Endoscopic mucosal resection with a multiband ligator for the treatment of Barrett s high-grade dysplasia and early gastric cancer.

AIM: Due to surgery s high mortality and morbidity, local therapeutic techniques are required for Barrett s high-grade dysplasia (BHGD) and early gastric cancer (EGC). Various techniques are available for endoscopic mucosal resection (EMR) in the GI tract. The " suck and cut technique, which uses a transparent cap or modified multiband variceal ligator, is usually the most practiced method. A multiband ligator (ML) allows sequential resection without the need for submucosal injection and endoscope withdrawal. The objective of this study was to evaluate the efficacy and safety of EMR with a ML device in the treatment of Barrett s high-grade dysplasia and early gastric cancer. PATIENTS AND METHODS: Prospective study. Eight consecutive patients (4 men; median age, 62 years; range 38-89 years) with BHGD (4) or EGC (4) were treated. EMR was performed with a multiband ligator in order to create a pseudopolyp and then permit snare polypectomy of flat mucosal lesions. The pseudopolyp was resected by using pure coagulating current. No submucosal saline injection was administered before resection. RESULTS: A total of 8 consecutive patients were treated with the multiband ligator (ML) technique. Barrett s esophagus (BE): one patient with long BE received 3 EMR sessions. Three patients presented with short BE and received 1 EMR session each. The histology of the EMR specimens confirmed a moderately differentiated adenocarcinoma with submucosal infiltration (1 patient) and BHGD (3 patients). Early gastric cancer (EGC): 3 patients had EGC (type IIa) and 1 patient had high-grade dysplasia. EMR was accomplished in 1 session for each patient. The histology of EMR specimens confirmed a mucinous adenocarcinoma with submucosal infiltration (1 patient), EGC (2 patients), and HGD (1 patient). Complications (mild esophageal stenosis, minor bleeding) occurred in 2 patients. CONCLUSIONS: EMR has diagnostic and therapeutic implications, and represents a superior diagnostic modality as compared to traditional biopsy. By means of EMR the resected mucosa is pathologically examined, and the lesion may be appropriately treated. EMR-ML is a safe and effective technique for the treatment of superficial lesions of the digestive tract, and is accepted as an alternative to surgical therapy for non-invasive lesions. Long-term follow-up is needed to determine the clinical impact of this method.

Endoscopic mucosal resection with a multiband ligator for the treatment of Barrett’s high-grade dysplasia and early gastric cancer

Aim: due to surgery´s high mortality and morbidity, local therapeutictechniques are required for Barrett’s high-grade dysplasia(BHGD) and early gastric cancer (EGC). Various techniques areavailable for endoscopic mucosal resection (EMR) in the GI tract.The ‘’suck and cut’’ technique, which uses a transparent cap ormodified multiband variceal ligator, is usually the most practicedmethod. A multiband ligator (ML) allows sequential resection withoutthe need for submucosal injection and endoscope withdrawal.The objective of this study was to evaluate the efficacy and safetyof EMR with a ML device in the treatment of Barrett’s high-gradedysplasia and early gastric cancer.Patients and methods: prospective study. Eight consecutivepatients (4 men; median age, 62 years; range 38-89 years) withBHGD (4) or EGC (4) were treated. EMR was performed with amultiband ligator in order to create a pseudopolyp and then permitsnare polypectomy of flat mucosal lesions. The pseudopolypwas resected by using pure coagulating current. No submucosalsaline injection was administered before resection.Results: a total of 8 consecutive patients were treated withthe multiband ligator (ML) technique. Barrett’s esophagus (BE):one patient with long BE received 3 EMR sessions. Three patientspresented with short BE and received 1 EMR session each. Thehistology of the EMR specimens confirmed a moderately differentiatedadenocarcinoma with submucosal infiltration (1 patient) andBHGD (3 patients). Early gastric cancer (EGC): 3 patients hadEGC (type IIa) and 1 patient had high-grade dysplasia. EMR wasaccomplished in 1 session for each patient. The histology of EMRspecimens confirmed a mucinous adenocarcinoma with submucosalinfiltration (1 patient), EGC (2 patients), and HGD (1 patient).Complications (mild esophageal stenosis, minor bleeding)occurred in 2 patients...(AU)

