Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study.

BACKGROUND: The most common adverse event of endoscopic retrograde cholangiopancreatography is pancreatitis. Precut sphincterotomy has been regarded as a risk factor. Some authors have stated that early precut may actually reduce post-ERCP pancreatitis risk. However, early precut as a preventive measure has not been compared to other preventive measures, such as pancreatic duct stent placement. AIM: To compare the efficacy of early precut sphincterotomy versus pancreatic duct stent placement in high-risk subjects undergoing endoscopic retrograde cholangiopancreatography for the prevention of post-endoscopic cholangiopancreatography. MATERIALS AND METHODS: This was a single-blinded, randomized trial that took place in two tertiary referral centers in Buenos Aires, from November 2011 to December 2013. ERCP subjects presented at least one of the following risk factors: female sex, age less than 40 years, clinical suspicion of sphincter of Oddi dysfunction, previous pancreatitis, and/or common bile duct diameter of less than 8 mm. Only those who presented a difficult biliary cannulation were randomized into two groups: those who received early precut sphincterotomy and those in whom persistency of biliary cannulation was intended, with subsequent pancreatic duct stent placement after cholangiography was achieved. The incidence of post-ERCP pancreatitis, as well as other adverse events incidence, was compared. RESULTS: Overall, 101 patients were enrolled, 51 in the pancreatic duct stent group and 50 in the early precut group. Pancreatitis rate was similar in both groups (3.92% vs 4%, p NS). In all cases, pancreatitis was classified as mild. There were no deaths registered. CONCLUSION: Early precut was associated with an incidence of adverse events similar to pancreatic duct stent placement.

Los adenomas metacrónicos de colon presentan un patrón de desarrollo diferente en pacientes obesos.

INTRODUCTION: XSome authors have assessed the link between obesity and colon adenoma risk. Moreover, it has been reported that obesity could increase the risk of proximal adenoma development. Accordingly, obese patients may have a distinctive pattern of adenoma recurrence. AIM: To determine whether metachronous adenoma features differ between obese and non-obese subjects submitted to colonoscopy surveillance. MATERIALS AND METHODS: We prospectively evaluated all patients over 18 years old that underwent surveillance colonoscopy at our institution between June 2013 and June 2014. Date of prior colonoscopy was registered. A body mass index ≥ 30 was used to define obesity. Analysis looking for variables significantly associated with metachronous adenoma was performed. Metachronous adenoma rate was compared between obese and non-obese subjects, as well as size, location, morphological and histopathological characteristics. RESULTS: Overall, 825 subjects were enrolled. Median time of surveillance colonoscopy was 38.9 months. Obesity was statistically more frequent in those subjects with metachronous adenomas (40% vs 25.71%, p < 0.001). On multivariate analysis, obesity [OR 1.7 (1.01-2.9)] and age [OR 1.02 (1-1.05)] were independently associated with metachronous adenoma presence. Obesity was also significantly associated with a higher risk of right colon adenomas [OR 2.4 (1.76-3.26)] and advanced adenoma [OR 1.99 (1.29-3.06)]. The risk is significantly higher in men and in those with a family history of colorectal cancer/adenoma. CONCLUSION: Obesity was associated with a higher risk of metachronous adenomas on surveillance colonoscopy. A higher risk of right-sided lesions and advanced adenomas was also found in this population.

Celiac disease prevalence is not increased in patients with functional dyspepsia.

BACKGROUND: - Previous evidence trying to assess the risk of celiac disease among dyspeptic patients has been inconclusive, showing in some cases notorious discrepancies. OBJECTIVE: - To determine the prevalence of celiac disease in patients with dyspepsia compared to healthy controls without dyspepsia. METHODS: - Adult patients under evaluation for dyspepsia were invited to participate. These patients were offered an upper gastrointestinal endoscopy with duodenal biopsies. On the other hand, asymptomatic adult volunteers who performed a preventive visit to their primary care physician were invited to participate and agreed to undertake an upper gastrointestinal endoscopy with duodenal biopsies as well. Those patients with histologic signs of villous atrophy were furtherly evaluated and serological tests were performed in order to determine celiac disease diagnosis. Celiac disease prevalence was compared between groups. RESULTS: - Overall, 320 patients with dyspepsia and 320 healthy controls were recruited. There were no significant differences in terms of gender or age between groups. Celiac disease diagnosis was made in 1.25% (4/320) of patients in the dyspepsia group versus 0.62% (2/320) in the control group. CONCLUSION: - Patients with dyspepsia who underwent routine duodenal biopsies did not show an increased risk for celiac disease when compared to healthy individuals.

