Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas.

Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present an additional option--biodegradable stents--for the treatment of colonic strictures and fistulas that have proven refractory to other endoscopic interventions. We analyzed the results from 10 patients with either a postsurgical colorectal stricture (n =7) or rectocutaneous fistula (n =3) treated with the biodegradable SX-ELLA esophageal stent (covered or uncovered). Stents were successfully placed in nine patients, although early migration subsequently occurred in one. Placement was impossible in one patient due to deformity of the area and the fact that the stricture was approximately 30cm from the anus. The fistulas were successfully closed in all patients, although symptoms reappeared in one patient. In the six patients who received stents for strictures, symptoms resolved in five; in the remaining patient, the stent migrated shortly after the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable stents is an effective alternative in the short-to-medium term. The stent does not have to be removed and is subject to very few complications. The drawbacks of this approach are the need to repeat the procedure in some patients and the lack of published series on efficacy.

Efficacy of pediatric colonoscopy used as push enteroscopy in the management of capsule endoscopy findings.

BACKGROUND: recent advances in endoscopy have enabled us to explore the small intestine more efficiently, both with capsule endoscopy and double-balloon enteroscopy. However, these methods are not available in all hospitals. Therefore, when capsule endoscopy reveals proximal jejunal lesions, a possible alternative for treatment could involve push enteroscopy combined with colonoscopy. Lesions can thus be marked for subsequent monitoring. OBJECTIVES: to describe the efficacy of pediatric colonoscopy for diagnosis, the marking of the area explored, and therapeutic options. MATERIAL AND METHODS: between October 2007 and September 2008 a total of 21 enteroscopies were performed using a pediatric colonoscope. Nine of these were used to take jejunal biopsy samples due to suspected disease of the mucosa. In 10 of the remaining 12, capsule endoscopy revealed lesions (vascular malformations or jejunal bleeding), and in 2 intestinal transit time was analyzed due to suspected jejunal stenosis. We used a PENTAX EC-3470-LK pediatric colonoscope, whose 11.6-mm sectional diameter and 3.8-mm working channel make it possible to administer all the usual endoscopic treatments. RESULTS: therapeutic endoscopy was performed on 7 men and 5 women (mean age 63.3 years). Jejunal lesions were observed in 10 cases (5 cases of angiodysplasia, 2 cases of jejunal stenosis, 1 case of nonmalignant thickened jejunal folds, 1 eroded submucosal tumor, and 1 case of duodenal and jejunal varices). The most distal area was marked with India ink (2), hemoclips (4), or both to help locate the lesions using simple abdominal radiography or capsule endoscopy. CONCLUSIONS: jejunal enteroscopy enabled a firm diagnosis to be made in most of the patients studied. We were able to treat 58% of patients and mark the areas explored for subsequent follow-up. With hemoclips we were able to locate the most distal point explored using simple abdominal radiography.

[Suitability of the use of low-molecular-weight heparins in the prevention of venous thromboembolism]. / Adecuación de la utilización de heparinas de bajo peso molecular en la prevención de la enfermedad tromboembólica venosa.

OBJECTIVE: To investigate the prevalence of low-molecular-weight heparin (LMWH) prescription in venous thromboembolism prophylaxis in a general hospital and the suitability of the recommendations from the clinical practice guidelines. METHOD: A descriptive, observational and cross-sectional study of the indication-prescription type, carried out on patients admitted to medical departments and for surgery. RESULTS: 345 patients were included. The prevalence of HBPM use was 44.6% (95% CI, 39.3-50.1). Depending on the risk of thromboembolism, the decision to treat prophylactically (or not) was appropriate in 261 cases (75.7%; 95% CI, 70.7-80.1), and the action guidelines were not suitable for the remainder of patients. 55 patients (15.9%; 95% CI, 12.2-20.2) presented a high risk and were not prescribed prophylactically (underuse); and 29 patients (8.4%; 95% CI, 5.7-11.8) at low risk were treated prophylactically (overuse). There was a relationship between the appropriateness of the prescription and the type of patient (p<0.01). In the group of medical patients the prevalence of prescription was 22.6% (95% CI, 16.9-29.1) and only 33.3% of patients with a high to moderate risk of thromboembolism received prophylaxis. The prevalence of prescription in general surgery was 84.2% and 91.3% in traumatology. CONCLUSIONS: The degree of prophylaxis is adequate in surgical patients, but there was a significant percentage of medical patients with a high to moderate risk who did not receive suitable prophylaxis (underuse), despite recommendations with scientific and professional backing.

