RESUMO
A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic "bird-beak" termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly-equipped health care delivery centers and could be used as a rescue treatment in refractory achalasia. We present the youngest patient with achalasia in our region who had a successful response to rescue POEM.
Assuntos
Acalasia Esofágica , Miotomia de Heller , Cirurgia Endoscópica por Orifício Natural , Adolescente , Criança , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura , Humanos , Masculino , Resultado do TratamentoRESUMO
INTRODUCTION: colorectal perforations are one of the most feared complications after performing an endoscopic resection. The use of endoclips is considered for the management of these complications. OBJECTIVES: to evaluate the efficacy and safety of the use of endoclips in the management of perforations and deep mural injuries that occur after an endoscopic colorectal resection. METHODS: a prospective cohort of consecutively included patients was used with a diagnosis of perforation or deep mural injury after an endoscopic colorectal resection treated with endoclips in our institution. The rates of perforation and deep mural injury were obtained. The factors associated with an unfavorable evolution after the placement of the endoclips were analyzed. RESULTS: after 342 endoscopic mucosal resections (EMR) and 42 endoscopic submucosal dissections (ESD), there were 25 cases with perforation or deep mural injury. The deep mural injury rate was 3.22 % and 7.14 % in the case of EMR and ESD, respectively. The perforation rate was 1.46 % and 14.29 % in the case of EMR and ESD, respectively. Successful closure with endoclips was achieved in 24 cases (96 %). Only one patient presented an unfavorable evolution (10 %) after successful closure. The factors associated with an unfavorable evolution were the presence of diffuse peritoneal symptoms and a perforation size greater than or equal to 10 mm. CONCLUSION: endoscopic closure with endoclips is effective to avoid surgery in cases of deep mural injury or perforation after an endoscopic resection.
Assuntos
Colo , Ressecção Endoscópica de Mucosa , Colo/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Endoscopia , Humanos , Mucosa Intestinal , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Duodenal type follicular lymphoma is a rare malignancy accounting for less than 4% of primary non-Hodgkin lymphomas of the gastrointestinal tract and it is a new entity that was recently described in the new update WHO 2016. Data regarding long-term outcome are currently lacking, and for that reason, a consensus on the management of this disease has not been established and treatment. We report a case of a 57-year-old female patient diagnosed with duodenal- type follicular lymphoma grade 3a who was treated with R-CHOP. The aim of this study is to add more data for a greater characterization of the entity and thus select the best management for each case.
Assuntos
Neoplasias Duodenais , Linfoma Folicular , Neoplasias Duodenais/classificação , Neoplasias Duodenais/tratamento farmacológico , Neoplasias Duodenais/patologia , Feminino , Humanos , Linfoma Folicular/classificação , Linfoma Folicular/tratamento farmacológico , Linfoma Folicular/patologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In recent years there has been an increase in the use of self-expanding metallic stents (SEMS) in patients with unresectable malignant stenosis of the bile duct. However, in Peru there are no reports on the safety and efficacy of this procedure. OBJECTIVE: To evaluate the safety and efficacy of the use of SEMS in the palliative management of malignant stenosis of the bile duct. MATERIALS AND METHODS: Retrospective cohort. All patients referred for placement of biliary SEMS as part of a palliative treatment between January 2016 and August 2018 were included. Rates of successful placement of SEMS, adequate palliation of the obstruction, and complications associated with the procedure were obtained. The patency of the prosthesis was evaluated during follow-up. Survival was determined after placement of the prosthesis. RESULTS: We included 32 patients with indication of palliative management due to an unresectable malignant stenosis of the bile duct. Pancreatic cancer (56.25%) followed by cholangiocarcinoma (31.25%) were the most frequent etiologies. A successful first-time placement rate of 96.97% was achieved. Adequate palliation of biliary obstruction was achieved in 100% of patients (p<0.05). Two SEMStc migrated during follow-up (6.25%) being managed with the placement of a new SEMSuc. CONCLUSIONS: The placement of SEMS is a safe and effective therapeutic strategy in the palliative management of patients with malignant obstruction of the biliary tract.
Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/etiologia , Colestase/cirurgia , Cuidados Paliativos/métodos , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do TratamentoRESUMO
We report the case of a 60-year-old Peruvian female who was admitted with abdominal pain and jaundice. Cholangioscopy revealed a leaf-like trematode, Fasciola hepatica. This trematode was extracted with a Dormia's basket via endoscopic retrograde cholangiopancreatography (ERCP).
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Doenças do Ducto Colédoco/parasitologia , Doenças do Ducto Colédoco/cirurgia , Ducto Colédoco/parasitologia , Fasciola hepatica/isolamento & purificação , Fasciolíase/cirurgia , Animais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine the efficacy and safety of double guidewire technique in patients with difficult biliary cannulation during ERCP. MATERIALS AND METHODS: We conducted a retrospective cohort study of all ERCPs performed between January 2015 and July 2016. DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. RESULTS: 24 patients were enrolled with ERCP and DGT; 17 were female (70.8%) and 7 male (29.2%). The average age was 65.21±16.49 years. The most frequent indication was choledocholithiasis (62.5%), then cholangiocarcinoma (12.5%). Post ERCP diagnosis was choledocholithiasis (45.8%), and papillary fibrosis (29.2%). The success of DGT was 87.5%. Three cases of failure cannulation with the DGT were reported, two patients had pancreatitis post ERCP (8.3%), there were no cases of perforations. CONCLUSIONS: TDG, is an effective alternative to difficult biliary cannulation during ERCP with conventional methods; with a high success rate and low rate of post ERCP pancreatitis, similarly to reported in other countries.
Assuntos
Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos RetrospectivosRESUMO
OBJECTIVE: The aim of this study was to report the initial experience of the combined use of biliary sphincterotomy plus balloon dilatation of the papilla for management of large stones. MATERIALS AND METHODS: Design: Retrospective, descriptive. This study included 18 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2012 and April 2014. Patients had multiple large stones, tapered distal common bile duct, previous sphincterotomy, or peri/ intradiverticular papilla. CRE™ dilatation balloons with diameters ranging from 12 to 20 mm were used. Data were recorded as successful procedure, use of lithotripsy and complications during the procedure. RESULTS: The average age was 66.1 years. There was a predominance of the female gender (66.7%). The average size of the bile duct stones was 16.7 mm. The main indications were: giant choledocholithiasis (12 patients, 66.7%) and tapered distal common bile duct (6 patients, 33.3%). The dilatation balloons diameter used were: 15 mm (8 patients, 44.4%), 18 mm (5 patients, 27.8%), 12 mm (3 patients, 16.7%) and 20 mm (2 patients, 11.1%). Complete stone clearance was achieved in 15 patients (83.3%). Lithotripsy was performed in 4 patients (22.2%). There were 3 patients in whom the removal with balloon was unsuccessful, performed surgical management. It was reported 1 case of mild acute pancreatitis (5.5%). CONCLUSIONS: The results show that endoscopic papillary large balloon dilation after sphincterotomy is a safe and effective technique for treatment of difficult bile duct stones.
Assuntos
Coledocolitíase/terapia , Dilatação/métodos , Esfinterotomia Endoscópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Terapia Combinada , Dilatação/instrumentação , Feminino , Humanos , Litotripsia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Visceral hypersensitivity has been proposed as a biological marker of Irritable bowel syndrome (IBS). OBJECTIVE: To evaluate the pain perception during sigmoidoscopy using a visual analog scale of pain in patients with or without IBS, and to assess the pain perception as diagnostic criteria for IBS. We further assessed the sensitivity, specificity and diagnostic efficiency of pain scores to diagnose IBS. METHODS: A prospective case-control study in patients who underwent sigmoidoscopy for the evaluation of gastrointestinal symptoms. All patients completed Rome III criteria questionnaires and divided into two groups: IBS and non-IBS. All participants reported pain scores on visual analog scales after of study. Differences were evaluated. We calculated a receiver-operator characteristic curve (ROC), sensitivity, specificity and diagnostic efficiency. RESULTS: We analyzed 20 patients with IBS and 20 controls. The pain scores were higher in IBS patients compared with non-IBS patients (median, 52.5 vs. 27.5, p = 0.006). The area under the curve was 0.84, at pain score level of ≥ 40 mm with a sensitivity, specificity and diagnostic efficiency of 85%, 75% and 80%, respectively. CONCLUSIONS: The degree of pain perception was higher in IBS patients than in non-IBS patients during sigmoidoscopy. A score of pain perception in ≥ 40 mm may predict the diagnosis of IBS with good sensitivity (85%) and specificity (75%).
