Dysphagia and stenosis secondary to intramural esophageal pseudodiverticulosis.

We present the case of a patient with smoking, alcoholism, cirrhosis and HIV who was endoscopically diagnosed with esophageal candidiasis due to an episode of dysphagia. After treatment with antifungals and PPIs, the patient remained asymptomatic for almost 3 years. He presented an event of food impaction that was resolved by an upper endoscopy in which an esophageal stenosis and multiple esophageal pseudodiverticulosis were visualized. The biopsies only showed chronic nonspecific esophagitis. The stenosis was dilated with a balloon and PPIs were continued, with good response. Esophageal intramural pseudodiverticulosis is rare and can lead to motor disorders and strictures. It has a doubtful association with HIV and a clearer relationship with alcoholism, smoking, diabetes, reflux and candidiasis. The endoscopic diagnosis can be difficult so in order to make an accurate diagnosis is necessary an esophagram or CT. Treatment is based on controlling risk factors and dilating stenosis. The prognosis is usually favorable.

Colocación de prótesis esofágica para el fracaso del tratamiento endoscópico / Esophageal stent placement for endoscopic treatment failure

Up until approximately 10 years ago, the treatment for acute refractory esophageal variceal bleeding was balloon tamponading. Esophageal fully covered self-expanding stents are considered as effective as balloons and also much safer. They are kept in situ for longer periods, what eases the access to more definitive treatments with a low complication rate. We present 6 cases of patients with cirrhosis and massive bleeding due to esophageal varices refractory to conventional treatment, successfully treated with an esophageal fully covered self-expanding stent. There were no major complications, achieving an effective bleeding control in all cases.(AU)

Esophageal stent placement for endoscopic treatment failure.

Up until approximately 10 years ago, the treatment for acute refractory esophageal variceal bleeding was balloon tamponading. Esophageal fully covered self-expanding stents are considered as effective as balloons and also much safer. They are kept in situ for longer periods, what eases the access to more definitive treatments with a low complication rate. We present 6 cases of patients with cirrhosis and massive bleeding due to esophageal varices refractory to conventional treatment, successfully treated with an esophageal fully covered self-expanding stent. There were no major complications, achieving an effective bleeding control in all cases.

Use of teduglutide for short bowel syndrome and Crohn's disease in a patient treated with ustekinumab and vedolizumab dual biologic therapy.

Surgery in Crohn's disease may be the cause of short bowel syndrome that may lead to kidney dysfunction. Dual biologic therapy is rarely needed to control activity. We present a case of a 61-year-old steroid dependent (A2L1B3p) female who had undergone surgery on three occasions: ileocecal resection (resection of 15 cm of terminal ileum); resection of right and left colon up to sigmoid; proctectomy with intersphincteric resection along with ileostomy due to a rectovaginal fistula. She had been previously treated with prednisone, azathioprine, methotrexate, infliximab and adalimumab but the treatment was discontinued owing to adverse effects. Vedolizumab was started, showing good control of the luminal activity but the rectovaginal fistula recurred. Treatment changed to ustekinumab, the fistula activity was controlled but the mucosa activity recurred. 11 months after commencing with ustekinumab, vedolizumab was added to the treatment and complete remission was achieved for three years. Simultaneously, the patient developed renal dysfunction derived from the short bowel syndrome that led to chronic kidney failure. In the face of potential renal replacement therapy, a new therapy with 2.5 mg/sc/d teduglutide was started achieving stable figures of creatinine and normalization of the glomerular filtration rate.

A rare endoscopic finding: primary esophageal melanoma.

We report a case of a patient accidentally diagnosed with an esophageal lesion compatible (histologically and immunohistochemically) with epithelioid melanoma. The skin examination did not reveal any evidence of melanoma and the patient was diagnosed with primary malignant melanoma of the esophagus. It's a very rare tumour. The majority of melanocytic lesions of the gastrointestinal tract are presumably secondary to a cutaneous melanoma and in order to discard this, a thorough skin examination is needed. Diagnosis is based on endoscopic image, histological data and especially on immunohistochemical evaluation. Primary malignant melanoma has a very poor prognosis as it usually presents distant metastasis when diagnosed. Surgery (with or without associated immunotherapy) remains the base of treatment in absence of advanced disease.

Correction: Chaparro et al. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J. Clin. Med. 2021, 10, 2885.

The authors wish to make the following corrections to this paper [...].

Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study.

(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD-Crohn's disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)-during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31-56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.