Celiac disease prevalence is not increased in patients with functional dyspepsia / A prevalência de doença celíaca não é aumentada em pacientes com dispepsia funcional

ABSTRACT BACKGROUND Previous evidence trying to assess the risk of celiac disease among dyspeptic patients has been inconclusive, showing in some cases notorious discrepancies. OBJECTIVE To determine the prevalence of celiac disease in patients with dyspepsia compared to healthy controls without dyspepsia. METHODS Adult patients under evaluation for dyspepsia were invited to participate. These patients were offered an upper gastrointestinal endoscopy with duodenal biopsies. On the other hand, asymptomatic adult volunteers who performed a preventive visit to their primary care physician were invited to participate and agreed to undertake an upper gastrointestinal endoscopy with duodenal biopsies as well. Those patients with histologic signs of villous atrophy were furtherly evaluated and serological tests were performed in order to determine celiac disease diagnosis. Celiac disease prevalence was compared between groups. RESULTS Overall, 320 patients with dyspepsia and 320 healthy controls were recruited. There were no significant differences in terms of gender or age between groups. Celiac disease diagnosis was made in 1.25% (4/320) of patients in the dyspepsia group versus 0.62% (2/320) in the control group. CONCLUSION Patients with dyspepsia who underwent routine duodenal biopsies did not show an increased risk for celiac disease when compared to healthy individuals.

RESUMO CONTEXTO As evidências ao avaliar o risco da doença celíaca entre pacientes dispéptico têm sido inconclusivas, mostrando discrepâncias notórias em alguns casos. OBJETIVO Determinar a prevalência da doença celíaca em pacientes com dispepsia em comparação com controles saudáveis sem dispepsia. MÉTODOS Pacientes adultos sob avaliação para dispepsia foram convidados a participar. A estes pacientes foi oferecida uma endoscopia digestiva com biópsias duodenais. Por outro lado, voluntários adultos assintomáticos, que realizaram uma visita preventiva ao seu médico de atenção primária foram convidados a participar e concordaram em realizar endoscopia digestiva com biópsias duodenais também. Naqueles pacientes com sinais histológicos de atrofia das vilosidades foram melhor avaliados e foram realizados testes sorológicos para determinar o diagnóstico de doença celíaca. A prevalência de doença celíaca foi comparada entre os grupos. RESULTADOS No total, 320 pacientes com dispepsia e 320 controles saudáveis foram recrutados. Não houve nenhuma diferença significativa entre os grupos em termos de sexo ou idade. O diagnóstico de doença celíaca foi feito em 1,25% (4/320) dos pacientes no grupo de dispepsia, contra 0,62% (2/320) no grupo controle. CONCLUSÃO Pacientes com dispepsia submetidos a biópsias duodenais de rotina não têm risco aumentado para a doença celíaca quando comparados com indivíduos saudáveis.

Electromagnetic interference with implantable cardiac pacemakers by video capsule.

BACKGROUND: Electromagnetic fields, such as those generated by cellular phones and metal detectors, may interfere with normal pacemaker function. However, it remains unclear whether the wireless capsule endoscope interacts with implanted pacemakers. This prospective study evaluated potential interactions between the M2A video capsule (Given Imaging, Yoknam, Israel) and implanted pacemakers. METHODS: A total of 100 consecutive patients (70 men, 30 women) with an implanted pacemaker (95 on bipolar mode) were studied. The testing was performed with a functional testing device (Test Cap) for the Given Diagnostic System that reproduces the effect of the video capsule by transmitting at exactly the same frequency. During continuous electrocardiographic monitoring and recording, 100 tests were carried out without changing the pacemaker settings. Those with a positive result were retested 1 week later. RESULTS: The 100 pacemakers evaluated in the study population included the following: 70 dual chamber (11 DDD, 56 DDDR, 3 VDD) and 30 ventricular inhibited (12 VVI, 18 VVIR). In 4 of the 100 patients, pacemaker interference (noise-mode function forcing a synchronous mode) was registered during the Test Cap operation. Three patients had a dual-chamber pacemaker, and one had a single-chamber pacemaker. The interference was reproducible in all cases 1 week later. None of the implanted pacemakers tested was affected by oversensing. CONCLUSIONS: Electromagnetic interferences with pacemakers from the M2A video capsule can occur, but this is without clinical significance. No potentially dangerous pacemaker inhibition was observed.

