Factores asociados a la presencia de valores alterados de calprotectina fecal en pacientes con estudio endoscópico panentérico normal / No disponible

INTRODUCCIÓN: la calprotectina fecal es un parámetro útil a la hora de decidir si un paciente se puede beneficiar de la realización de estudios endoscópicos. No obstante, cierto número de individuos sintomáticos y con cifras elevadas de este marcador no tendrán lesiones endoscópicas. El objetivo de este estudio es determinar qué factores se asocian a cifras alteradas de calprotectina fecal en pacientes con estudios endoscópicos de intestino delgado y colon normales. MÉTODOS: estudio prospectivo y observacional de pacientes con síntomas digestivos. Se ha analizado la asociación de diferentes variables con cifras alteradas de calprotectina y estudios endoscópicos (cápsula de intestino delgado y colonoscopia) negativos. RESULTADOS: se incluyen 143 pacientes (98 mujeres - 68,5 %), con una edad media 40,06 ± 16,42 (15-82) años. El consumo de tabaco y la toma de antiinflamatorios no esteroideos se asoció a la presencia de cifras alteradas de calprotectina y estudios endoscópicos negativos (p: 0,029 y p: 0,006). Los valores medios de calprotectina fecal fueron significativamente mayores entre los fumadores, consumidores de antiinflamatorios y pacientes con test positivo de sobrecrecimiento bacteriano de intestino delgado. El tabaquismo (OR: 3,505; p: 0,028), la toma de antiinflamatorios (OR: 3,473; p: 0,021) y el sobrecrecimiento bacteriano (OR: 3,172; p: 0,013) son factores de riesgo independientes para presentar una calprotectina alterada sin lesiones endoscópicas. No se obtuvo asociación con ninguna otra variable. CONCLUSIONES: el consumo de tabaco y de antiinflamatorios no esteroideos tiene una fuerte asociación con la presencia de valores elevados de calprotectina en ausencia de lesiones endoscópicas. Se ha observado también asociación con el sobrecrecimiento bacteriano de intestino delgado

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Factors associated with the presence of abnormal levels of fecal calprotectin in patients with negative panenteric studies.

BACKGROUND: fecal calprotectin is a selection tool prior to endoscopic studies in patients with gastrointestinal symptoms. However, some symptomatic patients with altered fecal calprotectin will not have any endoscopic lesions. The aim of the study was to determine the factors associated with the presence of altered fecal calprotectin in patients with negative endoscopic studies of the colon and small bowel. METHODS: this was an observational, prospective study of patients with digestive symptoms. The association of different clinical factors with elevated fecal calprotectin in the absence of endoscopic lesions of the colon and small bowel were analyzed. RESULTS: 143 patients were included in the study, 98 were female (68.5 %) and the mean age was 40.06 ± 16.42 (15-82) years. Smoking and non-steroidal anti-inflammatory drug intake were associated with altered fecal calprotectin in patients with a negative endoscopy of the colon and small bowel (p = 0.029 and p = 0.006). The mean values of fecal calprotectin were significantly higher in smokers, users of non-steroidal anti-inflammatory drugs and patients with small intestine bacterial overgrowth. Smoking (OR: 3.505; p = 0.028), non-steroidal anti-inflammatory drugs intake (OR: 3.473; p = 0.021) and small intestine bacterial overgrowth (OR: 3.172; p = 0.013) were independent risk factors for altered fecal calprotectin in the absence of endoscopic lesions. No association was found for any of the other variables. CONCLUSIONS: smoking and the use of non-steroidal anti-inflammatory drugs are strongly associated with elevated levels of fecal calprotectin in symptomatic patients with a negative colonoscopy and capsule endoscopy of the small bowel. Small intestine bacterial overgrowth is also associated.

Formación en Ecografía de los Médicos Residentes de Aparato Digestivo: encuesta y proyecto docente de la Asociación Española de Ecografía Digestiva / Training in Ultrasound for Resident Physicians in Gastroenterology: a survey and training project by the Spanish Association of Digestive Ultrasound (Asociación Española de Ecografía Digestiva - AEED)