Dilatación de la papila de Vater con balón de gran diámetro para la extracción de coledocolitiasis / No disponible

Objetivo: valorar la eficacia y seguridad de la dilatación de lapapila de Vater con balones de gran diámetro (BGD) para la extracciónde coledocolitiasis en pacientes con factores que dificultano hacen peligrosa la extracción, por las características de loscálculos o de la anatomía peripapilar.Diseño: prospectivo.Pacientes: estudio que incluye 93 pacientes a los que se realizódilatación hidrostática de la papila con balones de gran diámetroentre junio de 2005 y enero de 2008 por presentar cálculosde gran tamaño, múltiples, colédoco distal afilado, papila peri/intradiverticular,esfinterotomía previa o Billroth-II. Se emplearondilatadores CRE de diámetros entre 12 y 20 mm.Resultados: se consiguió la extracción de los cálculos en unasesión en todos los pacientes (100%). La mayor parte de las exploraciones(86%) no requirieron tiempos prolongados para la extracción.Se precisó litotricia en el 3,2%. Hubo dos complicacionesleves (2,1%). Se detectó hiperamilasemia en el 16% de lospacientes.Conclusiones: la dilatación de la papila de Vater con balónde gran diámetro es una técnica eficaz y segura en la extracciónde cálculos difíciles de la vía biliar, sin incrementar el tiempo de laexploración, ni las complicaciones, evitando la necesidad de litotriciaen la mayoría de los pacientes

Aim: to assess the efficacy and safety of dilatation of the papillaof Vater with large balloons for the treatment of choledocolithiasisin patients with difficult or risky extraction due to stone characteristicsor peripapillary anatomy.Design: prospective.Patients: this study includes 93 patients in whom large-balloondilation was performed between June 2005 and January2008. Patients had multiple large stones, tapered distal CBD(common bile duct), peri-/intra-diverticular papilla, and previoussphincterotomy or Billroth-II surgery. A controlled radial expansion(CRE) balloon with a diameter range of 12-20 mm was used.Results: stone removal was achieved in a single session in allpatients (100 %). Most procedures (86%) did not require an extendedexploration time. Mechanical lithotripsy was needed in 3.2% of cases. There were two mild complications (2.1%). Hyperamilasemiawas detected in 16% of patients.Conclusions: papillary dilation with a large balloon is an effective,safe, and easy technique for the retrieval of difficult commonbile-duct stones. The procedure neither adds time to the exploration,nor increases complications, and obviates the need formechanical lithotripsy in a majority of patients

Los campos magnéticos de baja amplitud y de frecuencia extremadamente baja para el tratamiento de la gonalgia crónica / Low amplitude and extremely low frequency magnetic fields for the treatment of the chronic knee pain

Introducción. El objetivo de este estudio esevaluar los efectos de la resonancia magnética terapéutica (RMT) en pacientes con gonalgia crónica, mediante valoraciones pre y postratamiento inmediato (durante el primer mes tras finalizado el tratamiento), así como a los 3 y a los 6 meses de finalizado éste; y compararlo con una serie de pacientes tratados con RMT placebo (RMTp).Material y método. Se trata de un estudio prospectivo, doble ciego. Se evaluaron 120 rodillas (20 placebo) correspondientes a 105 pacientes con gonalgia crónica. Las patologías principales fueron: artrosis primarias, artrosis secundarias y condropatías. El protocolo terapéutico consistió en 6 sesiones de 60 minutos, a días alternos.Las valoraciones de la evolución clínica y funcional se hicieron mediante la escala Womac, el índice de Lequesne y el grado subjetivo de mejoría del dolor mediante la escala visual analógica.Resultados. Se registró una diferencia significativa (p < 0,0001) entre el grupo tratado con RMT y el grupo con RMTp. El estudio entre las diferentes patologías con las tres escalas de valoración mostró diferencias significativas (p < 0,005) entre las valoraciones pretratamiento y las postratamiento inmediato(durante el primer mes), a los 3 y 6 meses en los pacientes tratados con RMT en las diferentes patologías, más significativamente a favor de las artrosis primarias.Conclusiones. Según estos resultados, la RMT constituye un método eficaz de tratamiento frente al dolor y las alteraciones funcionales en las gonalgias crónicas