Avances diagnósticos en el estudio de la hemorragia digestiva de origen oscuro / Diagnostic advances in the study of the obscure digestive hemorrhage

Aproximadamente un 5 por ciento de los pacientes con hemorragia digestiva y más del 38 por ciento de los pacientes con anemia ferropénica sin sangrado visible, no tienen identificado el sitio de sangrado luego del estudio de rutina con esofagogastroduodenoscopía y colonoscopía. Este grupo de pacientes es el que denominamos como "hemorragias digestivas de origen oscuro". En estos pacientes a menudo la causa del sangrado se encuentra a nivel del intestino delgado, y en un 30-40 por ciento de los casos son debidas a angiodisplasias. Los estudios radiológicos del intestino delgado, aún los de doble contraste, son poco sensibles para la detección de lesiones planas, erosiones o alteraciones vasculares. El examen endoscópico del intestino delgado está limitado por la longitud del órgano, su localización libre intraperitoneal sujeto únicamente por el mesenterio, sus múltiples y complejas asas y la distancia a los accesos anatómicos. La cápsula endoscópica es un método no invasivo que permite el estudio del intestino delgado con una mayor sensibilidad diagnóstica que los métodos tradicionales y sin efectos secundarios. Su indicación más frecuente es el estudio de los pacientes con hemorragia digestiva de origen oscuro. Se realiza una reseña de las características del método, sus indicaciones, contraindicaciones y limitaciones actuales. Se presenta la experiencia de los autores en 20 casos estudiados con este método en pacientes con sospecha de hemorragia digestiva de origen oscuro.

Tratamiento de la constipación con una fibra dietética / Treatment of constipation with a dietetic fiber

Es sabido que la dieta ejerce distintos efectos sobre el hábito intestinal, de ahí que las características evacuatorias difieren grandemente entre poblaciones africanas y occidentales. En la literatura mundial existen muchos estudios experimentales que también confirman que la fibra produce materia fecal de mayor peso y disminuye el tiempo de tránsito, así como la motividad colónica. En este ensayo doble ciego cruzado, randomizado contra placebo, fue evaluada la actividad de una fibra dietética (extracto fibroso de granos y ctricos) sobre 40 pacientes adultos (13 hombres y 27 mujeres) que presentaban constipación crónica. La posología utilizada fue de 12 tabletas de la fibra dietética por día, por vía oral durante 4 semanas. La evaluación de los resultados demostró una mejoría de todos los parámetros, mostrando cambios beneficiosos en las características de las deposiciones en concordancia a lo referido por la literatura mundial. El análisis comparativo de los distintos parámetros valorados mostró un aumento evidente del peso de las deposiciones, una disminución del tiempo de tránsito oro-anal, así como del intervalo entre una y otra deposición y una menor consistencia de la materia fecal, con disminución del esfuerzo evacuatorio. La tolerancia general del producto fue buena, ya que los efectos secundarios que se presentaron fueron fundamentalmente distensión abdominal y meteorismo, que en general cedían a los 10 días de tratamiento en forma espontánea

Correlacion entre funcion y estructura pancreatica. Evaluacion del test de secretina y la colangiopancreatografia retrograda. / Correlation of pancreatic function and structure. Evaluation of secretin test and retrograde cholangiopancreatography

Se ha efectuado, en 25 pacientes, un analisis de correlacion entre el test de Secretina y la pancreatografia retrograda. El valor predictivo de normalidad o de alteracion patologica de la glandula brindado por la exploracion funcional del pancreon mediante el test de secretina es confirmado en esta evaluacion comparativa. Esto justifica que este examen sea utilizado como un primer medio de "rastreo" en el estudio de las diferentes pancreatopatias

Litiasis biliar y cirrosis hepática / Biliary lithiasis and hepatic cirrhosis

Presentamos una serie de 17 pacientes con cirrosis hepatica asociada a una litiasis biliar; 14 fueron operados y 3 recibieron un gesto endoscópico. Se lo dividió en 5 grupos: I)con litiasis vesicular (6 casos). II) con litiasis vesicular y de la via biliar principal con colestasis extrahepática (4 casos). III)con litiasis vesicular y de la vía biliar principal con pancreatitis aguda (3 casos). IV)con litiasis residual y colangitis aguda (1 caso operado de urgencia) y V)con litiasis vesicular y de la vía biliar principal con colestasis extrahepática y tratados por vía endoscópica (3 casos). Fueron considerados la bilirrubinemia, la albuminemia y la protrombinemia para evaluar la funcionalidad hepática y el pronóstico. La mortalidad del 23,5%(4 casos), falleciendo 3 de los 4 pacientes colestáticos operados en período electivo y el paciente intervenido de urgencia (Grupo II y IV). Ello evidencia la gravedad de la colestasis extrahepática y de la cirugía de urgencia en los pacientes cirróticos. La papilotmía endoscópica constituye el mejor método terapéutico en los pacientes cirróticos con litiasis de la vía biliar principal y colestasis extrahepática