Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia. / Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago.

OBJECTIVE: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. MATERIALS AND METHODS: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. RESULTS: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). CONCLUSION: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

OBJETIVOS: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. RESULTADOS: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7; p = 0,1). CONCLUSION: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.

Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago / Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia

Objetivos: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. Material y métodos: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. Resultados: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7;p = 0,1). Conclusión: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.(AU)

Objective: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. Material and methods: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett’s esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett’s esophagus. Conventional parameters and substantially impaired values of the tests were compared. Results: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). Conclusion: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.(AU)

En bloc resection vs. Gips procedure in pilonidal sinus surgery. / Resección en bloque vs. técnica de Gips en cirugía del sinus pilonidal.

INTRODUCTION: Pilonidal sinus (PS) is an infectious/inflammatory condition of the sacrococcygeal region, with frequent relapses. There is no clear consensus as to which management technique is best. The most widely used technique is en bloc resection (EBR), but less invasive methods (Gips procedure) are now being developed. OBJECTIVE: To compare complications and progression of pediatric patients undergoing PS surgery in our institution using two different surgical techniques. MATERIAL AND METHODS: A retrospective study of patients under 16 years of age undergoing PS surgery (EBR/Gips procedure) for the first time from 2014 to 2020 was carried out. Demographic variables, complications in the first month (exudate, wound infection, dehiscence, and bleeding), and result at the end of follow-up were collected. Qualitative variables were expressed as absolute frequency and percentage, whereas quantitative variables were expressed as mean and standard deviation. RESULTS: 60 patients underwent surgery. EBR was used in the first group, and the Gips procedure was used in the second group (76.67%, n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex (32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI (26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention (10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips procedure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%. CONCLUSION: The Gips procedure is a minimally invasive alternative to EBR. It avoids dehiscence, and time to healing is shorter. Therefore, it should be regarded as the first-line treatment in PS patients.

INTRODUCCION: El sinus pilonidal (SP) es una enfermedad infecciosa/inflamatoria de la región sacrococcígea, que asocia recaídas frecuentes, sin un consenso claro sobre su manejo óptimo. La técnica más empleada es la resección en bloque (RB), pero se están desarrollando métodos menos invasivos (técnica de Gips). OBJETIVOS: Comparar las complicaciones y evolución de pacientes pediátricos intervenidos de SP en nuestro centro con dos técnicas quirúrgicas diferentes. MATERIAL Y METODOS: Estudio retrospectivo de pacientes menores de 16 años intervenidos por primera vez de SP (RB/técnica de Gips) entre 2014 y 2020. Se recogieron variables demográficas, complicaciones en el primer mes (exudado, infección de herida, dehiscencia, sangrado) y resultado al final del seguimiento. Las variables cualitativas se expresaron mediante frecuencia absoluta y porcentaje, y las cuantitativas mediante media y desviación estándar. RESULTADOS: Se intervinieron 60 pacientes: el primer grupo mediante RB y el segundo mediante técnica de Gips (76,67%, n = 46 vs. 23,33%, n = 14). Ambos fueron comparables en cuanto a sexo (32,61% vs. 35,71% varones), edad (14,04 vs. 13,79 años) e IMC (26,63 vs. 26,20 kg/m2) durante la cirugía. Se reintervinieron 6 pacientes (10,87% vs. 7,14%; p = 0,684). La mediana del tiempo de seguimiento hasta la curación fue de 6,13 ± 0,98 vs. 3,31 ± 1,26 meses (p < 0,024). La técnica de Gips no presenta dehiscencias, a diferencia de la RB con un 65,22%. CONCLUSION: La técnica de Gips es una alternativa mínimamente invasiva a la RB, que evita la dehiscencia y precisa menos tiempo en alcanzar la curación, por lo que debería emplearse como tratamiento de primera elección.

