artery branch) and the liver. Although the collateral blood supply to the stomach is protective, systemic hypotension or occlusion of the main arteries, as in the case of our patient, may result in gastric ischemia. The stent placement is an alternative to surgery in patients with high comorbidity and with good outcomes. The clinical awareness of this syndrome will allow gastroenterologists and radiologists to appropriately diagnose and manage affected patients.

Esophageal lesions detected during small bowel capsule endoscopy : incidence, diagnostic and therapeutic impact.

BACKGROUND: Nowadays, capsule endoscopy is the first-line procedure for the visualization of the small bowel. Although it was primarily designed with this goal, it may also identify other segments of the gastrointestinal tract. The aim of the current study is to evaluate the incidence of esophageal abnormalities detected in patients undergoing small bowel capsule endoscopy and its impact on patient management. PATIENTS AND METHODS: This study is a retrospective analysis of data from 2217 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between January 2008 and February 2016. Patient baseline characteristics, esophageal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was then performed. RESULTS: 2217 patients were finally included in the analysis. 1070 were male (48.2%) and the mean age was 56.1 ± 19.5 years (12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Esophageal abnormalities were detected in 105 out of 2217 patients (4.7%). The most common lesions detected were peptic esophagitis (58.1%) and esophageal varices (17.1%). This information had a clinical/diagnostic impact of 3.3% and a therapeutic impact of 3.2%. CONCLUSION: Capsule endoscopy detects not only small bowel lesions, but also significant esophageal lesions that may be overlooked during initial gastroscopy. Therefore, all images of the esophagus should be read during small bowel capsule endoscopy, since it could provide relevant information that may result in changes on patient´s management.

[Non-small bowel lesions detected with capsule endoscopy in patients with obscure gastrointestinal bleeding]. / Detección de lesiones fuera del intestino delgado con cápsula endoscópica en pacientes con hemorragia digestiva oculta.

Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule en-doscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. Howe-ver, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST.

Detección de lesiones fuera del intestino delgado con cápsula endoscópica en pacientes con hemorragia digestiva oculta / Non-small bowel lesions detected with capsule endoscopy in patients with obscure gastrointestinal bleeding

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica (AU)

Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule endoscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. However, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST (AU)