Safety and efficacy of endoscopic ultrasound-guided gallbladder drainage combined with endoscopic retrograde cholangiopancreatography in the same session.

BACKGROUND AND AIM: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients. METHODS: Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage. RESULTS: One hundred and nine consecutive patients underwent EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B. CONCLUSIONS: Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.

A Dieulafoy's lesion in a duodenal diverticulum. An infrequent cause of UGIB.

We present the case of an 82-year-old man with a history of heart failure, mitral regurgitation, type 2 DM, hypertension, dilated cardiomyopathy and a paroxysmal atrial flutter. The patient was under treatment with Sintrom. The patient presented to the emergency department due to melenic depositions of a one day evolution and dietary vomiting. There was no rectal bleeding and the patient was admitted three months previously due to self-limited melena with a normal gastroscopy. Anemia of 8 g and an overdose of Sintrom was diagnosed. A gastroscopy was performed and a large duodenal diverticulum with a fresh clot was found that was washed. A Dieulafoy lesion was subsequently found underneath with jet bleeding, which was sclerotic with adrenaline and a hemoclip. There was a favorable evolution after correcting the coagulopathy.

Intramural gastric hematoma in the context of an acute pancreatitis.

Bleeding complications are well known in the context of acute pancreatitis however, intramural hematomas of the superior gastrointestinal tract are rare. The treatment of choice, in absence of active bleeding or other complications, must be conservative, resulting in spontaneous resolution of the hematoma in most of the cases.

Endoscopic ultrasound versus multidetector computed tomography in preoperative gastric cancer staging.

INTRODUCTION: Endoscopic ultrasonography (EUS) is the gold standard technique in loco-regional staging of gastric adenocarcinoma (GAC). Nevertheless, the introduction of multidetector-row computed tomography (MDCT) allows accurate studies to be performed. OBJECTIVE: To compare the diagnostic yield of EUS and MDCT in loco-regional preoperative staging of gastric adenocarcinoma. MATERIAL AND METHODS: This was a retrospective and comparative study of all surgical patients with GAC and preoperative staging by EUS and 64-row MDCT. The results for each case were compared with the histological data. RESULTS: Seventy seven surgical patients with GAC were identified and forty two had a complete preoperative staging and were finally included in the study. With regard to overall accuracy of T staging, EUS was superior to MDCT (62% vs 50%). In a subanalysis of early stages (T1-T2) and advanced stages (T3-T4), accuracy and sensitivity (S) were higher for EUS than for MDTC (83.3% vs 64.29% and 84.4% vs 59.5% respectively), although this did not reach statistical significance. The overall accuracy and sensitivity of EUS for N staging was lower than that for MDCT, although neither comparison reached statistical significance (57% vs 64% and 29% vs 55%). CONCLUSION: EUS diagnostic yield is similar to new MDCT with regard to T and N preoperative staging of GAC. Nevertheless, both techniques should be considered as complementary until more extensive and randomized studies can confirm these results.

Lesión de Dieulafoy en divertículo duodenal. Una causa infrecuente de HDA / A Dieulafoy's lesion in a duodenal diverticulum. An infrequent cause of UGIB

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Hematoma gástrico intramural en el contexto de una pancreatitis aguda / Intramural gastric hematoma in the context of an acute pancreatitis

No disponible

Ultrasonografía endoscópica versus tomografía computarizada en la estadificación preoperatoria del cáncer gástrico / Endoscopic ultrasound versus multidetector computed tomography in preoperative gastric cancer staging

Introducción: la ultrasonografía endoscópica (USE) es la técnica de elección para la estadificación loco-regional del adenocarcinoma gástrico (ACG). Sin embargo, la introducción de la tomografía computarizada multidetector (TCMD) permite obtener estudios de muy alta calidad diagnóstica. Objetivo: nuestro objetivo fue comparar la rentabilidad diagnóstica de la USE frente a la TCMD en la estadificación loco-regional preoperatoria de los pacientes con ACG. Material y métodos: se realizó un estudio retrospectivo y comparativo entre pacientes intervenidos de ACG con estadificación preoperatoria mediante USE y TCMD de 64 filas, comparando en cada caso los resultados con el informe anatomopatológico final. Resultados: se analizaron 77 pacientes intervenidos de ACG, incluyéndose finalmente 42 que disponían de estadificación completa. Para la estadificación "T", la precisión diagnóstica (PD) global de USE fue superior a la de TCMD (62% vs. 50%). En un subanálisis entre estadios precoces (T1-2) y avanzados (T3-T4), la PD y sensibilidad (S) de la USE resultaron ser superiores a las de la TCMD (83,3% vs. 64,29% y 84,4% vs. 59,5% respectivamente), aunque sin alcanzarse niveles de significación estadística. Respecto al estadio N, la PD y S de la USE resultaron inferiores a las de la TCMD, aunque tampoco se alcanzaron diferencias estadísticamente significativas (57% vs. 64% y 29% vs. 55%). Conclusiones: en nuestra experiencia, la rentabilidad diagnóstica de la ecoendoscopia es similar a la de los nuevos TCMD en la estadificación preoperatoria T y N en pacientes con ACG. Sin embargo, ambas técnicas deberían considerarse complementarias hasta que estudios más extensos y aleatorizados puedan confirmar estos resultados (AU)

Introduction: Endoscopic ultrasonography (EUS) is the gold standard technique in loco-regional staging of gastric adenocarcinoma (GAC). Nevertheless, the introduction of multidetector-row computed tomography (MDCT) allows accurate studies to be performed. Objective: To compare the diagnostic yield of EUS and MDCT in loco-regional preoperative staging of gastric adenocarcinoma. Material and methods: This was a retrospective and comparative study of all surgical patients with GAC and preoperative staging by EUS and 64-row MDCT. The results for each case were compared with the histological data. Results: Seventy seven surgical patients with GAC were identified and forty two had a complete preoperative staging and were finally included in the study. With regard to overall accuracy of T staging, EUS was superior to MDCT (62% vs 50%). In a subanalysis of early stages (T1-T2) and advanced stages (T3-T4), accuracy and sensitivity (S) were higher for EUS than for MDTC (83.3% vs 64.29% and 84.4% vs 59.5% respectively), although this did not reach statistical significance. The overall accuracy and sensitivity of EUS for N staging was lower than that for MDCT, although neither comparison reached statistical significance (57% vs 64% and 29% vs 55%). Conclusion: EUS diagnostic yield is similar to new MDCT with regard to T and N preoperative staging of GAC. Nevertheless, both techniques should be considered as complementary until more extensive and randomized studies can confirm these results (AU)