Resección en bloque vs. técnica de Gips en cirugía del sinus pilonidal / En bloc resection vs. Gips procedure in pilonidal sinus surgery

Introducción: El sinus pilonidal (SP) es una enfermedad infecciosa/inflamatoria de la región sacrococcígea, que asocia recaídas frecuentes,sin un consenso claro sobre su manejo óptimo. La técnica más empleadaes la resección en bloque (RB), pero se están desarrollando métodosmenos invasivos (técnica de Gips).Objetivo. Comparar las complicaciones y evolución de pacientespediátricos intervenidos de SP en nuestro centro con dos técnicas qui-rúrgicas diferentes.Material y métodos: Estudio retrospectivo de pacientes < 16 añosintervenidos por primera vez de SP (RB/técnica de Gips) entre 2014 y2020. Se recogieron variables demográficas, complicaciones en el primermes (exudado, infección de herida, dehiscencia, sangrado) y resultado alfinal del seguimiento. Las variables cualitativas se expresaron mediantefrecuencia absoluta y porcentaje, y las cuantitativas mediante media ydesviación estándar.Resultados: Se intervinieron 60 pacientes: el primer grupo me-diante RB y el segundo mediante técnica de Gips (76,67%, n = 46 vs.23,33%, n = 14). Ambos fueron comparables en cuanto a sexo (32,61%vs. 35,71% varones), edad (14,04 vs. 13,79 años) e IMC (26,63 vs. 26,20kg/m 2 ) durante la cirugía. Se reintervinieron 6 pacientes (10,87% vs.7,14%; p = 0,684). La mediana del tiempo de seguimiento hasta la cu-ración fue de 6,13 ± 0,98 vs. 3,31 ± 1,26 meses (p < 0,024). La técnicade Gips no presenta dehiscencias, a diferencia de la RB con un 65,22%.Conclusiones: La técnica de Gips es una alternativa mínimamenteinvasiva a la RB, que evita la dehiscencia y precisa menos tiempo enalcanzar la curación, por lo que debería emplearse como tratamientode primera elección.

Introduction: Pilonidal sinus (PS) is an infectious/inflammatorycondition of the sacrococcygeal region, with frequent relapses. Thereis no clear consensus as to which management technique is best. Themost widely used technique is en bloc resection (EBR), but less invasivemethods (Gips procedure) are now being developed.Objective: To compare complications and progression of pediatricpatients undergoing PS surgery in our institution using two differentsurgical techniques.Materials and methods: A retrospective study of patients under 16years of age undergoing PS surgery (EBR/Gips procedure) for the firsttime from 2014 to 2020 was carried out. Demographic variables, com-plications in the first month (exudate, wound infection, dehiscence, andbleeding), and result at the end of follow-up were collected. Qualitativevariables were expressed as absolute frequency and percentage, whereasquantitative variables were expressed as mean and standard deviation.Results: 60 patients underwent surgery. EBR was used in the firstgroup, and the Gips procedure was used in the second group (76.67%,n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex(32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI(26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention(10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips proce-dure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%.Conclusions: The Gips procedure is a minimally invasive alternativeto EBR. It avoids dehiscence, and time to healing is shorter. Therefore,it should be regarded as the first-line treatment in PS patients.

Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital. / Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario.

INTRODUCTION: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014. OBJECTIVE: To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established. MATERIAL AND METHODS: A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05. RESULTS: 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed. CONCLUSION: Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.

INTRODUCCION: La exploración de vía aérea mediante broncoscopia flexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugía cardiaca. En nuestro hospital estas exploraciones son practicadas por un neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátrico del Comité de Vía Aérea Pediátrica, formado en 2014. OBJETIVO: Analizar las exploraciones de vía aérea practicadas a neonatos durante su estancia en Neonatología/Unidad de Cuidados Intensivos Neonatales desde la constitución del Comité de Vía Aérea. MATERIAL Y METODOS: Estudio retrospectivo de exploraciones de vía aérea practicadas a neonatos de 2015-2019. Se recogen datos clínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviación estándar. Se consideró un resultado estadísticamente significativo cuando p < 0,05. RESULTADOS: Se analizaron 92 exploraciones de vía aérea en 51 pacientes (género femenino: 54,9%). El 51% de los pacientes fueron prematuros. La extubación fallida y la persistencia de sintomatología respiratoria tras una extubación satisfactoria fueron las indicaciones más frecuentes (35,3%). La estratificación por edad gestacional o por peso al nacimiento no se asociaba a un mayor riesgo de presentar hallazgos patológicos en la exploración. El hallazgo más frecuente fue la parálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) no se encontraron hallazgos patológicos. CONCLUSION: La exploración de la vía aérea es útil en pacientes con estridor postextubación y para identificar parálisis de cuerda vocal tras extubación fallida. Además, permite el diagnóstico y tratamiento de patologías congénitas de la vía aérea.

Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario / Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital

Introducción: La exploración de vía aérea mediante broncoscopiaflexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugíacardiaca. En nuestro hospital estas exploraciones son practicadas porun neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátricodel Comité de Vía Aérea Pediátrica, formado en 2014. Objetivo: Analizar las exploraciones de vía aérea practicadas aneonatos durante su estancia en Neonatología/Unidad de CuidadosIntensivos Neonatales desde la constitución del Comité de Vía Aérea.Materiales. Estudio retrospectivo de exploraciones de vía aéreapracticadas a neonatos en el periodo 2015-2019. Se recogen datosclínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviaciónestándar. Se consideró un resultado estadísticamente significativocuando p < 0,05. Resultados: Se analizaron 92 exploraciones de vía aérea en 51pacientes (género femenino: 54,9%). El 51% de los pacientes fueronprematuros. La extubación fallida y la persistencia de sintomatologíarespiratoria tras una extubación satisfactoria fueron las indicacionesmás frecuentes (35,3%). La estratificación por edad gestacional o porpeso al nacimiento no se asociaba a un mayor riesgo de presentar ha-llazgos patológicos en la exploración. El hallazgo más frecuente fue laparálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) nose encontraron hallazgos patológicos. Conclusión: La exploración de la vía aérea es útil en pacientes conestridor postextubación y para identificar parálisis de cuerda vocal trasextubación fallida. Además, permite el diagnóstico y tratamiento depatologías congénitas de la vía aérea.(AU)

Introduction: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persis-tent stridor and extubation failure, as well as to assess complicationsfollowing cardiac surgery. At our institution, these examinations arecarried out by a pulmonologist, a neonatologist, an otorhinolaryngolo-gist, and a pediatric surgeon from the pediatric airway committee,established in 2014. Objective: To analyze the airway examinations performed in neo-nates during their stay at the neonatology/neonatal intensive care unitsince the airway committee was established.Materials and methods. A retrospective study of the airway ex-aminations conducted in neonates from 2015 to 2019 was carried out.Clinical and demographic data, number of examinations, indications,findings, and complications were collected. Results are presented asmean and standard deviation. Statistical significance was establishedat p < 0.05. Results: 92 airway examinations were analyzed in 51 patients(54.9% of whom were female). 51% of the patients were premature.Extubation failure and persistent respiratory symptoms followingsuccessful extubation were the most frequent indications for airwayexamination (35.3%). Stratification by gestational age or weight atbirth was not associated with an increased risk of pathological findingsat examination (p > 0.05). The most frequent finding was vocal cordparalysis (n = 14; 27.5%). In 10 patients (19.6%), no pathologicalfindings were observed. Conclusion: Airway examination is useful in patients with stridorto identify vocal cord paralysis following extubation failure. It alsoallows congenital airway pathologies to be diagnosed and treated. Thenumber of examinations with no pathological findings was similar tothat reported in international series.(AU)

Usefulness of digestive biopsy in the diagnosis of graft-versus-host disease. / Utilidad de la biopsia digestiva para el diagnóstico de la enfermedad injerto contra huésped.

INTRODUCTION: Graft-versus-host disease (GVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), with high morbidity and mortality rates. Intestinal clinical signs are unspecific, which means differential diagnosis with infections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standard technique, there is no consensus as to which sampling method is best. OBJECTIVE: To assess the results of the biopsy techniques used in patients with suspected intestinal GVHD. MATERIAL AND METHODS: A retrospective study of patients with suspected intestinal GVHD undergoing allo-HSCT from 2010 to 2019 was carried out. They were assessed through digestive biopsy - esophagogastroduodenal biopsy (upper GI endoscopy - UGIE) or rectal biopsy (colonoscopy or direct biopsy). Quantitative variables, expressed as median and interquartile range, and qualitative variables, expressed as absolute frequency and percentage, were collected. RESULTS: 23 patients were studied, 60.9% of whom were male. Median age at biopsy was 9 years (7-14 years). UGIE was used in 47.8% of patients (n=11), colonoscopy was used in 26.1% of patients (n=6), and direct biopsy was used in 34.8% of patients (n=8), with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%) patients, respectively. CONCLUSIONS: Samples taken through direct biopsy stand as an effective alternative in GVHD diagnosis.

