Endoscopic closure of tracheoesophageal fistula for tuberculosis with an over-the-scope-clip.

Surgical management has been the main approach for enteral fistulae. This approach is usually complex due to comorbidities, a wasted nutritional state and anatomical difficulties related to prior multiple interventions. Therefore, endoscopic methods such as clips, self-expanding metal stent (SEMS) and recently, the over scope clip (OTSC®) are increasing in popularity and use. Herein, we present the case of a patient with a HIV infection who was admitted due to respiratory symptoms. Radiological and microbiological studies documented a tracheoesophageal fistula due to tuberculosis (TB) and cytomegalovirus (CMV) infection. Therefore, an esophageal fully-covered stent was placed, which migrated into the stomach. The thoracic surgeons considered an esophagectomy with gastric ascent and muscle patch in the trachea. However, due to his poor nutritional status and comorbidity, an OTSC was placed to treat the fistulae. The patient also received medical treatment with anti-tuberculotics and anti-retrovirals.

Utilización de clip Ovesco en el cierre de fistula traqueoesofágica secundaria a tuberculosis / Endoscopic closure of tracheoesophageal fistula for tuberculosis with an over-the-scope-clip

Las fístulas enterales siempre han sido entidades de manejo quirúrgico y su abordaje suele ser difícil debido a las comorbilidades, el estado nutricional deteriorado y las dificultades anatómicas relacionadas con múltiples intervenciones en estos pacientes. Por estas razones viene aumentando la utilización de métodos endoscópicos como los clips, los stent autoexpandibles y, más recientemente, el over the scope clip (OTSC(R)). Presentamos el caso de un paciente con infección por VIH, que ingresó por síntomas respiratorios. En los estudios se le documenta una fístula traqueoesofágica cuya patología demuestra infección por tuberculosis (TB) y citomegalovirus (CMV), por lo cual se decidió inicialmente colocar un stent esofágico; sin embargo, este migró hacia el estómago. Cirugía de tórax consideró llevarlo a esofagectomía con ascenso gástrico y parche muscular en la tráquea, pero por su mal estado nutricional y comorbilidad decidimos colocar un OTSC(R), con lo cual se corrigió la fistula. Además, se le dio tratamiento antituberculoso y antirretroviral

Surgical management has been the main approach for enteral fistulae. This approach is usually complex due to comorbidities, a wasted nutritional state and anatomical difficulties related to prior multiple interventions. Therefore, endoscopic methods such as clips, self-expanding metal stent (SEMS) and recently, the over scope clip (OTSC(R)) are increasing in popularity and use. Herein, we present the case of a patient with a HIV infection who was admitted due to respiratory symptoms. Radiological and microbiological studies documented a tracheoesophageal fistula due to tuberculosis (TB) and cytomegalovirus (CMV) infection. Therefore, an esophageal fully-covered stent was placed, which migrated into the stomach. The thoracic surgeons considered an esophagectomy with gastric ascent and muscle patch in the trachea. However, due to his poor nutritional status and comorbidity, an OTSC was placed to treat the fistulae. The patient also received medical treatment with anti-tuberculotics and anti-retrovirals

Una mirada actual a la peritonitis bacteriana espontánea / Update on Spontaneous Bacterial Peritonitis

La peritonitis bacteriana espontánea (PBE) es una de las principales complicaciones de los pacientes cirróticos con ascitis y tiene gran importancia por las altas tasas de mortalidad y de recurrencia que presenta y que pueden mejorar considerablemente si se tiene un diagnóstico oportuno y se brinda el tratamiento óptimo. Es de tener en cuenta que, incluso en pacientes asintomáticos, se ha documentado una alta prevalencia de PBE. La profilaxis primaria y secundaria se constituye como una medida de gran relevancia al mejorar la sobrevida y disminuir las tasas de incidencia o recurrencia; sin embargo, deben ser aplicadas con mucha rigurosidad y con un buen seguimiento de los pacientes que van a ser sometidos a las mismas con el fin de prevenir la aparición de resistencia antibiótica. Algunos de los factores determinantes para someter a un paciente a profilaxis antibiótica son: episodio previo de PBE, pacientes con hemorragia de tracto digestivo y pacientes con evidencia de disfunción hepática dada por bajas concentraciones de proteínas en líquido ascítico e hiperbilirrubinemia. Con el uso de las principales bases de datos biomédicas (PubMed, ClinicalKey, EBSCO, Scielo, Scopus y OVID) se hizo una revisión de la literatura médica referente a la PBE, publicada tanto en español como en inglés, durante los últimos 5 años; dentro de esta se encontraron referencias bibliográficas muy valiosas, las cuales también fueron consultadas. Se evidenció cómo hay pocas publicaciones tanto a nivel latinoamericano como colombiano, dentro de las cuales se referencian algunas escritas por el mismo autor o por su grupo de trabajo.

Spontaneous bacterial peritonitis (SBP) is a serious complication that occurs among cirrhotic patients with ascites. It is a major cause of the high rates of mortality among these patients and has high rates of recurrence. Early diagnosis and optimal treatment can result in considerable improvements. It is noteworthy that high rates of prevalence of SBP have even been documented in asymptomatic patients. Primary and secondary prophylaxis are of great significance for improving patients chances of survival and for decreasing the initial incidence and recurrence of SBP. Nevertheless, treatment must be applied with great rigor and patients must be monitored carefully to prevent the development of antibiotic resistance. Some of determinants for treatment with antibiotics are previous episode(s) of SBP, digestive tract, evidence of hepatic dysfunction, low concentrations of proteins in ascetic fluid and hyperbilirubinemia. This updates is based on a review of the medical literature about SBP published in both Spanish and English over the last five years and available in major biomedical databases (PubMed, ClinicalKey, EBSCO, Scielo, Scopus and OVID). Our review revealed that there are very few publications in Colombia and the rest of Latin America and Colombia, some of which were written by the authors and their workgroup.