Antecedentes: el programa de formación de la Especialidad de Aparato Digestivo, que deben seguir los Médicos Internos y Residentes de Aparato Digestivo, obliga a que estos dominen la ecografía digestiva diagnóstica y terapéutica. Métodos: la Asociación Española de Ecografía Digestiva ha realizado una encuesta a los 93 Servicios de Aparato Digestivo con programa de formación de Médicos Internos y Residentes de Aparato Digestivo para conocer la situación exacta de la docencia en ecografía digestiva. Resultados: solo 31 de los 93 (33%) Servicios de Aparato Digestivo podían dar formación en Ecografía Digestiva. Un 33% (48 de 148) de los Médicos Internos y Residentes de Aparato Digestivo no recibían una formación específica en ecografía digestiva, y otro 31% (46 de 148) recibían una formación específica pero en condiciones mejorables. Estas deficiencias afectaban a todas las Comunidades Autónomas de España, 8 de las cuales carecían totalmente de Servicios de Aparato Digestivo con capacidad para formar en Ecografía Digestiva. Conclusiones: existe un déficit importante de Servicios de Aparato Digestivo que puedan dar formación en Ecografía Digestiva a los Médicos Internos y Residentes de Aparato Digestivo y ello provoca una notable desigualdad formativa. Hasta que se pueda revertir esta situación, la Asociación Española de Ecografía Digestiva ha diseñado un proyecto formativo en Ecografía Digestiva dirigido a dar una docencia adecuada a todos los Médicos Internos y Residentes de Aparato Digestivo que lo necesiten

Background: the training program of the gastroenterology specialty that is mandatory for resident physicians, obliges them to be proficient in diagnostic and therapeutic digestive ultrasound tools. Methodology: the Asociación Española de Ecografía Digestiva (AEED) performed a survey of the 93 Departments of Gastroenterology with training programs for resident physicians in gastroenterology, in order to assess the exact situation of training in digestive ultrasound in Spain. Results: only 31 of the 93 (33%) Departments of Gastroenterology were able to provide training in Digestive Ultrasound. Moreover, 33% (48 out of 148) of the residents in gastroenterology did not receive specific training in digestive ultrasound. Whereas, 31% (46 out of 148) had received some specific training, but with ample room for improvement. These deficiencies were spread throughout the Spanish regions (Autonomous Communities) in an uneven manner, with almost half totally lacking gastroenterology departments that were capable of providing digestive ultrasound training. Conclusions: there is a significant deficit of gastroenterology departments capable of providing training in digestive ultrasound to residents, causing a significant training inequality. Until this situation can be reversed, the AEED has designed a training project in digestive ultrasound aimed at providing adequate training to all residents in gastroenterology as required

Training in Ultrasound for Resident Physicians in Gastroenterology: a survey and training project by the Spanish Association of Digestive Ultrasound (Asociación Española de Ecografía Digestiva - AEED).

BACKGROUND: the training program of the gastroenterology specialty that is mandatory for resident physicians, obliges them to be proficient in diagnostic and therapeutic digestive ultrasound tools. METHODOLOGY: the Asociación Española de Ecografía Digestiva (AEED) performed a survey of the 93 Departments of Gastroenterology with training programs for resident physicians in gastroenterology, in order to assess the exact situation of training in digestive ultrasound in Spain. RESULTS: only 31 of the 93 (33%) Departments of Gastroenterology were able to provide training in Digestive Ultrasound. Moreover, 33% (48 out of 148) of the residents in gastroenterology did not receive specific training in digestive ultrasound. Whereas, 31% (46 out of 148) had received some specific training, but with ample room for improvement. These deficiencies were spread throughout the Spanish regions (Autonomous Communities) in an uneven manner, with almost half totally lacking gastroenterology departments that were capable of providing digestive ultrasound training. CONCLUSIONS: there is a significant deficit of gastroenterology departments capable of providing training in digestive ultrasound to residents, causing a significant training inequality. Until this situation can be reversed, the AEED has designed a training project in digestive ultrasound aimed at providing adequate training to all residents in gastroenterology as required.

Liposarcoma intraabdominal gigante / Giant intra-abdominal liposarcoma

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Giant intra-abdominal liposarcoma.

We report the case of a 67-year-old male with epigastric pain and weight loss during the last nine months. Physical examination revealed a hard palpable mass in the epi-mesogastrium. An abdominal ultrasound identified a large, heterogeneous and hypovascular mass, which compressed the left hepatic lobe and the pancreas.

Gastric schwannoma presenting as a casual ultrasonographic findings.

We present the case of a patient under study due to ascites in which a mass located on the gastric wall was observed during ultrasonography. Further studies (upper endoscopy and computed tomography) confirmed this finding. After an ultrasound-guided percutaneous biopsy, diagnosis of gastric schwannoma was made as intense S-100 expression was found. Surgery was rejected due to the bad clinical situation of the patient and because the mass was an asymptomatic benign tumor.

