Triple terapia 10 días con esomeprazol 40 mg/12 h vs. cuádruple concomitante sin bismuto como tratamiento de primera línea de la infección por Helicobacter pylori / 10-day triple therapy with esomeprazole 40 mg/12 h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection

INTRODUCCIÓN: Recientemente la cuádruple terapia concomitante sin bismuto se ha postulado como tratamiento de primera línea para la infección por Helicobacter pylori en España. Se desconoce si la optimización de la triple terapia clásica puede incrementar su efectividad hasta límites aceptables. MATERIAL Y MÉTODOS: Estudio retrospectivo que compara la eficacia de la triple terapia con la cuádruple concomitante realizando posteriormente un subanálisis cuando ambas se administran durante 10 días empleando esomeprazol 40mg/12h. RESULTADOS: Desde el 1 de enero de 2012 hasta el 31 de diciembre de 2014 recibieron al menos una primera línea de tratamiento 657 pacientes. La cuádruple combinación (n = 371) presentó una eficacia superior a la de la triple terapia clásica (n = 248) tanto «por intención de tratar» (85,9% vs. 65,5%; p < 0,001) como «por protocolo» (88,8% vs. 68,4%; p < 0,001). Cuando ambos tratamientos se administraron durante 10 días empleando esomeprazol 40 mg/12h la cuádruple terapia (n = 108) también fue más eficaz que la triple terapia clásica «optimizada» (n = 76), tanto «por intención de tratar» (90,7% vs. 73,6%; p = 0,003) como «por protocolo» (92,5% vs. 74,6%; p = 0,002). CONCLUSIONES: La terapia cuádruple concomitante con dosis altas de IBP durante 10 días consigue tasas de erradicación significativamente superiores a las obtenidos con la triple terapia optimizada y superiores al 90% cuando se utiliza esomeprazol 40 mg/12h

INTRODUCTION: Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen. MATERIAL AND METHODS: Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40 mg/12h. RESULTS: A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n = 371) showed higher efficacy than triple therapy (n = 248) for both intention-to-treat (85.9% vs. 65.7%; P < .001) and per protocol analysis (92.5% vs. 68.4%; P < .001). When both therapies included esomeprazole 40 mg/12h administered for 10 days, quadruple concomitant therapy (n = 108) also had higher efficacy than triple therapy (n = 76) for intention-to-treat (90.7% vs. 73.6%; P = .003) and per protocol analysis (92.5% vs.74.6%; P = .002). CONCLUSIONS: Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40 mg/12h

Comparación de cuádruple terapia concomitante sin bismuto con triple terapia clásica como primera línea de tratamiento para la erradicación del Helicobacter pylori / Cuadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy forHelicobacter pylori infection

Fundamento y objetivo: Tras constatar que en nuestro medio la triple terapia clásica presentaba una eficacia subóptima en la erradicación del Helicobacter pylori (H. pylori), a mediados de 2012 decidimos implantar la cuádruple terapia concomitante sin bismuto. El objetivo de este estudio es comparar la eficacia de ambas pautas. Material y métodos: Estudio retrospectivo observacional de las pautas erradicadoras administradas entre el 1 de enero de 2012 y el 5 de mayo de 2014, así como su eficacia. Resultados: En el periodo de estudio 510 pacientes recibieron al menos una primera línea de tratamiento que en 179 casos (35,1%) consistió en amoxicilina+claritromicina+IBP durante 7-14 días, y en 298 (58,4%) en la combinación amoxicilina+claritromicina+metronidazol+IBP 10 días. La pauta cuádruple concomitante fue más eficaz que la combinación clásica, tanto «por intención de tratar» (84,8 vs. 65,7%; p=0,001) como «por protocolo» (86,9 vs. 67,2%; p=0,001). La triple terapia fue más eficaz cuando se empleaba en pautas de 10 días que de 7 (77,9 vs. 56,5%; p: 0,005 por «intención de tratar» y 77,9 vs. 58,5%; p: 0,011 por «protocolo»). Al comparar la eficacia de la cuádruple terapia con la triple administrada 10 días no se encontraron diferencias significativas. Conclusiones: En nuestro medio, la cuádruple terapia concomitante sin bismuto presenta una elevada eficacia como primera línea de tratamiento para la erradicación del H. pylori, superando ampliamente la de la triple terapia en la forma en que esta viene administrándose mayoritariamente (pautas cortas de 7 días) (AU)