Introduction. The study has aimed to evaluatethe effects of the magnetic resonance therapeutic (MRT)in the chronic knee pain, by means of pre-treatment andpost-treatment evaluations (during the first month at theend of treatment) and at 3 and 6 months of its end and tocompare it with a placebo treated patient series (MRTp).Material and methods. A total of 120 knees (20 placebo)corresponding to 105 patients with chronic knee pain wereevaluated in a prospective, double blind study. The main conditions were: primary arthrosis, secondary arthrosis and chondropathies. The therapeutic protocol was 6 sessions of 60 minutes, on alternative days. The evaluations of the clinical and functional course were performed with the Womac scale, Lequesne index and subjective grade of pain improvement with the visual analogue scale.Results. Significant difference (p < 0.0001) between thegroup treated with MRT and the MRTp group. The study onthe different diseases, with the three evaluation scalesshowed significant differences (p < 0.005) among thepre-treatment evaluations with the immediate post-treatment (during the first month), at 3 and 6 months, in the MRT treated patients in the different diseases, more significantly in favor of the primary arthrosis.Conclusions. According to these results, MRT is an efficient method of treatment for pain and functional disorders in chronic knee pain

[Large balloon dilation for removal of bile duct stones]. / Dilatación de la papila de Vater con balón de gran diámetro para la extracción de coledocolitiasis.

AIM: To assess the efficacy and safety of dilatation of the papilla of Vater with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy. DESIGN: Prospective. PATIENTS: This study includes 93 patients in whom large-balloon dilation was performed between June 2005 and January 2008. Patients had multiple large stones, tapered distal CBD (common bile duct), peri-/intra-diverticular papilla, and previous sphincterotomy or Billroth-II surgery. A controlled radial expansion (CRE) balloon with a diameter range of 12-20 mm was used. RESULTS: Stone removal was achieved in a single session in all patients (100 %). Most procedures (86%) did not require an extended exploration time. Mechanical lithotripsy was needed in 3.2 % of cases. There were two mild complications (2.1%). Hyperamilasemia was detected in 16% of patients. CONCLUSIONS: Papillary dilation with a large balloon is an effective, safe, and easy technique for the retrieval of difficult common bile-duct stones. The procedure neither adds time to the exploration, nor increases complications, and obviates the need for mechanical lithotripsy in a majority of patients.

[Large hydrostatic balloon for choledocolithiasis]. / Balón hidrostático de gran diámetro en coledocolitiasis.

AIM: To assess the efficacy and safety of hydrostatic dilatation with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy. DESIGN: Prospective. PATIENTS: This study included 22 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2005 and April 2006. Patients had multiple large stones, tapered distal common bile duct, peri-/intradiverticular papilla, previous sphincterotomy, or Billroth-II surgery. Esophageal, pyloric and colonic CRE dilatation balloons with diameters ranging from 12 to 20 mm (Boston Scientific Corporation) were used. RESULTS: Stone removal was achieved in a single session in all patients (100%). Most procedures (73%) did not require an extended exploration time. There were no complications. Hyperamilasemia was detected in 18% of patients. CONCLUSIONS: Hydrostatic papillary dilatation with large balloons is a simple, effective, and safe technique for the removal of difficult stones located in the distal common bile duct. It does not add to exploration time, nor increases complications, and reduces the need for lithotripsy. Further studies are needed to define the usefulness of this technique.

Balón hidrostático de gran diámetro en coledocolitiasis / Large hydrostatic balloon for choledocolithiasis