Assuntos
Síndrome do Intestino Irritável/diagnóstico , Percepção da Dor , Sigmoidoscopia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC. METHODS: We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure. RESULTS: The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively. CONCLUSION: Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.
RESUMO
We report the case of 48 year old female patient without a history of significance importance.(refuses blood transfusion). She complaint of diarrhea of four months of duration and weight loss of 8 kg. she added episodes of hematochezia and severe anemia requiring transfusion. An intrahemorrhagic colonoscopy was performed detecting three ulcerated lesions. First at 10 cm from the anus, one in transverse colon distal, another similar ulcer in the proximal transverse The biopsies showed ulcer granulation tissue, abundant macrophages with intracytoplasmic structures consistent with histoplasmosis. Tests showed no tuberculosis or intestinal parasitosis. HIV testing (ELISA and Western Blot) were positive. The CD4 (78 cells) and extrapulmonary histoplasmosis were the criteria defined stage AIDS. The extrapulmonary histoplasmosis defines stage IV in immunosuppressed patients with HIV. Lower gastrointestinal bleeding colonic ulcer secondary to Histoplasma is a rare form presentation as a diagnostic manifestation of AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Doenças do Colo/etiologia , Soropositividade para HIV/diagnóstico , Histoplasmose/etiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Doenças do Colo/tratamento farmacológico , Colonoscopia , Quimioterapia Combinada , Feminino , Hemorragia Gastrointestinal/etiologia , Histoplasmose/tratamento farmacológico , Humanos , Macrófagos/microbiologia , Pessoa de Meia-Idade , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Úlcera/etiologia , Úlcera/microbiologiaRESUMO
A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic "bird-beak" termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly- equipped health care delivery centers and could be used as a rescue treatment in refractory achalasia. We present the youngest patient with achalasia in our region who had a successful response to rescue POEM.
Un paciente varón de 15 años, con el diagnóstico de acalasia realizado 4 años antes, acudió a evaluación por presentar disfagia, regurgitación, pérdida de peso y dolor restroesternal. El esofagograma baritado evidenció una dilatación severa del esófago y la terminación clásica en "pico de pájaro". El paciente había sido sometido a una miotomía de Heller más fundoplicatura y posteriormente a una dilatación esofágica con balón 4 meses atrás. Sin embargo, los síntomas persistían y la última manometría de alta resolución reveló acalasia tipo II. Finalmente, se realizó una miotomía endoscópica por vía oral (POEM); el cual es un procedimiento seguro y accesible en centros experimentados y debidamente equipados, pudiendo ser una adecuada opción de tratamiento en casos de acalasia refractaria. Presentamos el caso del paciente más joven en nuestra región con acalasia con una respuesta exitosa a un POEM de rescate.
RESUMO
Antecedentes: En los últimos años se ha producido un incremento del uso de prótesis metálicas autoexpandibles (SEMS) en pacientes con estenosis malignas irresecables de la vía biliar. Sin embargo, en Perú no se cuentan con reportes sobre la seguridad y eficacia de este procedimiento. Objetivo: Evaluar la seguridad y eficacia del uso de las SEMS en el manejo paliativo de las estenosis malignas de la vía biliar. Materiales y métodos: Cohorte retrospectiva. Se incluyeron a todos los pacientes referidos para colocación de SEMS biliar como parte de un tratamiento paliativo entre enero del 2016 y agosto del 2018. Se obtuvieron las tasas de colocación exitosa de las SEMS, de paliación adecuada de la obstrucción y de complicaciones asociadas al procedimiento. Se evaluó la patencia de la prótesis durante el seguimiento. Se determinó la supervivencia luego de la colocación de la prótesis. Resultados: Se incluyeron 32 pacientes con indicación de manejo paliativo debido a una estenosis maligna irresecable de la vía biliar. El cáncer de páncreas (56,25%) seguido del colangiocarcinoma (31,25%) fueron las etiologías más frecuentes. Se alcanzó una tasa de colocación exitosa en primera intención de 96,97%. La paliación adecuada de la obstrucción biliar se alcanzó en el 100% de los pacientes (p<0,05). Dos SEMStc migraron durante el seguimiento (6,25%) siendo manejados con la colocación de una nueva SEMSnc. Conclusiones: La colocación de SEMS constituye una estrategia segura, con alta tasa de éxito terapéutico en el manejo paliativo de los pacientes con obstrucción maligna de la vía biliar.