Background and objective: In a previous study we found that the classical triple therapy for Helicobacter pylori (H. pylori)had low efficacy (under 70%) in our area. After this finding, in mid 2012 quadruple concomitant therapy started to be prescribed in our hospital. The aim of the present study is to compare the efficacy of classical triple therapy and quadruple concomitant therapy without bismuth. Material and methods: Observational retrospective study of prescribed treatments between 1st January 2012 and 5th May 2014 and their efficacy. Results: During the study period 510 patients were prescribed a first line therapy; in 179 cases (35,1%) the combination amoxiciline+clarithromicine+PPI was prescribed during 7-14 days, and 298 patients (58,4%) were treated with amoxicillin+clarithromycin+metronidazole+PPI for 10 days. The quadruple concomitant therapy had a higher efficacy than the classical triple therapy, both in an "intention to treat" (84.8% vs. 65.7%, P=.001) and "per protocol" (86.9% vs. 67.2%, P=.001) analysis. Triple therapy had a higher efficacy when it was prescribed for 10 days compared to 7 days (77.9% vs. 56.5%, P=.005 per "intention to treat" and 77.9% vs. 58.5%, P=.011 "per protocol"). When quadruple concomitant therapy was compared with classical triple therapy prescribed over 10 days no significant differences were found. Conclusions: In our setting, cuadruple concomitant therapy without bismuth has a high efficacy as first line therapy for H. pylori eradication, with much better results than classical triple therapy in the way that it is most widely prescribed (short courses of 7-day with a single dose of omeprazole) (AU)

[Cuadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy for Helicobacter pylori infection]. / Comparación de cuádruple terapia concomitante sin bismuto con triple terapia clásica como primera línea de tratamiento para la erradicación del Helicobacter pylori.

BACKGROUND AND OBJECTIVE: In a previous study we found that the classical triple therapy for Helicobacter pylori (H. pylori) had low efficacy (under 70%) in our area. After this finding, in mid 2012 quadruple concomitant therapy started to be prescribed in our hospital. The aim of the present study is to compare the efficacy of classical triple therapy and quadruple concomitant therapy without bismuth. MATERIAL AND METHODS: Observational retrospective study of prescribed treatments between 1st January 2012 and 5th May 2014 and their efficacy. RESULTS: During the study period 510 patients were prescribed a first line therapy; in 179 cases (35,1%) the combination amoxiciline+clarithromicine+PPI was prescribed during 7-14 days, and 298 patients (58,4%) were treated with amoxicillin+clarithromycin+metronidazole+PPI for 10 days. The quadruple concomitant therapy had a higher efficacy than the classical triple therapy, both in an "intention to treat" (84.8% vs. 65.7%, P=.001) and "per protocol" (86.9% vs. 67.2%, P=.001) analysis. Triple therapy had a higher efficacy when it was prescribed for 10 days compared to 7 days (77.9% vs. 56.5%, P=.005 per "intention to treat" and 77.9% vs. 58.5%, P=.011 "per protocol"). When quadruple concomitant therapy was compared with classical triple therapy prescribed over 10 days no significant differences were found. CONCLUSIONS: In our setting, cuadruple concomitant therapy without bismuth has a high efficacy as first line therapy for H. pylori eradication, with much better results than classical triple therapy in the way that it is most widely prescribed (short courses of 7-day with a single dose of omeprazole).

[10-day triple therapy with esomeprazole 40 mg/12 h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection]. / Triple terapia 10 días con esomeprazol 40 mg/12 h vs. cuádruple concomitante sin bismuto como tratamiento de primera línea de la infección por Helicobacter pylori.

INTRODUCTION: Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen. MATERIAL AND METHODS: Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40mg/12h. RESULTS: A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n=371) showed higher efficacy than triple therapy (n=248) for both intention-to-treat (85.9% vs. 65.7%; P<.001) and per protocol analysis (92.5% vs. 68.4%; P<.001). When both therapies included esomeprazole 40mg/12h administered for 10 days, quadruple concomitant therapy (n=108) also had higher efficacy than triple therapy (n=76) for intention-to-treat (90.7% vs. 73.6%; P=.003) and per protocol analysis (92.5% vs.74.6%; P=.002). CONCLUSIONS: Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40mg/12h.