INTRODUCCION: La enfermedad injerto contra huésped (EICH) es una complicación frecuente de los trasplantes de células precursoras hematopoyéticas alogénicos (alo-TCPH), con gran morbimortalidad. La clínica intestinal es inespecífica, planteando el diagnóstico diferencial con infecciones y etiología medicamentosa. Aunque las biopsias intestinales son el gold standard, no existe consenso sobre la mejor técnica para obtenerlas. OBJETIVO: Evaluar los resultados de las técnicas empleadas para obtener biopsias en pacientes con sospecha de EICH intestinal. MATERIAL Y METODOS: Estudio retrospectivo que incluye pacientes sometidos a alo-TCPH entre 2010 y 2019, con sospecha de EICH intestinal estudiados mediante biopsias digestivas: esofagogastroduodenales (endoscopia digestiva alta - EDA) o rectales (colonoscopia o biopsia directa). Recogimos variables cuantitativas, expresadas como mediana y rango intercuartílico; y cualitativas, expresadas en frecuencia absoluta y porcentaje. RESULTADOS: Estudiamos 23 pacientes (60,9% varones). La mediana de edad en el momento de la biopsia fue 9 años (7-14 años). Empleamos EDA en el 47,8% (n= 11), colonoscopia en 26,1% (n= 6) y biopsia directa en el 34,8% (n= 8); siendo positivas para EICH en 2 (18,2%), 2 (33,3%) y 4 (50%), respectivamente. CONCLUSIONES: Las muestras obtenidas mediante biopsia directa se plantean como una alternativa eficiente en el diagnóstico del EICH.

Utilidad de la biopsia digestiva para el diagnóstico de la enfermedad injerto contra huésped / Usefulness of digestive biopsy in the diagnosis of graft-versus-host disease

Introducción: La enfermedad injerto contra huésped (EICH) esuna complicación frecuente de los trasplantes de células precursorashematopoyéticas alogénicos (alo-TCPH), con gran morbimortalidad.La clínica intestinal es inespecífica, planteando el diagnóstico diferencial con infecciones y etiología medicamentosa. Aunque las biopsiasintestinales son el gold standard, no existe consenso sobre la mejortécnica para obtenerlas.nObjetivo: Evaluar los resultados de las técnicas empleadas paraobtener biopsias en pacientes con sospecha de EICH intestinal. Material y métodos: Estudio retrospectivo que incluye pacientessometidos a alo-TCPH entre 2010 y 2019, con sospecha de EICH intes-tinal estudiados mediante biopsias digestivas: esofagogastroduodenales(endoscopia digestiva alta - EDA) o rectales (colonoscopia o biopsiadirecta). Recogimos variables cuantitativas, expresadas como medianay rango intercuartílico; y cualitativas, expresadas en frecuencia absolutay porcentaje. Resultados: Estudiamos 23 pacientes (60,9% varones). La medianade edad en el momento de la biopsia fue 9 años (7-14 años). EmpleamosEDA en el 47,8% (n= 11), colonoscopia en 26,1% (n= 6) y biopsiadirecta en el 34,8% (n= 8); siendo positivas para EICH en 2 (18,2%), 2(33,3%) y 4 (50%), respectivamente.Conclusiones. Las muestras obtenidas mediante biopsia directase plantean como una alternativa eficiente en el diagnóstico del EICH.(AU)