Background: In recent years there has been an increase in the use of self-expanding metallic stents (SEMS) in patients with unresectable malignant stenosis of the bile duct. However, in Peru there are no reports on the safety and efficacy of this procedure. Objective: To evaluate the safety and efficacy of the use of SEMS in the palliative management of malignant stenosis of the bile duct. Materials and methods: Retrospective cohort. All patients referred for placement of biliary SEMS as part of a palliative treatment between January 2016 and August 2018 were included. Rates of successful placement of SEMS, adequate palliation of the obstruction, and complications associated with the procedure were obtained. The patency of the prosthesis was evaluated during follow-up. Survival was determined after placement of the prosthesis. Results: We included 32 patients with indication of palliative management due to an unresectable malignant stenosis of the bile duct. Pancreatic cancer (56.25%) followed by cholangiocarcinoma (31.25%) were the most frequent etiologies. A successful first-time placement rate of 96.97% was achieved. Adequate palliation of biliary obstruction was achieved in 100% of patients (p<0.05). Two SEMStc migrated during follow-up (6.25%) being managed with the placement of a new SEMSuc. Conclusions: The placement of SEMS is a safe and effective therapeutic strategy in the palliative management of patients with malignant obstruction of the biliary tract.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Colestase/etiologia , Stents Metálicos Autoexpansíveis , Estudos Retrospectivos , Estudos de Coortes , Resultado do Tratamento , Stents Metálicos Autoexpansíveis/efeitos adversosRESUMO
We report the case of a 60-year-old Peruvian female who was admitted with abdominal pain and jaundice. Cholangioscopy revealed a leaf-like trematode, Fasciola hepatica. This trematode was extracted with a Dormia's basket via endoscopic retrograde cholangiopancreatography (ERCP)
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fasciola hepatica/isolamento & purificação , Fasciolíase/diagnóstico , Ductos Biliares/parasitologia , Ductos Biliares/diagnóstico por imagem , Endoscopia do Sistema Digestório/métodos , Colestase/etiologiaRESUMO
RESUMEN Objetivo: Determinar la eficacia y seguridad de la técnica de doble guía en pacientes con canulación difícil durante una CPRE. Materiales y métodos: El presente estudio se realizó, entre el mes de enero del 2015 y julio del 2016. Se procedió a sintetizar la data, de éxito y complicaciones de la TDG en pacientes con canulación difícil y cuando la inserción de la guía en el conducto pancreático fue hecha involuntariamente después de una técnica estándar. Resultados: 24 pacientes sometidos a una CPRE con TDG; 17 fueron mujeres (70,8%) y 7 varones (29,2%). La edad promedio fue 65,21±16,49 años. La indicación más frecuente fue coledocolitiasis en 62,5 %, luego colangiocarcinoma, 12,5 %. El diagnóstico final post CPRE, fue coledocolitiasis en 45,8%, seguido por fibrosis de papila, 29,2%. El éxito de la técnica de la doble guía fue de 87,5%. Hubo 3 casos de canulación frustra con la TDG, dos pacientes presentaron pancreatitis post CPRE (8,3%), no hubo casos de perforaciones. Conclusiones: La TDG es una alternativa eficaz a la CPRE catalogada como de canulación difícil por técnica convencional, sea cual fuere la etiología, con un alto porcentaje de éxito técnico y con una tasa baja de pancreatitis post CPRE, semejante a la reportada en otros países.
