Pseudoachalasia as a paraneoplastic event in a patient with Hodgkin’s disease

Pseudoachalasia or secondary achalasia (5% of achalasias that are deemed primary achalasias) is an esophageal motor disorder with manometric criteria for achalasia, but it appears in the context of an underlying pathology that can be attributed to its origin. Usually appears in >60 years with rapid evolution of symptoms (<1 year). The main cause of pseudoachalasia is neoformative etiology, but there are others. Our patient started with rapid progression dysphagia and was diagnosed with type II achalasia within a Hodgkin's lymphoma. In the radiological-metabolic studies, disease involvement was ruled out as an extrinsic compression of the esophagogastric junction as well as signs of its activity at this level. Chemotherapy has not been shown to play a role in the development of this pathology. On the other hand, radiotherapy has been associated with an esophageal motor disorder, but, in our case, it was after its onset. Therefore, we propose that the mechanism of pseudoachalasia in our case is a paraneoplastic event. This hypothesis is related to other similar cases reported, and it reflects the importance of continuing to investigate this clinical condition that is indistinguishable by manometry from primary achalasia. In addition, it usually presents differential clinical characteristics whose early recognition has implications for the diagnostic, therapeutic, and prognostic management of the patient. (AU)

Recurrent hemobilia secondary to extrahepatic biliary tract cholangiocarcinoma. A diagnostic challenge.

The etiology of hemobilia has mainly iatrogenic (>50%), followed by traumatic causes. Others are biliopathy due to portal high pressure, or neoplastic or infective biliopathy. In the case of non-clear hemobilia, direct-vision-cholangioscopy can change the management in >34% of cases. Our patient had episodes of obstructive hemobilia with secondary cholangitis without objectifying underlying pathology. When she was referred to our center, SpyGlass®-cholangioscopy identified the suspicious lesion compatible with early-stage cholangiocarcinoma despite the diagnostic delay. In conclusion, it is important to keep in mind the neoformative etiology as a potential cause of hemobilia of unclear origin, in which case, cholangioscopy (SpyGlass®) can contribute to the recognition of the signs of malignancy of the lesion and, therefore, to the diagnosis.

Pseudoachalasia as a paraneoplastic event in a patient with Hodking's disease.

Pseudoachalasia or secondary achalasia (5% of achalasias that are deemed primary achalasias) is an esophageal motor disorder with manometric criteria for achalasia, but it appears in the context of an underlying pathology that can be attributed to its origin. Usually appears in >60 years with rapid evolution of symptoms (<1 year). The main cause of pseudoachalasia is neoformative etiology, but there are others. Our patient started with rapid progression dysphagia and was diagnosed with type II achalasia within a Hodgkin's lymphoma. In the radiological-metabolic studies, disease involvement was ruled out as an extrinsic compression of the esophagogastric junction as well as signs of its activity at this level. Chemotherapy has not been shown to play a role in the development of this pathology. On the other hand, radiotherapy has been associated with an esophageal motor disorder, but, in our case, it was after its onset. Therefore, we propose that the mechanism of pseudoachalasia in our case is a paraneoplastic event. This hypothesis is related to other similar cases reported, and it reflects the importance of continuing to investigate this clinical condition that is indistinguishable by manometry from primary achalasia. In addition, it usually presents differential clinical characteristics whose early recognition has implications for the diagnostic, therapeutic, and prognostic management of the patient.

Mesalazine-induced esophageal ulcers. a rare adverse effect.