Introduction: Graft-versus-host disease (GVHD) is a frequentcomplication of allogeneic hematopoietic stem cell transplantation(allo-HSCT), with high morbidity and mortality rates. Intestinalclinical signs are unspecific, which means differential diagnosis withinfections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standardtechnique, there is no consensus as to which sampling method is best. Objective: To assess the results of the biopsy techniques usedin patients with suspected intestinal GVHD.Materials and methods. A retrospective study of patients withsuspected intestinal GVHD undergoing allo-HSCT from 2010 to2019 was carried out. They were assessed through digestive biopsy– esophagogastroduodenal biopsy (upper GI endoscopy – UGIE)or rectal biopsy (colonoscopy or direct biopsy). Quantitative vari-ables, expressed as median and interquartile range, and qualitativevariables, expressed as absolute frequency and percentage, werecollected. Results:23 patients were studied, 60.9% of whom were male.Median age at biopsy was 9 years (7-14 years). UGIE was used in47.8% of patients (n=11), colonoscopy was used in 26.1% of pa-tients (n=6), and direct biopsy was used in 34.8% of patients (n=8),with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%)patients, respectively. Conclusions: Samples taken through direct biopsy stand as aneffective alternative in GVHD diagnosis.(AU)

[Duodenal capillary hemangioma as an atypical cause of iron deficiency. Case report].

Hemangiomas are benign vascular gastrointestinal tumours. They are infrequent, located in the submucosa, and can be asymptomatic or cause intestinal obstruction, anaemia or ferropenia. Their initial diagnosis is usually endoscopic despite the absence of pathognomonic features. Traditionally their treatment has been surgical although endoscopic resection is now possible. We present a case of ferropenia resolved after endoscopic resection of a capillary duodenal hemangioma.

Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience. / Tratamiento con adhesivo de fibrina asociado o no a diatermia para las fístulas traqueoesofágicas recurrentes: resultados tras más de 20 años de experiencia.

INTRODUCTION: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIAL AND METHODS: A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS: 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS: Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.

INTRODUCCION: La fístula traqueoesofágica recurrente (FTER) representa una complicación frecuente (5-10%) en los pacientes con atresia de esófago (AE). La cirugía abierta de FTER implica una alta morbimortalidad, por lo que los abordajes endoscópicos suponen una alternativa prometedora. Presentamos los resultados a largo plazo de la aplicación broncoscópica de adhesivo de fibrina (AF) en pacientes con FTER secundaria a AE, técnica utilizada por primera vez en 1994 por nuestro equipo. METODOS: Revisión retrospectiva de 1993 a 2019, incluyendo a todos los pacientes diagnosticados de FTER tras la reparación de AE, y tratados con aplicación broncoscópica de AF. En la mayoría de los casos se aplicó diatermia previamente al sellado con AF. El número máximo de sesiones endoscópicas se estableció en cinco; en caso de persistir FTER tras la quinta sesión, se procedió a cirugía abierta. RESULTADOS: 14 pacientes con FTER fueron tratados con AF; en todos salvo los primeros 3 casos (11 pacientes, 78,6%) se aplicó diatermia concomitante. El día promedio del primer tratamiento fue el día 85 de vida (14 a 770). Los pacientes recibieron una media de 2,1 (1-5) sesiones endoscópicas. El seguimiento medio fue de 12,1 (10-20) años. El éxito global fue del 71,4%, sin apenas variar con la aplicación o no de diatermia concomitante (72,7% vs. 66,6%). CONCLUSIONES: La aplicación broncoscópica de adhesivo de fibrina asociado o no a diatermia representa una excelente opción para el tratamiento de FTER en pacientes con AE. El abordaje endoscópico debe considerarse como tratamiento de primera elección para FTER.

[Applicability of a clinical score in patients with suspected foreign body aspiration]. / Aplicabilidad de un score clínico en pacientes con sospecha de aspiración de cuerpo extraño.

OBJECTIVE: To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. MATERIAL AND METHODS: Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. RESULTS: Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. CONCLUSIONS: The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.