ABSTRACT Objective: To determine the efficacy and safety of double guidewire technique in patients with difficult biliary cannulation during ERCP. Materials and methods: We conducted a retrospective cohort study of all ERCPs performed between January 2015 and July 2016. DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. Results: 24 patients were enrolled with ERCP and DGT; 17 were female (70.8%) and 7 male (29.2%). The average age was 65.21±16.49 years. The most frequent indication was choledocholithiasis (62.5%), then cholangiocarcinoma (12.5%). Post ERCP diagnosis was choledocholithiasis (45.8%), and papillary fibrosis (29.2%). The success of DGT was 87.5%. Three cases of failure cannulation with the DGT were reported, two patients had pancreatitis post ERCP (8.3%), there were no cases of perforations. Conclusions: TDG, is an effective alternative to difficult biliary cannulation during ERCP with conventional methods; with a high success rate and low rate of post ERCP pancreatitis, similarly to reported in other countries.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Cateterismo/instrumentação , Estudos Retrospectivos , Seguimentos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Avaliação de Resultados em Cuidados de SaúdeRESUMO
Objetivo: Describir la experiencia clínica con la técnica de dilatación de la esfinterotomía papilar con balones de gran diámetro en pacientes con coledocolitiasis de difícil extracción. Materiales y métodos: Estudio retrospectivo, diseño descriptivo. Serie de Casos. Se analizaron las historias clínicas de 18 pacientes que fueron sometidos a colangiopancreatografía retrograda endoscópica (CPRE) más dilatación papilar con balón de gran diámetro (DPBGD) por presentar coledocolitiasis de gran tamaño (≥15 mm), desproporción de diámetro entre cálculo y colédoco distal y/o papila yuxtadiverticular. Se emplearon balones dilatadores CRETM entre 12 y 20mm de diámetro. Se consignaron datos como éxito del procedimiento, uso de litotricia; así como complicaciones durante el procedimiento. Resultados: La edad promedio fue 66,1 años. Hubo predominio del género femenino (66,7%). El tamaño promedio de los cálculos en vía biliar fue de 16,7 mm. Las indicaciones de DPBGD fueron: coledocolitiasis gigante (12 pacientes, 66,7%), discordancia entre el diámetro del cálculo y el colédoco distal (6 pacientes, 33,3%). El diámetro de los balones de dilatación más frecuentemente empleados fueron: 15 mm (8 pacientes, 44,4%), 18 mm (5 pacientes, 27,8%), 12 mm (3 pacientes, 16,7%) y 20 mm (2 pacientes, 11,1%). Se consiguió la extracción completa de los cálculos en 15 pacientes (83,3%). Se precisó litotricia en 4 pacientes (22,2%). Hubo 3 pacientes en los que la extracción con balón fue frustra, realizándose manejo quirúrgico. Se reportó 1 caso de pancreatitis aguda leve (5,5%). Conclusiones: Los resultados demuestran que la dilatación con balón es una alternativa segura y eficaz en el manejo de los cálculos en vía biliar de difícil extracción
Objective: The aim of this study was to report the initial experience of the combined use of biliary sphincterotomy plus balloon dilatation of the papilla for management of large stones. Materials and methods: Design: Retrospective, descriptive. This study included 18 patients in whom a hydrostatic dilatation of the papilla with large balloons was performed between June 2012 and April 2014. Patients had multiple large stones, tapered distal common bile duct, previous sphincterotomy, or peri/ intradiverticular papilla. CRE™ dilatation balloons with diameters ranging from 12 to 20 mm were used. Data were recorded as successful procedure, use of lithotripsy and complications during the procedure. Results: The average age was 66.1 years. There was a predominance of the female gender (66.7%). The average size of the bile duct stones was 16.7 mm. The main indications were: giant choledocholithiasis (12 patients, 66.7%) and tapered distal common bile duct (6 patients, 33.3%). The dilatation balloons diameter used were: 15 mm (8 patients, 44.4%), 18 mm (5 patients, 27.8%), 12 mm (3 patients, 16.7%) and 20 mm (2 patients, 11.1%). Complete stone clearance was achieved in 15 patients (83.3%). Lithotripsy was performed in 4 patients (22.2%). There were 3 patients in whom the removal with balloon was unsuccessful, performed surgical management. It was reported 1 case of mild acute pancreatitis (5.5%). Conclusions: The results show that endoscopic papillary large balloon dilation after sphincterotomy is a safe and effective technique for treatment of difficult bile duct stones