31-year-old woman. Diagnosis of ulcerative proctitis in February/2022. Calprotectin 1832 µg/g. Colonoscopy: erythematous, friable and erosive mucosa up to 10 cm from the anal margin. Pathology: compatible with ulcerative colitis with moderate activity. Start of oral mesalazine (3 gr/24 h granules) and topical (1 gr/24 h suppository). After three months, she achieved clinical remission. Calprotectin 57 µg/g. Two months later, she consulted for solid dysphagia, loss of 10 kg, and low-grade fever for a month. Fifteen days before, she went to an emergency room where Prednisone 50 mg/24 h was started. On the day of the assessment, she was receiving 30 mg with no improvement. The next day, gastroscopy showed 6-12 mm esophageal ulcers with non-confluent shallow geographic borders, biopsies were taken. Viral serologies and HLA B51 were requested. Given the severity of the symptoms, empirical treatment was started with Valaciclovir 1 g/12 h. Serologies: IgG for Ebstein Barr virus, cytomegalovirus and herpes virus with negative IgM. Cytomegalovirus viral load: <30 IU/ml. Pathology: acute extensively ulcerated esophagitis, inflammatory infiltrate and some eosinophils with negative histochemical staining for fungi, cytomegalovirus and herpes virus I and II. HLA B51 was negative. Valaciclovir and mesalazine are discontinued after seven days given the known relationship of the latter with low-grade fever and, exceptionally, with esophageal pathology. Three days later, the patient reported clear improvement in dysphagia from the day the mesalazine was discontinued. After eight months, she was still asymptomatic. Upon resolution of the symptoms, control gastroscopy was not performed, and mesalazine has not been reintroduced due to its probable causal association. Mesalazine has an excellent safety profile. Adverse effects include fever, headache, diarrhea and.

Poor agreement between clinical screening and universal pre-procedure SARS-CoV-2 PCR testing prior to endoscopy.

INTRODUCTION: scientific societies recommend screening for SARS-CoV-2 in patients prior to endoscopy. There is no solid evidence regarding the efficiency of universal screening by PCR testing for SARS-CoV-2. The present study aimed to assess the usefulness of clinical screening and universal pre-procedure PCR testing for the identification of patients capable of transmitting the SARS-CoV-2 infection. Concordance between both strategies was also evaluated. METHOD: a retrospective review was performed in a consecutive cohort of patients undergoing endoscopy at a tertiary teaching hospital between April 22 and June 22, 2020, following a screening protocol. RESULTS: three hundred and sixty-one patients were included. Clinical screening detected 13 patients with a high risk of infection (3.6 %, 95 % CI: 2.62-4.58) while the pre-procedure PCR test was positive in five patients (1.40 %, 95 % CI: 0.20-2.60). Three patients developed COVID-19 and one died from the disease. Agreement between both strategies was poor, with a kappa value of 0.093 (95 % CI: 0.001-0.185). Clinical screening only identified one of the five patients with a positive PCR test. CONCLUSION: clinical screening prior to endoscopy has a poor agreement with pre-procedure PCR testing.

Aspectos endoscópicos del tratamiento de la enfermedad de Parkinson avanzada con levodopa/carbidopa intraduodenal / Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson's disease

Introducción: el tratamiento con levodopa intraduodenal mediante gastrostomía endoscópica percutánea constituye una alternativa terapéutica en pacientes con enfermedad de Parkinson. Disponemos de pocos estudios que evalúen los aspectos endoscópicos en esta indicación. Objetivos: describir nuestra experiencia en esta técnica e identificar factores asociados a la aparición de complicaciones. Métodos: estudio observacional retrospectivo en centro terciario entre enero de 2007 y enero de 2019. Resultados: se incluyeron 37 pacientes (21 varones, edad 65,1 +/- 10,3 años, diez años [rango 25] de evolución de la enfermedad) seguidos durante una mediana de 16 meses (rango 143). El sistema se colocó con éxito en el 100% de los casos. La tasa de persistencia con el tratamiento al final del seguimiento fue del 62,2%. El sistema se retiró en 14 pacientes: siete por empeoramiento, cuatro por deseo del paciente y tres por complicaciones. Hubo 53 complicaciones en 23 pacientes (62,2%; 0,63 por paciente-año), cuatro mayores (8,1%, 0,05 por paciente-año). Complicaciones menores: 14 (37,8%) relacionados con el estoma, seis (16,2%) con la gastrostomía y 15 (40,5%) con la sonda duodenal. La mayoría se resolvieron endoscópicamente. Se realizaron 44 recambios de sonda en 20 pacientes (54,1%; 0,52 por paciente-año). El sexo masculino, la edad mayor de 70 años y un mayor índice de comorbilidad se asociaron a mayor probabilidad de persistencia del sistema. No se identificaron factores predictores de complicaciones asociadas a la gastrostomía. Conclusiones: la gastrostomía para infusión de levodopa intraduodenal presenta una alta tasa de éxito técnico. Las complicaciones son frecuentes, pero la mayoría se resuelven endoscópicamente