Eficacia del colonoscopio pediátrico como enteroscopio de pulsión en el manejo de los hallazgos de la cápsula endoscópica / Efficacy of pediatric colonoscopy used as push enteroscopy in the management of capsule endoscopy findings

Introducción: los recientes avances en endoscopia nos hanpermitido explorar de una forma más eficaz el intestino delgado,tanto con la cápsula endoscópica (CE) como con enteroscopia dedoble balón. El problema que aparece es la no disponibilidad deestos dos métodos en todos los hospitales. Por ello, cuando se venlesiones en la CE, una alternativa posible para el tratamiento delas lesiones de yeyuno proximal podría ser la realización de unaenteroscopia de pulsión con colonoscopio con fines terapéuticosy de marcaje para control de las lesiones.Objetivos: describir la eficacia del colonoscopio pediátrico encuanto al diagnóstico, señalización de zona explorada y posibilidadesterapéuticas.Material y métodos: durante el periodo comprendido entreoctubre de 2007 y septiembre de 2008, se han realizado 21 enteroscopiascon colonoscopio pediátrico, de las cuales 9 eran paratomar biopsias yeyunales por sospecha de patología mucosa. Delas otras 12, en 10 se vieron lesiones por la cápsula endoscópica(malformaciones vasculares o sangrado yeyunal) y en 2 se hizotránsito intestinal sospecha de estenosis yeyunal.Se utilizó un colonoscopio pediátrico PENTAX EC-3470-LKque presenta un diámetro de sección de 11,6 mm y un canal detrabajo de 3,8 mm, lo cual nos permite realizar cualquier tipo detratamiento endoscópico habitual.Resultados: se hizo enteroscopia con fines terapéuticos en7 hombres y 5 mujeres, con una edad media de 63,3 años. Sevieron lesiones endoscópicas en yeyuno en diez casos: 5 angiodisplasias,2 estenosis yeyunales, uno con pliegues engrosados yeyunalescon histología normal, un tumor submucoso erosionado yun caso de varices duodenales y yeyunales.En los últimos pacientes se hizo marcaje de la zona más distalexplorada con tinta china (2) o con hemoclips (4) o con ambos,para ayudar a localizar topográficamente las lesiones mediante radiologíasimple de abdomen o cápsula endoscópica...(AU)

Background: recent advances in endoscopy have enabled us toexplore the small intestine more efficiently, both with capsule endoscopyand double-balloon enteroscopy. However, these methodsare not available in all hospitals. Therefore, when capsule endoscopyreveals proximal jejunal lesions, a possible alternative for treatmentcould involve push enteroscopy combined with colonoscopy. Lesionscan thus be marked for subsequent monitoring.Objectives: to describe the efficacy of pediatric colonoscopyfor diagnosis, the marking of the area explored, and therapeuticoptions.Material and methods: between October 2007 and September2008 a total of 21 enteroscopies were performed using apediatric colonoscope. Nine of these were used to take jejunalbiopsy samples due to suspected disease of the mucosa. In 10 ofthe remaining 12, capsule endoscopy revealed lesions (vascularmalformations or jejunal bleeding), and in 2 intestinal transit timewas analyzed due to suspected jejunal stenosis. We used a PENTAXEC-3470-LK pediatric colonoscope, whose 11.6-mm sectionaldiameter and 3.8-mm working channel make it possible toadminister all the usual endoscopic treatments.Results: therapeutic endoscopy was performed on 7 men and5 women (mean age 63.3 years). Jejunal lesions were observed in10 cases (5 cases of angiodysplasia, 2 cases of jejunal stenosis, 1case of nonmalignant thickened jejunal folds, 1 eroded submucosaltumor, and 1 case of duodenal and jejunal varices). The mostdistal area was marked with India ink (2), hemoclips (4), or both tohelp locate the lesions using simple abdominal radiography orcapsule endoscopy.Conclusions: jejunal enteroscopy enabled a firm diagnosis tobe made in most of the patients studied. We were able to treat58% of patients and mark the areas explored for subsequent follow-up. With hemoclips we were able to locate the most distalpoint explored using simple abdominal radiography(AU)

Meningitis por Listeria como complicación del tratamiento con infliximab en paciente con enfermedad de Crohn / Listeria meningitis as complication of treatment with infliximab in a patient with Crohn's disease

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