OBJETIVOS: Validar el score clínico de Valdivieso y cols. en el manejo de los pacientes con sospecha de aspiración de cuerpo extraño en un hospital de tercer nivel. Dicho score plantea escenarios diferentes según la puntuación obtenida: broncoscopia, TAC, observación o alta. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes a los que se realizó una broncoscopia por sospecha de cuerpo extraño entre noviembre de 2015 y noviembre de 2018. Se recogieron las variables propuestas por el score (atragantamiento presenciado, estridor, sibilancias, hipoventilación unilateral, radiografía alterada y cuerpo extraño de riesgo) y su puntuación para cada paciente, analizando el rendimiento de la prueba mediante la curva COR (característica operativa del receptor). RESULTADOS: Se realizó broncoscopia en 81 pacientes con una edad media de 2,1 años (7 meses-11 años), encontrando cuerpo extraño en el 33,3%. El área bajo la curva COR del score fue de 0,803 (0,695-0,911). En 6 (22,2%) pacientes con cuerpo extraño confirmado el score indicaba inicialmente observación en 5 casos y alta en 1. Excluyendo a los 49 pacientes con atragantamiento con fruto seco o con auscultación alterada unilateral, a los que en nuestro medio se indica directamente broncoscopia, el score clasificó correctamente a los 32 pacientes restantes, lo que hubiese reducido el porcentaje de broncoscopias "blancas" en un 21%. CONCLUSIONES: El score presenta en nuestra muestra un alto rendimiento diagnóstico pero una tasa de falsos negativos no despreciable. En cambio, tiene una especial utilidad en los pacientes que no presentan atragantamiento con fruto seco y/o auscultación alterada unilateral, permitiendo reducir broncoscopias blancas.

Selective Indication of T-Tube in Liver Transplantation: Prospective Validation of the Results of a Randomized Controlled Trial.

BACKGROUND AND AIMS: T-tube placement during choledochocholedochostomy (CCS) associated with liver transplantation (LT) remains controversial. This study was designed to validate the results of an earlier prospective randomized controlled trial (RCT) on use versus nonuse of the T-tube during CCS associated with LT. METHODS: Prospective cohort study. The primary outcome was the overall incidence of biliary complications (BCs). RESULTS: In total, 405 patients were included, and the median overall monitoring period was 29 months (interquartile range: 13-47 months). Selective use of the T-tube reduced BCs (23% vs 13%; P = .003), of which 75% were type IIIa or less in the Clavien-Dindo classification. The overall BC rate did not differ between patients with versus without T-tube placement. CONCLUSIONS: We confirmed that selective use of a rubber T-tube during CCS associated with LT, following the principles established in our prospective RCT, reduced the rate of BC by 10% without detriment, even after enrolling patients at an a priori greater risk of BCs than were the RCT patients.

[Multidisciplinary approach on subglottic pathology: a 5-year review]. / Manejo multidisciplinar de la patología subglótica: revisión a 5 años.

INTRODUCTION: Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. MATERIAL AND METHODS: Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. RESULTS: Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. CONCLUSIONS: Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results.

OBJETIVOS: La patología del espacio subglótico en pacientes pediátricos sigue representando un reto a la hora de elegir el tratamiento idóneo. Presentamos el manejo de los pacientes seguidos en nuestro centro por este motivo durante los últimos 5 años. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes seguidos por patología glotosubglótica (estenosis, quistes o granulomas) entre 2011 y 2016 en un centro de tercer nivel. RESULTADOS: Veintisiete pacientes fueron incluidos en la revisión. Las opciones de tratamiento variaron en función de la naturaleza, la localización y la gravedad de la afectación subglótica. Dos pacientes con estenosis subglótica congénita fueron tratados mediante laringotraqueoplastia. Se incluyeron 17 pacientes con estenosis subglótica adquirida: en uno (5,9%) se realizó laringotraqueoplastia, en uno (5,9%) split cricotiroideo, dos de ellos (11,8%) se intervinieron mediante resección cricotraqueal parcial (PCTR), siete pacientes (41,2%) se sometieron a microcirugía, tres (17,6%) recibieron dilatación traqueal y los tres últimos (17,6%) se sometieron a observación sin necesitar finalmente tratamiento. Cinco pacientes con quistes subglóticos postintubación recibieron microcirugía. De tres pacientes diagnosticados de granuloma subglótico postintubación, dos (66%) se resolvieron espontáneamente y uno (33%) requirió microcirugía. CONCLUSIONES: El manejo de la patología subglótica pediátrica sigue representando un gran desafío. Desde la creación del Comité de Vía Aérea en nuestro centro, la mejoría en la gestión de estos pacientes ha conducido a un manejo multidisciplinar de los mismos, con el consiguiente impacto en los resultados clínicos.

