A rare complication of jejunal extension of a percutaneous endoscopic gastrostomy tube for levodopa-carbidopa intestinal gel administration.

Direct intestinal administration of levodopa-carbidopa gel has shown good results in selected patients with Parkinson's disease (1, 2). We want to present a complication related to the device necessary for the administration of this drug. A 58-year-old man, diagnosed with Parkinson's disease, treated for six months with levodopa-carbidopa intestinal gel, administered through a percutaneous endoscopic gastrostomy (PEG) tube with jejunal extension, presented at the emergency department for abdominal pain. The patient complained abdominal discomfort that lasted two months. It was described as pain around the umbilical area that radiated to the left lumbar region, worsened after ingestion, and did not subside with conventional analgesia.

Brunneroma: an infrequent duodenal neoplasm.

An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests showed no remarkable findings. Upper endoscopy revealed a sessile lesion (Paris 0-IIa) in the anterior wall of the duodenal bulb, with smooth surface and slightly ulcerated at the top.

Lesión acral como primera manifestación de un adenocarcinoma de colon metastásico / Acral injury as first manifestation of a metastatic adenocarcinoma of the colon

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Criterios estándar versus clasificación de Rosemont para el diagnóstico ecoendoscópico de pancreatitis crónica / Standard criteria versus Rosemont classification for EUS-diagnosis of chronic pancreatitis

Objetivo: analizar las posibles diferencias en el diagnóstico final de pancreatitis crónica empleando los criterios estándar descritos por Wiersema y cols. y la nueva clasificación propuesta recientemente en Rosemont. Material y métodos: se incluyen 47 pacientes con diagnóstico de pancreatitis crónica. Se estudian los criterios parenquimatosos y ductales, dividiendo a los pacientes en 2 grupos según los criterios de Wiersema: < 4 criterios, no diagnóstico de pancreatitis crónica, >= 4 criterios, diagnóstico de pancreatitis crónica. Se estudiaron nuevamente dichos pacientes aplicando la clasificación de Rosemont: páncreas normal, indeterminado, sugestivo y diagnóstico de pancreatitis crónica. Se analizaron estos datos con la prueba estadística Chi-cuadrado con un intervalo de confianza de 95%. Resultados: en los pacientes con pancreatitis crónica el criterio presente con mayor frecuencia es la lobularidad en 66% de los casos seguido de la dilatación del Wirsung y la presencia de calcificaciones en 57,4% respectivamente. Se observó una asociación estadísticamente significativa entre los resultados de ambas clasificaciones (p < 0,05). La mayor asociación se encontró para pacientes que presentaban más de 4 criterios estándar y diagnóstico definitivo de pancreatitis crónica según la clasificación de Rosemont. Sin embargo, los pacientes que presentaron menos de 4 criterios estándar fueron sugestivos de pancreatitis crónica mediante el empleo de la clasificación de Rosemont en un 27,66% de los casos (p < 0,05). Conclusión: estos resultados muestran que no existen diferencias estadísticamente significativas para los pacientes que presentan >= 4 criterios diagnósticos según los criterios estándar. No obstante, 27,66% pacientes con menos de 4 criterios estándar serían sugestivos de pancreatitis crónica según la clasificación de Rosemont (p < 0,05). Por tanto, esta nueva clasificación sería útil para pacientes con elevada sospecha de pancreatitis crónica que presenten < 4 criterios estándar pero con presencia de criterios de mayor importancia como las calcificaciones intraparenquimatosas, la lobularidad o las litiasis intraductales(AU)