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esfinterotomia Endoscópica , Coledocolitíase/terapia , Dilatação/métodos , Litotripsia , Estudos Retrospectivos , Colangiopancreatografia Retrógrada Endoscópica , Resultado do Tratamento , Terapia Combinada , Coledocolitíase/diagnóstico por imagem , Dilatação/instrumentaçãoRESUMO
INTRODUCTION: colorectal perforations are one of the most feared complications after performing an endoscopic resection. The use of endoclips is considered for the management of these complications. OBJECTIVES: to evaluate the efficacy and safety of the use of endoclips in the management of perforations and deep mural injuries that occur after an endoscopic colorectal resection. METHODS: a prospective cohort of consecutively included patients was used with a diagnosis of perforation or deep mural injury after an endoscopic colorectal resection treated with endoclips in our institution. The rates of perforation and deep mural injury were obtained. The factors associated with an unfavorable evolution after the placement of the endoclips were analyzed. RESULTS: after 342 endoscopic mucosal resections (EMR) and 42 endoscopic submucosal dissections (ESD), there were 25 cases with perforation or deep mural injury. The deep mural injury rate was 3.22 % and 7.14 % in the case of EMR and ESD, respectively. The perforation rate was 1.46 % and 14.29 % in the case of EMR and ESD, respectively. Successful closure with endoclips was achieved in 24 cases (96 %). Only one patient presented an unfavorable evolution (10 %) after successful closure. The factors associated with an unfavorable evolution were the presence of diffuse peritoneal symptoms and a perforation size greater than or equal to 10 mm. CONCLUSION: endoscopic closure with endoclips is effective to avoid surgery in cases of deep mural injury or perforation after an endoscopic resection
No disponible
Assuntos
Humanos , Masculino , Feminino , Idoso , Instrumentos Cirúrgicos , Cirurgia Colorretal/efeitos adversos , Endoscopia/efeitos adversos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/terapia , Colo/cirurgia , Deiscência da Ferida Operatória/diagnóstico , Estudos Prospectivos , Cirurgia Colorretal/métodos , Colo/lesões , Deiscência da Ferida Operatória/cirurgiaRESUMO
We review the case of a 14 year old patient complaining of 5 months of bloody and mucous diarrhea, abdominal pain, fever and 10 kg weight loss. At the beginning she received cotrimoxazole and then chloramphenicol with no success. With the suspicious of tuberculosis she was treated for a month with the corresponding drugs with no clinical improvement. Colonoscopy revealed the presence of punch - like ulcers, deep linear ones cobblestoning and skip lesions. The histological analysis showed severe distortion the colonic mucosa, ulcers, granulation tissue, lymphoid follicles and a trend towards the formation of granulomatous lesions. The clinical, endoscopic and histological features were consistent with Crohn disease. The activity index for it was greater than 450. The patient received 60 mg bid hydrocortisone but switched to 20 mg bid methylprednisolone at day 10th. After 10 days and because she was doing worst refractoriness to corticoids was considered and 5 mg / kg Infliximab was started. At the third day of treatment symptoms improved dramatically and one week later was almost asymptomatic. Similar dosage of Infliximab was repeated at weeks 2, 6 and 8. Currently the patient is being treated with 75 mg azathioprine as maintenance therapy.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Doença de Crohn/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Feminino , Humanos , Infliximab , Indução de Remissão , Falha de TratamentoRESUMO
We report the case of a 35-year-old male patient, with a history of six months of pallor and dyspnea associated with severe iron deficiency anemia and positive fecal occult blood tests. Endoscopy of the lower and upper gastrointestinal tract, and a small bowel follow-through were performed, but did not reveal the origin of the bledding. Later, a capsule endoscopy study were performed and detected an elevated area - not well defined - with active bleeding in the jejunal portion of the small bowel, for that reason we decided to complement the study with a double balloon enteroscopy, that allowed us to see more clearly the jejunal lesion: an elevated and ulcerated lesion; the area was marked with India ink to guide the surgeon. In the surgical intervention a resection of the involved jejunal segment was performed; the study of pathological anatomy established the diagnosis of jejunal angiodysplasia. We present this case of obscure gastrointestinal bleeding to emphasize the diagnostic utility of capsule endoscopy and double balloon enteroscopy.