[Recommendations for the prevention of poisoning]. / Recomendaciones sobre la prevención de intoxicaciones.

Poisoning is the fifth leading cause of death from unintentional injury in the WHO European region, while Spain is in the group with a lower rate. Most involuntary poisonings occur in young children while they are at the home, due to unintentional ingestion of therapeutic drugs or household products. Of these, a large percentage is stored in non-original containers and/or within reach of children. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of recommendations, educational as well as legal, to prevent such cases.

[Recommendations for the prevention of drowning]. / Recomendaciones sobre la prevención de ahogamientos.

Drowning is the second leading cause of non-intentional death in children under the age of 19 in Europe. Weather conditions in Spain allow an extended period of contact with water, therefore increasing the risk of drowning (due to the increased exposure), and constitutes the second leading cause of accidental death in children less than 14 years of age. In children younger than 5 years, drowning occurs mostly in pools belonging to private homes or communities, while in older children, drowning is often linked to aquatic recreational activities in lakes, sea, rivers and canals, and at times associated with alcohol consumption. In this article, the Committee on Safety and Non-Intentional Injury Prevention in Childhood of the Spanish Association of Pediatrics provides a series of architectonic, educational and legislative recommendations to prevent such incidents.

[Vascular rings, our experience with 18 cases]. / Anillos vasculares, nuestra experiencia en 18 casos.

AIM: Vascular rings are a rare cause of compression of the trachea and/or the esophagus, causing stridor and/or severe dysphagia. We present our experience in the diagnosis and management of vascular rings. METHODS: Retrospective study in which we analyzed clinical history, diagnosis and management of 18 patients diagnosed with vascular ring between January 1985 and December 2013. We evaluate endoscopy as a diagnostic method. RESULTS: A total of 18 patients were included, with a median age of 2 years. 83.3% (15/18) had some type of symptom: 46.7% (7/15) had respiratory symptoms such as respiratory distress, stridor, recurrent respiratory infections, bronchospasm with wheezing or asthma in older children; 20% (3/15) had digestive symptoms such as dysphagia, vomiting and regurgitation; and 33.3% (5/15) combined respiratory and digestive symptoms. The remaining patients, 16.7% (3/18) were asymptomatic and the diagnosis was casual. The most common types of vascular rings were double aortic arch (27.8%) and aberrant subclavian right artery (27.8%). In 3 cases (16.7%) a Kommerell diverticulum was associated. 44.4% (n = 8) was operated on, the remaining did not present symp- toms which justify the intervention (n = 10). 37.5% of patients had postoperative complications (iatrogenic recurrent paralysis and persistent tracheomalacia). There was no mortality in our series. The median follow-up was 6.4 years. At the moment, 88.9% of patients are asymptomatic, and 33.3% have been definitely discharged. CONCLUSIONS: Vascular rings are rare, and usually presented with common symptoms in childhood. Therefore, in front of a longstanding and recurrent respiratory symptoms, or dysphagia, we should think of a vascular ring. Not all subjects are candidates for surgical correction; therefore a multidisciplinary evaluation is essential.

[Complicated omental cyst after a herniorrhaphy in an infant]. / Quiste epiploico complicado tras una herniorrafia en un lactante.

Omental cysts are uncommon benign masses localized in the abdomen. This article describes the case of a male infant who underwent surgery due to a left inguinal hernia. During the operation a small omental cyst was found inside the sac that was resected. The first postoperative days were uneventful but the infant came back to hospital seven days after. Subsequent imaging and operative findings revealed a complicated omental cyst. This cyst was removed and the histopathology report described an inflammatory pseudotumor. The postoperative evolution was satisfactory and the patient has remained asymptomatic since he was discharged from hospital. In conclusion, it is important to explore the contents of the hernial sac during inguinal hernia repair. The finding of a small omental cyst inside the sac should encourage to study other potential intraabdominal lesions.