Schwannoma gástrico como hallazgo ecográfico casual / Gastric schwannoma presenting as a casual ultrasonographic findings

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Fibrolamellar hepatocellular carcinoma: a rare entity diagnosed by abdominal ultrasound.

We present the case of a young man with a hepatic mass in which ultrasound gives great and immediate support for diferential diagnosis.

Utilidad de la elastografía percutánea con la técnica de radiación acústica de la fuerza de impulso para el diagnóstico no invasivo de la pancreatitis crónica / Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis

Objetivo: determinar la precisión diagnóstica con la técnica de la radiación acústica de la fuerza de impulso (ARFI) para el diagnóstico de pancreatitis crónica (PC). Material y métodos: estudio observacional, monocentro, de pacientes a quienes, por sospecha de pancreatitis crónica entre octubre de 2012 y septiembre de 2015, se les realizó un estudio por ultrasonografía endoscópica (USE) y se les clasificó según los criterios estándar y de Rosemont. Evaluamos los mismos pacientes mediante un equipo de ultrasonido ACUSON S2000TM equipado con el software Virtual TouchTM Quantification para obtener la velocidad de onda de corte (Vc) en la cabeza, cuerpo y cola del páncreas. Los datos fueron analizados mediante análisis de la varianza y técnicas de correlación no paramétricos; la precisión diagnóstica fue obtenida mediante el análisis de las curvas ROC. Resultados: evaluamos 33 pacientes (45,5% mujeres) con media de edad de 58,3 ± 11,8 años. Diecisiete con PC y dieciséis clasificados como normal según los criterios estándar. Detectamos diferencias significativas en las medias de Vc en cuerpo de páncreas de pacientes sin (1,27 m/s) y con PC (1,57 m/s) (p = 0,037). El área bajo la curva ROC fue de 0,713 (IC 95% 0,532-0,895) y la precisión diagnóstica, de 69,7% para una Vc de 1,4 m/s en cuerpo pancreático. La media de la Vc en la cabeza (r = 0,421/p < 0,05) y cuerpo de páncreas (r = 0,455/p < 0,05) mostró correlación significativa con el número de criterios USE para PC. Conclusión: la cuantificación percutánea de la rigidez pancreática mediante la técnica ARFI resulta de utilidad para el diagnóstico no invasivo de la pancreatitis crónica (AU)

Objective: To determine the accuracy of the acoustic radiation force impulse (ARFI) technique for the diagnosis of chronic pancreatitis. Materials and methods: We present an observational, single-center study that included patients with suspected chronic pancreatitis in the period between October 2012 and September 2015 who underwent endoscopic ultrasound (EUS) and were classified according to the standard and Rosemont criteria. The same group of patients was assessed by the ARFI technology using ACUSON S2000(TM) equipment with Virtual Touch(TM) Quantification software for the assessment of pancreatic stiffness by obtaining the shear wave velocity (SWV) in the head, body and tail of the pancreas. Data were analyzed using ANOVA and nonparametric correlation methods. Diagnostic accuracy was obtained by analyzing receiver operating characteristic (ROC) curve. Results: A total of thirty-three patients were studied (45.5% women); mean age was 58.3 ± 11.8 years. Seventeen with a diagnosis of chronic pancreatitis and sixteen classified as normal according to standard criteria. A significant difference was detected between the means of SWV in pancreatic body of patients without (SWV: 1.27 m/s) and with chronic pancreatitis (SWV 1.57 m/s), p = 0.037. The area under the ROC curve was 71.3% (95% CI 0.532-0.895) and the accuracy of ARFI for diagnosing chronic pancreatitis was 69.7% for a SWV of 1.4 m/s in the pancreatic body. The SWV means in head (r = 0.421, p < 0.05) and body (r = 0.455, p < 0.05) of the pancreas showed a significant correlation with the number of EUS criteria for chronic pancreatitis. Conclusion: Quantification of pancreatic stiffness with ARFI elastography technique has proven to be useful for the non-invasive diagnosis of chronic pancreatitis (AU)

Carcinoma hepatocelular fibrolamelar, una entidad infrecuente diagnosticada por ecografía abdominal / Fibrolamellar hepatocellular carcinoma: a rare entity diagnosed by abdominal ultrasound

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Usefulness of percutaneous elastography by acoustic radiation force impulse for the non-invasive diagnosis of chronic pancreatitis.