Aim: to study the possible differences in the final diagnosis of chronic pancreatitis by using standard classification described by Wiersema et al. and the new classification proposed recently by Ro - semont. Material and methods: forty-seven patients with the diagnosis of chronic pancreatitis were included in this study. The parenchymal and ductal criteria were studied, the patients were divided in two groups for Wiersema criteria: < 4 criteria, non-diagnostic for chronic pancreatitis and >= 4 criteria, diagnosis of chronic pancreatitis. The same patients were divided in four groups according to Rosemont classification: normal pancreas, indeterminate, suggestive and consistent with chronic pancreatitis. We analyzed these data with Chisquare test reported with 95% confidence intervals (CI). Results: in patients with chronic pancreatitis the most frequent criteria observed were lobularity in 66% of cases and pancreatic duct dilatation and calcifications in 57.4% of cases each. We found a significant statistical association between the results of both classifications (p < 0.05). The highest association is found in patients with more than 4 standard criteria and definitive diagnostic of chronic pancreatitis according to Rosemont classification. In patients who have less than 4 standard criteria the diagnosis is suggestive of chronic pancreatitis by using the Rosemont classification in 27.66% (p < 0.05). Conclusion: these results show that no significant statistical differences are found for patients with > 4 criteria diagnosis by standard criteria. But 27.66% patients with less than 4 standard criteria would be suggestive according to Rosemont classification (p < 0.05). Hence, the new classification would be useful in patients with high suspicion of chronic pancreatitis with < 4 standard criteria but with more significance such as parenchymal lithiasis, lobularity or ductal calcifications(AU)

Standard criteria versus Rosemont classification for EUS-diagnosis of chronic pancreatitis.

AIM: to study the possible differences in the final diagnosis of chronic pancreatitis by using standard classification described by Wiersema et al. and the new classification proposed recently by Rosemont. MATERIAL AND METHODS: forty-seven patients with the diagnosis of chronic pancreatitis were included in this study. The parenchymal and ductal criteria were studied, the patients were divided in two groups for Wiersema criteria: < 4 criteria, non-diagnostic for chronic pancreatitis and ≥ 4 criteria, diagnosis of chronic pancreatitis. The same patients were divided in four groups according to Rosemont classification: normal pancreas, indeterminate, suggestive and consistent with chronic pancreatitis. We analyzed these data with Chisquare test reported with 95% confidence intervals (CI). RESULTS: in patients with chronic pancreatitis the most frequent criteria observed were lobularity in 66% of cases and pancreatic duct dilatation and calcifications in 57.4% of cases each. We found a significant statistical association between the results of both classifications (p < 0.05). The highest association is found in patients with more than 4 standard criteria and definitive diagnostic of chronic pancreatitis according to Rosemont classification. In patients who have less than 4 standard criteria the diagnosis is suggestive of chronic pancreatitis by using the Rosemont classification in 27.66% (p < 0.05). CONCLUSION: these results show that no significant statistical differences are found for patients with > 4 criteria diagnosis by standard criteria. But 27.66% patients with less than 4 standard criteria would be suggestive according to Rosemont classification (p < 0.05). Hence, the new classification would be useful in patients with high suspicion of chronic pancreatitis with < 4 standard criteria but with more significance such as parenchymal lithiasis, lobularity or ductal calcifications.

Terapéutica biliar endoscópica en pacientes con 90 o más años de edad / Endoscopic biliary therapy in patients 90 years of age or older

La colangiopancreatografía retrógrada endoscópica (CPRE) es un método consolidado para el tratamiento de la patología obstructiva de la vía biliar y ocupa un lugar destacado en el intervencionismo endoscópico digestivo. Por su condición mínimamente invasiva puede aplicarse a una gran variedad de pacientes. Se analizan en esta revisión varias series que tratan de la CPRE en enfermos con 90 o más años. En ellas se comunican un total de 189 pacientes que precisaron la realización de esta técnica entre los años 1987-2003. Algunos requirieron más de una CPRE. Se registró drenaje biliar satisfactorio en 178 pacientes (94%), complicaciones leves en 8 (4%) y sólo un fallecimiento (0.5%) como consecuencia de la prueba. Los diagnósticos fueron: 120 coledocolitiasis (63%), 20 tumores (11%) y 49 (11%) por otras causas (principalmente dilatación de la vía biliar sin causa definida, en ocasiones por coledocolitiasis migradas). Estos datos permiten afirmar una vez más que las complicaciones de la CPRE no están relacionadas con la edad, que la eficacia de la técnica es, por lo menos, similar a la obtenida en pacientes más jóvenes y que no se debe rechazar sólo por la edad a ningún paciente que necesite CPRE.