Background: treatment of intraduodenal levodopa using percutaneous endoscopic gastrostomy is an alternative therapy in patients with advanced Parkinson's disease. There are few studies that have evaluated the endoscopic aspects of this technique. Objectives: to describe our experience and adverse events regarding this technique in advanced Parkinson's disease. Method: a retrospective study was performed from January 2007 to January 2019 in a tertiary healthcare center. Results: thirty-seven patients aged 65.1 +/- 10.3 years were included in the study, 21 were male and the disease duration was ten years (1-26). The median follow-up was 16 months (1-144). The device was successfully placed in all cases. The persistence rate with the PEG-D at the end of follow-up was 62.2%. The system was removed in 14 patients, seven due to neurological impairment, four because of the decision of the patient and three due to related events. Fifty-nine adverse events occurred in 23 patients (62.2%, 0.63 per patient-year), four of which were severe (8.1%, 0.05 per patient-year). Minor adverse events included 14 (37.8%) related to the stoma, six (16.2%) to the gastric tube and 15 (40.5%) to the duodenal tube. Forty-four system replacements were performed in 20 patients (54.1%, 0.52 per patient-year). Male sex, age over 70 and a higher comorbidity index were associated with a greater likelihood of persistence of the system (OR: 0.14, 95% CI: 0.03-0.62; OR: 0.52, 95% CI: 0.32-0.86; OR: 0.16, 95% CI: 0.03-0.99, respectively). No predictors of adverse events associated with PEG-D were identified. Conclusions: percutaneous endoscopic gastrostomy for the continuous delivery of duodenal levodopa is a highly effective technique. Adverse events are common, although most are resolved by endoscopy

Endoscopic management of duodenal levodopa-carbidopa therapy of advanced Parkinson's disease.

BACKGROUND: treatment of intraduodenal levodopa using percutaneous endoscopic gastrostomy is an alternative therapy in patients with advanced Parkinson's disease. There are few studies that have evaluated the endoscopic aspects of this technique. OBJECTIVES: to describe our experience and adverse events regarding this technique in advanced Parkinson's disease. METHOD: a retrospective study was performed from January 2007 to January 2019 in a tertiary healthcare center. RESULTS: thirty-seven patients aged 65.1 ± 10.3 years were included in the study, 21 were male and the disease duration was ten years (1-26). The median follow-up was 16 months (1-144). The device was successfully placed in all cases. The persistence rate with the PEG-D at the end of follow-up was 62.2%. The system was removed in 14 patients, seven due to neurological impairment, four because of the decision of the patient and three due to related events. Fifty-nine adverse events occurred in 23 patients (62.2%, 0.63 per patient-year), four of which were severe (8.1%, 0.05 per patient-year). Minor adverse events included 14 (37.8%) related to the stoma, six (16.2%) to the gastric tube and 15 (40.5%) to the duodenal tube. Forty-four system replacements were performed in 20 patients (54.1%, 0.52 per patient-year). Male sex, age over 70 and a higher comorbidity index were associated with a greater likelihood of persistence of the system (OR: 0.14, 95% CI: 0.03-0.62; OR: 0.52, 95% CI: 0.32-0.86; OR: 0.16, 95% CI: 0.03-0.99, respectively). No predictors of adverse events associated with PEG-D were identified. CONCLUSIONS: percutaneous endoscopic gastrostomy for the continuous delivery of duodenal levodopa is a highly effective technique. Adverse events are common, although most are resolved by endoscopy.

Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT.

AIM: to determine the proportion of incidental colon lesions detected by PET-CT and their correlation with the endoscopic and histological findings. In addition, to determine the maximum standardized uptake value (SUVmax) that can discriminate between benign and malignant lesions in our series of cases. METHODS: this was a retrospective study of 3,000 patients evaluated by PET-CT for staging or response to treatment of primary neoplasms, between 2011 and 2015. Patients with incidental uptake in the colon were included in the study. Exclusion criteria included an incomplete, poorly prepared or abandoned colonoscopy, inflammatory bowel disease and treatment with metformin. RESULTS: the study cohort comprised 71 patients evaluated by PET-CT and subsequently analyzed by endoscopy; 69% were male with a mean age of 65.77 ± 11.2. The rate of incidental colon lesions found by PET-CT was 1.73%, with 52 incidental colonic uptakes reported in 50 patients. The location of the uptake was the rectum (19.23%), sigmoid colon (34.62%), descending colon (13.46%), transverse colon (1.9%), ascending colon (19.23%), cecum (9.62%) and ileocolic anastomosis (1.92%). Thirty-five pathological colonoscopies (71.15%) were identified: the findings included five neoplasms (13.51%), two inflammatory lesions (5.4%) and 30 adenomatous polyps (81.1%). Significant differences were found between neoplastic SUVmax (11.7 g/ml; p = 0.03) and polyps (9.26 g/ml; p = 0.04) in relation to inflammatory lesions and normal endoscopies (6.05 g/ml). There were no differences in terms of the size of the polyps, nor the presence or absence of high grade dysplasia (p = 0.12 and 0.33). Both PET-CT and endoscopy proved consistent for locating lesions (k 0.90; CI 95% 0.86-0.93). CONCLUSION: there is a good correlation between the findings identified by PET-CT and the endoscopic study. In our study, a SUVmax > 11 g/ml suggests a malignant pathology, which aids the prioritization of an endoscopic study.

Relevancia clínico-endoscópica de las captaciones incidentales colónicas en PET-TAC / Clinical-endoscopic relevance of incidental colorectal lesions detected by PET-CT

Objetivo: establecer la proporción de lesiones incidentales en colon detectadas por PET-TC y su correlación con los hallazgos endoscópicos. Sugerir el valor máximo de captación estándar (SUVmax) que pueda discriminar lesiones benignas de malignas en nuestra serie. Métodos: estudio retrospectivo de 3.000 pacientes sometidos a PET-TC entre 2011 y 2015 para estadificación o respuesta a tratamiento de neoplasias. Se incluyeron pacientes con captación incidental en colon. Los criterios de exclusión fueron: colonoscopia incompleta, mal preparada o no realizada; enfermedad inflamatoria intestinal; tratamiento con metformina. Resultados: se incluyeron 71 pacientes (69% varones, edad media 65,77 ± 11,2) con captación colónica por PET-TC y endoscopia posterior. La tasa de lesiones incidentales por PET-TC fue del 1,73% y se describieron 52 captaciones en 50 pacientes. La localización de las captaciones fue: recto (19,23%), colon sigmoide (34,62%), descendente (13,46%), transverso (1,92%), ascendente (19,23%), ciego (9,62%) y anastomosis ileocólica (1,92%). Los hallazgos en 35 colonoscopias patológicas (71,15%) correspondieron a cinco neoplasias (13,51%), dos lesiones inflamatorias (5,4%) y 30 pólipos (81,1%). Se hallaron diferencias significativas en el SUVmax de neoplasias (11,7 g/ml; p = 0,03) y pólipos (9,26 g/ml; p = 0,04), respecto a lesiones inflamatorias (10,5 g/ml) y endoscopias normales (6,05 g/ml). No hubo diferencias en función del tamaño de los pólipos ni de la presencia o no de displasia de alto grado (p = 0,12 y 0,33). La localización de las lesiones por PET-TC y endoscopia presentó muy buena concordancia (k 0,90; IC 95% 0,86-0,93). Conclusiones: existe una buena correlación entre los hallazgos identificados por PET-TC y los endoscópicos. En nuestro estudio, un SUVmax > 11 g/ml sugiere patología maligna, ayudándonos a priorizar el estudio endoscópico