OBJECTIVE: To determine the accuracy of the acoustic radiation force impulse (ARFI) technique for the diagnosis of chronic pancreatitis. MATERIALS AND METHODS: We present an observational, single-center study that included patients with suspected chronic pancreatitis in the period between October 2012 and September 2015 who underwent endoscopic ultrasound (EUS) and were classified according to the standard and Rosemont criteria. The same group of patients was assessed by the ARFI technology using ACUSON S2000™ equipment with Virtual Touch™ Quantification software for the assessment of pancreatic stiffness by obtaining the shear wave velocity (SWV) in the head, body and tail of the pancreas. Data were analyzed using ANOVA and nonparametric correlation methods. Diagnostic accuracy was obtained by analyzing receiver operating characteristic (ROC) curve. RESULTS: A total of thirty-three patients were studied (45.5% women); mean age was 58.3 ± 11.8 years. Seventeen with a diagnosis of chronic pancreatitis and sixteen classified as normal according to standard criteria. A significant difference was detected between the means of SWV in pancreatic body of patients without (SWV: 1.27 m/s) and with chronic pancreatitis (SWV 1.57 m/s), p = 0.037. The area under the ROC curve was 71.3% (95% CI 0.532-0.895) and the accuracy of ARFI for diagnosing chronic pancreatitis was 69.7% for a SWV of 1.4 m/s in the pancreatic body. The SWV means in head (r = 0.421, p < 0.05) and body (r = 0.455, p < 0.05) of the pancreas showed a significant correlation with the number of EUS criteria for chronic pancreatitis. CONCLUSION: Quantification of pancreatic stiffness with ARFI elastography technique has proven to be useful for the non-invasive diagnosis of chronic pancreatitis.

Aneurisma gastroduodenal presentado como masa pancreática / Gastroduodenal artery aneurysm presenting as a pancreatic mass

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Direct percutaneous endoscopic jejunostomy in pediatric age with a pexies triangulation system: report of a case and literature review.

Direct percutaneous endoscopic jejunostomy (DPEJ) is an infrequent procedure as it is not always easy to obtain transillumination, being this the main reason for failure of this technique. In patients with previous surgery, this procedure is more complex and there are only 6 reported cases in pediatric population. In our case, we provide the use of an endoscopic triangulation system with "T" pexies not used before in these cases. With this technique, we guarantee not to replace the introduction system afterwards, obtaining the placement of a balloon fixation system initially. We also provide several improvements that helped us developing the procedure: Placement of the jejunostomy through a gastrostomy; use of water column to avoid penetration in hollow viscus; use of a guide wire, and a triangulation pexy system.

Yeyunostomía endoscópica directa en edad pediátrica mediante sistema de triangulación (PEXIA): aportación de un caso y revisión de la literatura / Direct percutaneous endoscopic jejunostomy in pediatric age with a pexies triangulation system: Report of a case and literature review

La yeyunostomía endoscópica directa es una técnica infrecuente pues no siempre es fácil conseguir la transiluminación, motivo por el que se fracasa en su colocación con mayor frecuencia. En pacientes con cirugía previa aún es más compleja, y en la edad pediátrica sólo hay 6 casos publicados en la literatura. Además se aporta la utilización de un sistema de triangulación con pexias en T que no se ha utilizado hasta ahora en esta indicación. De esta forma nos aseguramos el no tener que retirar posteriormente el sistema de introducción, dejando desde el principio un sistema de fijación con balón. Aportamos varias mejoras que nos ayudaron en la técnica: realización a través de la gastrostomía, uso de columna de agua para evitar paso por vísceras huecas, uso de hilo guía y sistema de pexia-triangulación (AU)

Direct percutaneous endoscopic jejunostomy (DPEJ) is an infrequent procedure as it is not always easy to obtain transillumination, being this the main reason for failure of this technique. In patients with previous surgery, this procedure is more complex and there are only 6 reported cases in pediatric population. In our case, we provide the use of an endoscopic triangulation system with "T" pexies not used before in these cases. With this technique, we guarantee not to replace the introduction system afterwards, obtaining the placement of a balloon fixation system initially. We also provide several improvements that helped us developing the procedure: Placement of the jejunostomy through a gastrostomy; use of water column to avoid penetration in hollow viscus; use of a guide wire, and a triangulation pexy system

Papel de la ecografia Doppler-color en la enfermedad de Rendu-Osler-Weber con afectación hepática / Colour-Doppler features of hepatic involvement in Rendu-Osler-Weber disease

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