Tratamiento de pancreatitis recidivante por páncreas divisum y ansa pancreática mediante técnica de Rendez-Vous guiada por ecoendoscopia / The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica

El tratamiento endoscópico de malformaciones ductales pancreáticas causantes de pancreatitis aguda de repetición, como el páncreas divisum o el ansa pancreática, se basa fundamentalmente en la esfinterotomía de la papila minor. En estos casos, no obstante, la complejidad técnica de la colangiopancreatografía endoscópica retrógrada (CPRE) convencional es mayor, pudiendo resultar fallida. Presentamos el caso de un páncreas divisum completo combinado con ansa pancreática, sintomático, en el que, tras fracasar el acceso endoscópico convencional a la papila minor, se logra la canulación y esfinterotomía de esta mediante técnica de Rendez-Vous guiada ecoendoscópicamente (AU)

Endoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP) is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique (AU)

The endoscopic ultrasound-assisted Rendez-Vous technique for treatment of recurrent pancreatitis due to pancreas divisum and ansa pancreatica.

Endoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP) is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique.

Enfermedad inflamatoria intestinal como efecto paradójico del tratamiento con anti-TNF-alfa / Inflammatory bowel disease as a paradoxical effect of anti-TNF alpha therapy

Los anti-TNF-α forman parte del tratamiento de distintas enfermedades inflamatorias, como la enfermedad inflamatoria intestinal (EII). Sin embargo, se han descrito los efectos paradójicos, es decir, el desenmascaramiento o producción de enfermedades similares a aquellas para las que se utilizan. Concretamente, en la EII, el fármaco biológico más implicado ha sido etanercept, el cual además no ha demostrado su utilidad como tratamiento de esta enfermedad. Esta asociación, que no es casual, y que cumple el criterio temporal de causalidad, es un cuadro infrecuente que se da especialmente en pacientes con espondiloartritis. Su reintroducción puede inducir nuevos brotes. No hay diferencias clínicas, endoscópicas ni anatomopatológicas que permitan discernirla de la EII primaria, y el proceso diagnóstico es el mismo. La presentación más habitual es la de enfermedad de Crohn. La estrategia terapéutica más extendida consiste en sustituir etanercept por infliximab, con el cual no se ha descrito recidiva de la enfermedad

Anti-TNF-α therapies are used in the treatment of different inflammatory conditions, such as inflammatory bowel disease (IBD). However, paradoxical effects may occur during treatment. In other words, these drugs can induce or unmask diseases similar to those they were intended to treat. Etanercept is the main anti-TNF-α agent associated with the development of paradoxical IBD; this drug, moreover, has no proven usefulness in the treatment of the disease. This association, which is not coincidental and meets the criteria for a temporal causal association, is infrequent and is seen particularly in patients with spondyloarthritis. Restarting treatment with etanercept may induce new intestinal symptoms. There are no endoscopic, histopathologic or clinical differences between primary and secondary IBD, and both are diagnosed in the same way. The most frequent presentation is Crohn disease. When a paradoxical event occurs, etanercept is usually replaced with infliximab, which has not been associated with disease recurrence

Inflammatory bowel disease as a paradoxical effect of anti-TNF alpha therapy. / Enfermedad inflamatoria intestinal como efecto paradójico del tratamiento con anti-TNF-α.

Anti-TNF-α therapies are used in the treatment of different inflammatory conditions, such as inflammatory bowel disease (IBD). However, paradoxical effects may occur during treatment. In other words, these drugs can induce or unmask diseases similar to those they were intended to treat. Etanercept is the main anti-TNF-α agent associated with the development of paradoxical IBD; this drug, moreover, has no proven usefulness in the treatment of the disease. This association, which is not coincidental and meets the criteria for a temporal causal association, is infrequent and is seen particularly in patients with spondyloarthritis. Restarting treatment with etanercept may induce new intestinal symptoms. There are no endoscopic, histopathologic or clinical differences between primary and secondary IBD, and both are diagnosed in the same way. The most frequent presentation is Crohn disease. When a paradoxical event occurs, etanercept is usually replaced with infliximab, which has not been associated with disease recurrence.