Aim: to determine the proportion of incidental colon lesions detected by PET-CT and their correlation with the endoscopic and histological findings. In addition, to determine the maximum standardized uptake value (SUVmax) that can discriminate between benign and malignant lesions in our series of cases. Methods: this was a retrospective study of 3,000 patients evaluated by PET-CT for staging or response to treatment of primary neoplasms, between 2011 and 2015. Patients with incidental uptake in the colon were included in the study. Exclusion criteria included an incomplete, poorly prepared or abandoned. Results: the study cohort comprised 71 patients evaluated by PET-CT and subsequently analyzed by endoscopy; 69% were male with a mean age of 65.77 ± 11.2. The rate of incidental colon lesions found by PET-CT was 1.73%, with 52 incidental colonic uptakes reported in 50 patients. The location of the uptake was the rectum (19.23%), sigmoid colon (34.62%), descending colon (13.46%), transverse colon (1.9%), ascending colon (19.23%), cecum (9.62%) and ileocolic anastomosis (1.92%). Thirty-five pathological colonoscopies (71.15%) were identified: the findings included five neoplasms (13.51%), two inflammatory lesions (5.4%) and 30 adenomatous polyps (81.1%). Significant differences were found between neoplastic SUVmax (11.7 g/ml; p = 0.03) and polyps (9.26 g/ml; p = 0.04) in relation to inflammatory lesions and normal endoscopies (6.05 g/ml). There were no differences in terms of the size of the polyps, nor the presence or absence of high grade dysplasia (p = 0.12 and 0.33). Both PET-CT and endoscopy proved consistent for locating lesions (k 0.9; CI 95% 0.86-0.93). Conclusion: there is a good correlation between the findings identified by PET-CT and the endoscopic study. In our study, a SUVmax > 11 g/ml suggests a malignant pathology, which aids the prioritization of an endoscopic study

Divertículo de Meckel invertido en paciente adulto diagnosticado por cápsula endoscópica / Inverted Meckel’s diverticulum in an adult patient diagnosed via capsule endoscopy

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Inverted Meckel's diverticulum in an adult patient diagnosed via capsule endoscopy.

Meckel's diverticulum is present in 2% of the general population and its inverted presentation is rare. The most frequent complications are gastrointestinal hemorrhage, obstruction, intussusception and perforation. In general, these complications occur in the first two decades of life, and mostly before the fourth decade. We present a case of inverted MD that started as a digestive hemorrhage of obscure origin in a 77-year-old man who was diagnosed by endoscopic capsule.

Intraperitoneal splenosis / Esplenosis Intraperitoneal

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Hemobilia due to intracholecystic papillary neoplasm.

We report the case of a 39-year-old patient who presented an episode of upper gastrointestinal bleeding due to hemobilia. The imaging tests showed the gallbladder occupied by solid tissue, with a diagnosis of intracholecystic papillary neoplasm after the cholecystectomy. The intracholecystic papillary neoplasm of the gallbladder is a newly established entity and it is considered a subtype of intraductal papillary neoplasm of the bile duct. Its presentation in the form of hemobilia has barely been described in the literature.