Revisión de la enfermedad relacionada con la IgG4 / Review of IgG4-related disease

La enfermedad relacionada (ER) con la IgG4 es un proceso fibroinflamatorio relacionado con la inmumomediación. Los órganos que se ven afectados por esta enfermedad más frecuentemente son: páncreas, vía biliar, glándulas salivares mayores, lacrimales, retroperitoneo y linfáticos. En las últimas décadas, esta enfermedad ha sido reconocida como un trastorno sistémico que engloba a muchas afecciones individuales de órganos, antes no relacionadas y conocidas como entidades independientes. Las características comunes compartidas por las distintas entidades que componen la ER-IgG4 son: cifras elevadas de IgG4 sérica, alteraciones en las pruebas de imagen con tumefacción de aspecto neoplásico de los órganos afectados, características histopatológicas propias y en inmunotinción, buena respuesta al tratamiento con glucocorticoides. En este trabajo, realizaremos una revisión de esta enfermedad con especial énfasis en las características de la pancreatitis autoinmune, colangitis esclerosante relacionada con IgG4, el compromiso del retroperitoneo y el mesenterio, y del tubo digestivo

IgG4-related disease is a fibrous-inflammatory process related to immunomodulation. The most commonly affected organs are: the pancreas, bile duct, major salivary glands, lacrimal glands, retroperitoneum and lymphatic ducts. In recent decades, this disease has been recognised as a systemic disorder that includes many single organ disorders, previously unrelated and known as independent entities. The common characteristics shared by the different entities that make up the IgG4-related disease are: raised serum IgG4 levels, alterations in the imaging tests with neoplastic-like swelling of the affected organs, specific histopathological characteristics and in immunostaining, as well as good response to treatment with glucocorticoids. In this work, we will review this pathology with a special emphasis on the characteristics of autoimmune pancreatitis, sclerosing cholangitis related to IgG4 and the involvement of the retroperitoneum, mesenterium and the digestive tract

Review of IgG4-related disease. / Revisión de la enfermedad relacionada con la IgG4.

IgG4-related disease is a fibrous-inflammatory process related to immunomodulation. The most commonly affected organs are: the pancreas, bile duct, major salivary glands, lacrimal glands, retroperitoneum and lymphatic ducts. In recent decades, this disease has been recognised as a systemic disorder that includes many single organ disorders, previously unrelated and known as independent entities. The common characteristics shared by the different entities that make up the IgG4-related disease are: raised serum IgG4 levels, alterations in the imaging tests with neoplastic-like swelling of the affected organs, specific histopathological characteristics and in immunostaining, as well as good response to treatment with glucocorticoids. In this work, we will review this pathology with a special emphasis on the characteristics of autoimmune pancreatitis, sclerosing cholangitis related to IgG4 and the involvement of the retroperitoneum, mesenterium and the digestive tract.

Ablación intraductal por radiofrecuencia en neoplasias biliopancreáticas inoperables con ictericia: experiencia en un hospital comarcal / Intraductal ablation by radiofrequency for inoperable biliopancreatic neoplasms with jaundice: experience at a regional hospital

En la actualidad, el tratamiento de elección en las neoplasias biliopancreáticas inoperables y/o irresecables complicadas con ictericia es la colocación de prótesis metálicas biliares, siendo la complicación más frecuente la obstrucción por crecimiento tumoral. La aplicación de ablación por radiofrecuencia (ARF) es una técnica novedosa mínimamente invasiva que tiene como objetivo la termoablación del tejido tumoral que condiciona la estenosis biliar. La experiencia con ARF es exigua, con escasos estudios retrospectivos de casos clínicos y con un número limitado de pacientes, por lo que los hay pocos datos sobre la dificultad técnica, seguridad y seguimiento a corto-medio plazo. Presentamos tres casos (un colangiocarcinoma y dos adenocarcinomas de cabeza pancreática) con ictericia por estenosis biliar en los que se aplica ARF con sonda ELRA durante la colangiopancreatografía retrógrada endoscópica (CPRE), realizando seguimiento durante diez meses donde se evalúa la dificultad del tratamiento, la eficacia y las complicaciones inmediatas y a medio plazo

The current treatment of choice for inoperable and/or unresectable biliopancreatic neoplasms complicated by jaundice is the placement of metal biliary stents. The most common complication is obstruction due to tumor growth. The application of radiofrequency ablation (RFA) is a new minimally invasive technique for the thermal ablation of the tumor tissue that causes biliary stenosis. Experience with RFA is scarce and there are few retrospective studies of clinical cases with a limited number of patients. Thus, there is little information on technical difficulty, safety and short-medium term monitoring. We present three cases, one cholangiocarcinoma and two pancreatic adenocarcinomas, with jaundice due to biliary stenosis. RFA was used with an ELRA catheter during endoscopic retrograde cholangiopancreatography (ERCP). The patients were monitored for ten months in order to assess the difficulty of treatment, efficacy and immediate and medium-term complications

Intraductal ablation by radiofrequency for inoperable biliopancreatic neoplasms with jaundice: experience at a regional hospital.

The current treatment of choice for inoperable and/or unresectable biliopancreatic neoplasms complicated by jaundice is the placement of metal biliary stents. The most common complication is obstruction due to tumor growth. The application of radiofrequency ablation (RFA) is a new minimally invasive technique for the thermal ablation of the tumor tissue that causes biliary stenosis. Experience with RFA is scarce and there are few retrospective studies of clinical cases with a limited number of patients. Thus, there is little information on technical difficulty, safety and short-medium term monitoring. We present three cases, one cholangiocarcinoma and two pancreatic adenocarcinomas, with jaundice due to biliary stenosis. RFA was used with an ELRA catheter during endoscopic retrograde cholangiopancreatography (ERCP). The patients were monitored for ten months in order to assess the difficulty of treatment, efficacy and immediate and medium-term complications.