Objetivo: valorar la eficacia y seguridad de la dilatación hidrostática con balones de gran diámetro en el tratamiento de la coledocolitiasis en pacientes con factores que dificultan o hacen peligrosa la extracción, por las características de los cálculos o de la anatomía peripapilar. Diseño: prospectivo. Pacientes: estudio que incluye 22 pacientes a los que se realizó dilatación hidrostática de la papila con balones de gran diámetro entre junio de 2005 y abril de 2006 por presentar cálculos de gran tamaño, múltiples, colédoco distal afilado, papila peri-/intradiverticular, esfinterotomía previa o Billroth-II. Se emplearon dilatadores CRE de esófago, píloro y colon (Boston Scientific Corporation) de diámetros entre 12 y 20 mm. Resultados: se consiguió la extracción de los cálculos en una sesión en todos los pacientes (100%). La mayor parte de las exploraciones (73%) no requirieron tiempos prolongados para la extracción. No hubo complicaciones. Se detectó hiperamilasemia en el 18% de los pacientes. Conclusiones: la dilatación hidrostática de la papila con balones de gran diámetro es una técnica sencilla, eficaz y segura en la extracción de cálculos difíciles de la vía biliar, sin incrementar el tiempo de la exploración, ni las complicaciones, reduciendo la necesidad de litotricia. Son necesarios estudios adicionales para definir la utilidad de esta técnica

Aim: to assess the efficacy and safety of hydrostatic dilatation with large balloons for the treatment of choledocolithiasis in patients with difficult or risky extraction due to stone characteristics or peripapillary anatomy. Design: prospective. Patients: this study included 22 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2005 and April 2006. Patients had multiple large stones, tapered distal common bile duct, peri-/intradiverticular papilla, previous sphincterotomy, or Billroth-II surgery. Esophageal, pyloric and colonic CRE dilatation balloons with diameters ranging from 12 to 20 mm (Boston Scientific Corporation) were used. Results: stone removal was achieved in a single session in all patients (100%). Most procedures (73%) did not require an extended exploration time. There were no complications. Hyperamilasemia was detected in 18% of patients. Conclusions: hydrostatic papillary dilatation with large balloons is a simple, effective, and safe technique for the removal of difficult stones located in the distal common bile duct. It does not add to exploration time, nor increases complications, and reduces the need for lithotripsy. Further studies are needed to define the usefulness of this technique

Enfermedad de Tangier: apariencia gástrica endoscópica / Gastric mucosa appearance in a patient with Tangier disease

No disponible

No disponible

Tratamiento ortopédico de la escoliosis idiopática del adolescente: revisión de los distintos corsés / Orthopedic treatment of adolescent idiopathic scoliosis: review of the different corsets

Hacemos una revisión bibliográfica de una selección de artículos publicados que se refieren al tratamiento ortopédico de la escoliosis idiopática del adolescente. Resumimos estos trabajos y extraemos unas conclusiones. Pensamos que este trabajo puede ser de ayuda a la hora de afrontar la actitud terapéutica conservadora de la escoliosis idiopática del adolescente

A bibliographic review of the selection of articles published that refer to orthopedic treatment of Adolescent Idiopathic Scoliosis has been performed. These works are summarized and conclusions are drawn. We consider that this work may be useful in the conservative therapeutic attitude of Adolescent Idiopathic Scoliosis

Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation.

BACKGROUND: Malignant gastrointestinal obstruction is a secondary complication of cancers in an advanced state. Treatment has consisted of gastrojejunostomy. However, the endoscopic placement of metallic stents has provided positive results. This study aimed to compare the efficiency of both therapeutic options. METHODS: A total of 41 patients with gastrointestinal obstruction caused by inoperable neoplasm were treated endoscopically with enteral stent (24 patients) or gastrojejunostomy (17 patients). RESULTS: In the endoscopic group (EG) 24 patients (100%) achieved efficient gastric emptying, as compared with 82.3% in the surgical group (SG). The difference was not significant. The average time for initiating oral food tolerance was 2.4 days for the EG and 5 days for the SG (p < 0.001). The average inpatient time was 7.1 days for the EG and 11.5 days for the SG (p < 0.001). Mortality at 30 days was lower in the EG (16.6%) than in the SG (29.4%) (p < 0.05). The survival time was 20 weeks for the EG and 21.6 weeks for the SG. The difference was not significant. The rate of complications was 4% in the (EG) and 17.6% in the (SG), with the difference was not significant. CONCLUSION: Endoscopic treatment of malignant gastrointestinal obstruction provides an adequate palliation of the symptoms. It is less invasive, avoids the morbidity associated with open gastrojejunostomy, and achieves a faster start to oral food and a shorter hospital stay, leading to a higher quality of life.