Disección submucosa endoscópica: indicaciones, resultados y posibilidades de desarrollo en España / Disección submucosa endoscópica: indicaciones, resultados y posibilidades de desarrollo en España / Endoscopic submucosal dissection in Spain: Outcomes and development possibilities

La disección submucosa endoscópica (DSE) permite la resección curativa mediante endoscopia de lesiones malignas o premalignas superficiales digestivas en una sola pieza. Esta técnica, nacida hace algo más de 10 años en Japón, no ha experimentado una gran difusión en países occidentales por diferentes motivos. En este artículo se hace una revisión de las indicaciones y resultados de la DSE, así como una discusión de los motivos por los que todavía son escasos los centros en occidente que realizan esta técnica. Por último se hacen unas recomendaciones de formación en DSE en nuestro medio (AU)

Endoscopic submucosal dissection (ESD) allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made (AU)

Endoscopic submucosal dissection in Spain: outcomes and development possibilities.

Endoscopic submucosal dissection (ESD) allows endoscopic, curative, en-bloc resection of superficial malignant or premalignant lesions. This procedure was conceived over 10 years ago in Japan, but has not experienced great expansion in Western countries for different reasons. This article reviews ESD indications and outcomes, and reflects on the reasons that prevent ESD from becoming common clinical practice in Western hospitals. Finally, recommendations on ESD training in our setting are made.

Ectopia tiroidea retroperitoneal / Ectopic retroperiotoneal thyroid gland

La ectopia tiroidea subdiafragmática es un hallazgo muy infrecuente, del cual hemos identificado únicamente 15 casos tras una revisión de la literatura médica. Su manejo no se encuentra establecido, si bien es frecuente su extirpación por la sospecha de enfermedad neoplásica. Presentamos el caso de una mujer de 76 años que presenta una ectopia tiroidea mesentérica en forma de masa retroperitoneal extirpada quirúrgicamente y que evolucionó de manera favorable (AU)

The presence of subdiaphragmatic thyroid tissue is a very rare finding. We reviewed the literature and found only 15 published cases. The most appropriate management of this entity has not been established, but surgical removal is common to exclude malignancy. We present the case of a 76-year-old woman with an ectopic mesenteric thyroid gland forming a retroperitoneal mass that was surgically removed. Outcome was favorable (AU)

[Ectopic retroperitoneal thyroid gland]. / Ectopia tiroidea retroperitoneal.

The presence of subdiaphragmatic thyroid tissue is a very rare finding. We reviewed the literature and found only 15 published cases. The most appropriate management of this entity has not been established, but surgical removal is common to exclude malignancy. We present the case of a 76-year-old woman with an ectopic mesenteric thyroid gland forming a retroperitoneal mass that was surgically removed. Outcome was favorable.

Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions.

AIM: To discuss the feasibility of single session endoscopic ultrasonography (EUS) to discuss and endoscopic retrograde cholangiopancreatography (ERCP) execution. METHODS: Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session (Group I) versus performing each procedure in two different sessions (Group II) was made. The following variables were evaluated: epidemiological variables, American Society of Anesthesiologists Physical Status Classification (ASA) level, procedural time, propofol dose, anesthetic complications, endoscopic complications and diagnostic yield, and therapeutic procedures on both groups. T-student, Chi-Square and Fisher test were used for comparison. RESULTS: We included 39 patients in Group I (mean age: 69.85 ± 9.25; 27 men) and 46 in Group II (mean age: 67.46 ± 12.57; 25 men). Procedural time did not differ significantly between both groups (Group Ivs Group II: 93 ± 32.78 vs 98.98 ± 38.17; P >0.05) but the dose of propofol differed (Group I vs Group II: 322.28 ± 250.54 mg vs 516.96 ± 289.06 mg; P = 0.001). Three patients had normal findings on both explorations. Three anesthetic complications [O(2) desaturation (2), broncoaspiration (1)] and 9 endoscopic complications [pancreatitis (6), bleeding (1), perforation (1), cholangitis (1)] occurred without significant differences between both groups (P > 0.05). We did not find any significant difference regarding age, sex, ASA scale level, diagnostic yield or therapeutic maneuvers between both groups. CONCLUSION: The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield, does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session.