Hemobilia por neoplasia papilar intracolecística / Hemobilia due to intracholecystic papillary neoplasm

Exponemos el caso de un paciente de 39 años que presentó un episodio de hemorragia digestiva alta secundario a hemobilia. Mediante las pruebas de imagen realizadas se objetivó ocupación de la vesícula biliar por tejido sólido, que tras colecistectomía se diagnosticó de neoplasia papilar intracolecística. Se trata una entidad recientemente establecida y se considera un subtipo de la neoplasia papilar intraductal de la vía biliar. La presentación en forma de hemobilia apenas ha sido descrita en la literatura (AU)

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Rentabilidad de la cápsula endoscópica en mujeres premenopáusicas con anemia ferropénica / Diagnostic yield of video capsule endoscopy in premenopausal women with iron-deficiency anemia

Las guías clínicas indican el estudio con cápsula endoscópica (CE) en pacientes con anemia ferropénica (AF) tras exploraciones endoscópicas convencionales normales, pero se precisan estudios que demuestren su rentabilidad, impacto clínico y coste en algunos subgrupos de pacientes. OBJETIVOS: 1. Determinar la rentabilidad diagnóstica de la CE en mujeres premenopáusicas con AF comparada con varones y mujeres posmenopáusicas. 2. Identificar la presencia de factores predictivos de patología en mujeres premenopáusicas. 3. Realizar una aproximación al gasto en esta indicación en relación con el impacto. MATERIAL Y MÉTODO: Estudio retrospectivo de 408 pacientes a los que se ha realizado CE. Se incluyeron pacientes con AF (mujeres en edad premenopáusica, posmenopáusica o varones), gastroscopia y colonoscopia previas. RESULTADOS: Incluimos 249 pacientes, 131 mujeres (52,6%), 51 premenopáusicas y 80 posmenopáusicas y 118 hombres, mediana de edad 60,7 ± 16 años. La rentabilidad global de la CE para el diagnóstico de AF fue 44,6% (IC 95% 39,9-50,8). Rentabilidad en varones vs. mujeres 50,8 vs. 38,9% (p = 0,05) y en mujeres posmenopáusicas vs. premenopáusicas 55 vs. 13,7% (p < 0,001). No se detectó ningún factor predictivo de patología en premenopáusicas. La lesión más frecuente en posmenopáusicas fueron angiodisplasias (70,5%) y en premenopáusicas lesiones erosivas (57,1%). El gasto aproximado en premenopáusicas supuso una inversión de 44.727 Euros El 86,3% no tuvo impacto clínico. CONCLUSIONES: La rentabilidad diagnóstica de la CE es baja en el estudio etiológico de AF en mujeres en edad fértil y poco costo-efectiva en relación con el impacto clínico. No detectamos factores predictivos de patología en ID en este subgrupo

Clinical practice guidelines recommend video capsule endoscopy (VCE) studies in patients with iron-deficiency anemia (IDA) after conventional upper and lower endoscopies but there is a need for studies demonstrating the diagnostic yield, clinical impact, and cost in some patient subgroups. OBJECTIVES: 1.To determine the diagnostic yield of VCE in premenopausal women with IDA compared with that in men and postmenopausal women. 2. To identify the presence of VCE predictors in premenopausal women. 3. To estimate the cost-clinical impact relationship associated with VCE in this indication. MATERIAL AND METHOD: We retrospectively analyzed 408 patients who underwent VCE. Patients with IDA were enrolled (premenopausal, postmenopausal women, and men), with previous normal work-up by conventional endoscopies. RESULTS: A total of 249 patients were enrolled: 131 women (52.6%), of which 51 were premenopausal and 80 were post-menopausal, and 118 men. The mean age was 60.7 ± 16 years. The diagnostic yield of VCE for the diagnosis of IDA was 44.6% (95% CI 39.9 - 50.8). Diagnostic yield was 50.8% vs 38.9% in men vs women (p = 0.05) and was 55% vs 13.7% in postmenopausal vs premenopausal women (p < 0.001). No predictors of small bowel lesions were found in premenopausal women. The most common findings in the postmenopausal group were angioectasias (70.5%) and erosions (57.1%) in the premenopausal group. The cost in premenopausal women was 44.727 Euros and 86.3% of the procedures had no clinical impact. CONCLUSIONS: The diagnostic yield of VCE is low in the etiological study of IDA in premenopausal women and there is no cost-effectiveness in relation to clinical impact. No predictors of small bowel lesions were found in this group

[Diagnostic yield of video capsule endoscopy in premenopausal women with iron-deficiency anemia]. / Rentabilidad de la cápsula endoscópica en mujeres premenopáusicas con anemia ferropénica.