Assuntos
Angiodisplasia/diagnóstico , Endoscopia por Cápsula , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/etiologia , Doenças do Jejuno/diagnóstico , Adulto , Angiodisplasia/complicações , Angiodisplasia/patologia , Angiodisplasia/cirurgia , Endoscópios , Desenho de Equipamento , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/patologia , Doenças do Jejuno/cirurgia , Laparotomia , Masculino , Sangue OcultoRESUMO
INTRODUCCIÓN: ante la ausencia de medidas objetivas para realizar el diagnóstico de Síndrome de Intestino Irritable (SII) se plantea el uso de la hipersensibilidad visceral como marcador biológico de la enfermedad. OBJETIVO: evaluar la percepción de dolor durante la sigmoidoscopia flexible mediante el uso de una escala analógica visual del dolor en pacientes con SII, además de valorar la percepción del dolor como criterio diagnóstico de ayuda al SII mediante la sensibilidad, especificidad y eficiencia diagnóstica de un valor de corte. METODOLOGÍA: se realizó un estudio prospectivo, tipo casos y controles, en pacientes con indicación para estudio sigmoidoscópico con y sin SII, para valorar la percepción del dolor después del examen mediante el empleo de una escala analógica visual. Se evaluaron las diferencias y se confeccionó una curva ROC, además de establecer la sensibilidad, especificidad y eficiencia diagnóstica. RESULTADOS: Se analizaron 20 pacientes con SII y 20 controles. El score de percepción del dolor fue mayor en los pacientes SII comparados con los pacientes no SII (mediana, 52.5 vs 27.5, p=0.006). El área bajo la curva fue de 0.84, determinándose un punto de corte en ≥ 40mm con una sensibilidad, especificidad y eficiencia diagnóstica de 85%, 75% y 80% respectivamente. CONCLUSIONES: Los pacientes con SII experimentan mayor percepción del dolor durante la sigmoidoscopia. Un valor de percepción del dolor en ≥ 40mm puede predecir el diagnóstico del SII con una buena sensibilidad (85%) y especificidad (75%).
INTRODUCTION: Visceral hypersensitivity has been proposed as a biological marker of Irritable bowel syndrome (IBS). OBJECTIVE: To evaluate the pain perception during sigmoidoscopy using a visual analog scale of pain in patients with or without IBS, and to asess the pain perception as diagnostic criteria for IBS. We further assessed the sensitivity, specificity and diagnostic efficiency of pain scores to diagnose IBS. METHODS: A prospective case-control study in patients who underwent sigmoidoscopy for the evaluation of gastrointestinal symptoms. All patients completed Rome III criteria questionnaries and divided into two groups: IBS and non-IBS. All participants reported pain scores on visual analog scales after of study. Differences were evaluated. We calculated a receiver-operator characteristic curve (ROC), sensitivity, specificity and diagnostic efficiency. RESULTS: We analyzed 20 patients with IBS and 20 controls. The pain scores were higher in IBS patients compared with non-IBS patients (median, 52.5 vs. 27.5, p = 0.006). The area under the curve was 0.84, at pain score level of ≥ 40 mm with a sensivity, specificity and diagnostic efficiency of 85%, 75% ando 80%, respectively. CONCLUSIONS: The degree of pain perception was higher in IBS patients than in non-IBS patients during sigmoidoscopy. A score of pain perception in ≥ 40 mm may predict the diagnosis of IBS with good sensivity (85%) and specificity (75%).