Safety and efficacy of large balloon sphincteroplasty in a third care hospital.

BACKGROUND AND AIMS: large balloon sphincteroplasty (LBS) associated with sphincterotomy (ES) has gained acceptance as a useful tool in extracting difficult bile duct stones. Our purpose was to evaluate the efficacy and safety of LBS with balloons > or = 10 mm in clinical practice setting. PATIENTS AND METHODS: unicentre prospective study in a tertiary care hospital. All patients who underwent LBS associated with ES between July 2007 and March 2011 were included prospectively in a database recording clinical aspects, procedure data, outcome and complications.Success is the main outcome defined as complete stone removal documented by absence of any filling defect during a final occlusion cholangiogram and absence of clinical or radiological findings after the ERCP consistent with remaining stones. Complications as pancreatitis, cholangitis, post-ERCP bleeding, perforation and others were also measured. RESULTS: one hundred twenty procedures were made in 109 patients with balloons ranging from 10 to 20 mm. Success rate was 91% in the first attempt and 96.7% after two procedures. Mechanical lithotripsy was only needed in one case (0.8%). Complication rate was 4.2% due to five cases of post-ERCP bleeding in high risk patients. CONCLUSION: large balloon sphincteroplasty associated to sphincterotomy in clinical practice is a very effective and safe technique.

Safety and diagnostic accuracy of percutaneous ultrasound-guided biopsy of the spleen: a multicenter study.

PURPOSE: To analyze the safety and accuracy of ultrasound-guided (USG) percutaneous needle biopsy of the spleen. METHODS: Sixty-two USG needle biopsies performed in 52 patients were retrospectively analyzed: there were 53 biopsies of local lesions and 9 biopsies of diffuse lesions. Fine-needle aspiration (FNA) was performed in 37 cases and core-needle biopsy (CNB) in 25 cases. The complications and diagnostic accuracy of the 2 types of biopsy were compared. RESULTS: Two patients (3.8%) had postprocedural hemorrhage after CNB; one was minor, and the other severe, requiring splenectomy. No bleeding occurred with FNA. The diagnostic accuracy was similar with FNA (86.5%) and CNB (92%), whereas in patients with lymphoma, accuracy of FNA (80%) tended to be lower than that of CNB (100%), although the difference was not statistically significant. CONCLUSION: USG needle biopsy is safe and effective for diagnosing both focal and diffuse splenic lesions. The risk of bleeding may be lower with FNA than with CNB.

Radiofrequency ablation for hepatocellular carcinoma and liver metastases: experience in Hospital La Paz.

INTRODUCTION: Radiofrequency ablation for patients presenting with non-resectable primary or metastatic liver tumours seems to be a valid therapeutic alternative. In the present study, we show a descriptive list of indications, results and complications of Radiofrequency Ablation Technique for treating non-resectable solid hepatic tumours. MATERIALS AND METHODS: Twenty two patients were included in this study; eleven of them (50%) sustained liver metastases from colorectal adenocarcinoma, ten patients (45.5%) had hepatocellular carcinoma and 1 patient had insulinoma. RESULTS: Local recurrence rate of hepatocellular carcinoma was 22.7% and 27.3% for colorectal carcinoma, after a respective median follow-up of 21 and 14 months. Complications rate was 6.9% and technique-associated mortality rate was 0%. CONCLUSIONS: Radiofrequency ablation is an easy to make, safe and useful technique for the treatment of primary and metastatic liver tumours.

[Secondary prophylaxis with elastic band ligation in esophageal-gastric varices]. / Profilaxis secundaria mediante ligadura con bandas elásticas en varices esofagogástricas.

The aim of the present study was to determine the usefulness of elastic band ligation in the prevention of hemorrhage recurrence due to esophageal-gastric varices. Sixty-five patients who survived an episode of variceal hemorrhage were included in the study. Twenty-nine patients (45%) were Child-Pugh class A, 25 (38%) were class B, and 11 (17%) were class C. The cause of cirrhosis was hepatitis C virus and alcohol in 45% and 31% of the patients, respectively. The first ligation session was performed between the third and fifth day after the hemorrhagic episode and subsequent sessions were carried out at intervals of 3-4 weeks. The ligation sessions were performed with antibiotic prophylaxis. A mean of 2.7 bands were placed per session (range 1-5), and the mean number of sessions required per patient to achieve variceal eradication was 2.5 (range 1-6). The rate of bleeding recurrence was 24.6% (16 episodes). In conclusion, endoscopic elastic band ligation is a useful technique for the eradication of esophageal varices and for the prevention of bleeding recurrence.