UNLABELLED: Clinical practice guidelines recommend video capsule endoscopy (VCE) studies in patients with iron-deficiency anemia (IDA) after conventional upper and lower endoscopies but there is a need for studies demonstrating the diagnostic yield, clinical impact, and cost in some patient subgroups. OBJECTIVES: 1.To determine the diagnostic yield of VCE in premenopausal women with IDA compared with that in men and postmenopausal women. 2. To identify the presence of VCE predictors in premenopausal women. 3. To estimate the cost-clinical impact relationship associated with VCE in this indication. MATERIAL AND METHOD: We retrospectively analyzed 408 patients who underwent VCE. Patients with IDA were enrolled (premenopausal, postmenopausal women, and men), with previous normal work-up by conventional endoscopies. RESULTS: A total of 249 patients were enrolled: 131 women (52.6%), of which 51 were premenopausal and 80 were post-menopausal, and 118 men. The mean age was 60.7±16 years. The diagnostic yield of VCE for the diagnosis of IDA was 44.6% (95% CI 39.9 - 50.8). Diagnostic yield was 50.8% vs 38.9% in men vs women (p=0.05) and was 55% vs 13.7% in postmenopausal vs premenopausal women (p<0.001). No predictors of small bowel lesions were found in premenopausal women. The most common findings in the postmenopausal group were angioectasias (70.5%) and erosions (57.1%) in the premenopausal group. The cost in premenopausal women was 44.727€ and 86.3% of the procedures had no clinical impact. CONCLUSIONS: The diagnostic yield of VCE is low in the etiological study of IDA in premenopausal women and there is no cost-effectiveness in relation to clinical impact. No predictors of small bowel lesions were found in this group.

Impactación de un cuerpo extraño en un paciente con enfermedad de Crohn / Impacted foreign body in a patient with Crohn's disease

La enfermedad de Crohn (EC) se puede complicar con la aparición de estenosis intestinal. Las estenosis que no responden al tratamiento médico habitualmente requieren cirugía. La dilatación endoscópica con balón es una alternativa a la cirugía.A continuación se presenta el caso de un paciente con EC y una estenosis de la válvula ileocecal asintomática que se manifestó como un cuadro oclusivo secundario a la impactación de un cuerpo extraño (semilla de níspero). Se realizó una dilatación endoscópica y la extracción del cuerpo extraño. En este trabajo se lleva a cabo una revisión de la literatura médica en relación al tratamiento endoscópico de las estenosis intestinales secundarias a la EC (AU)

Crohn's disease is often complicated by intestinal strictures. Symptomatic strictures refractory to medical therapy usually require surgery. Endoscopic balloon dilatation is an alternative to surgery. We report the case of a patient with CrohnŒs disease with asymptomatic ileocecal stricture, which was identified after intestinal obstruction due to an impacted foreign body. The patient underwent endoscopic dilatation and the foreign body was extracted. We provide a review of the literature on endoscopic balloon dilatation of intestinal strictures in Crohn's disease (AU)

[Severe tubulo-interstitial nephritis secondary to 5-ASA]. / Nefropatía tubulointersticial grave secundaria a 5-ASA.

We report a new case of chronic interstitial nephritis in a patient with ulcerative colitis diagnosed in 2002 who was originally treated with 5-ASA. Three years later deterioration of renal function was apparent with an increase in serum creatinine, which was normal before treatment. Withdrawal of 5-ASA led to partial improvement of renal function. In patients with a delayed diagnosis of kidney damage, recovery of renal function is incomplete and, in some cases, the patient even requires some form of renal replacement therapy. We stress the importance of monitoring renal function in patients diagnosed with inflammatory bowel disease treated with this drug.