Escleroterapia endoscópica asistida mediante balón oclusivo como tratamiento de varices gástricas cardiofúndicas de alto riesgo: reporte de dos casos y revisión de la literatura / Fundal variceal bleeding treated with balloon occluded endoscopic inyection sclerotherapy: report of two cases

Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO. Flow was interrupted in the gastro-renal shunt by a femoral access in both patients. The male patient had a new bleeding two months later and died. In the female patient an endosonography performed nine months after the procedure showed absence of remaining varices.

Lesiones focales hepáticas benignas: un hallazgo frecuente a la tomografía computada / Benign focal liver lesions detected by computed tomography: Review of 1,184 examinations

Background: Multidetector computed tomography (MDCT) of the abdomen, with use of contrast medium, is able to detect and differentiate most focal liver lesions. Aim: To determine the prevalence and features of benign focal liver lesions (BFLL) detected by abdominal MDCT. Patients and Methods: We reviewed the reports of contrast abdominal MDCT performed to outpatients between August 2011 and July 2012. Clinical data of examined patients and imaging findings in terms of description of the hepatic parenchyma and the presence of BFLL, were recorded. Results: Data from 1,184 studies were analyzed. Of these, 461 studies (38.4%) reported BFLL. The most prevalent lesions were simple cysts in 290 studies (24%) and hemangiomas in 61 studies (5.1%), granuloma-calcification in 39 (3.2%), focal nodular hyperplasia in 19 (1.6%) and one adenoma. If patients with known causes of liver disease were excluded, the prevalence of BFLL did not change substantially (lesions were found in 396 (37.5%) patients). Compared with livers with signs of damage, normal livers had more cystic lesions (27 and 16.2% respectively, p = 0.014) and hemangiomas (5.3 and 1.1% respectively, p = 0.043). Conclusions: BFLL are very common findings in MDCT studies. Most of these lesions are simple cysts and hemangiomas.

Mortalidad de la pancreatitis aguda: experiencia de 20 años en el Hospital Clínico Universidad de Chile / Mortality of acute pancreatitis in a 20 years period

Background: Mortality for acute pancreatitis (AP) in Chile has fluctuated between 7 ana 10% in last years. Aim: To evaluate AP mortality over a period of 20 years in a clinical hospital in Santiago, Chile. Material and Methods: Review of the database of hospital discharges with the diagnosis of acute pancreatitis, between 1990 and 2010 and the medical records of those patients. Age, gender, length of hospital stay, surgeries, percutaneous interventions and mortality were registered. To compare the evolution of the disease over time, patients were divided in two groups: those hospitalized between 1990 and 1999 and those hospitalized between 2000 and 2010. Results: We reviewed the records of 1367 patients with a median age of 48 years (48% men). In the first period, 93 of637 (14.6%) patients died, whereas in the second period, 22 of 730 patients died (3.0%). In the first and second period, 41.9 and 25.3% of patients were subjected to surgical procedures. The hospital stay was shorter in the second group, compared with the first (14.2 and 25.9 days respectively). Conclusions: There was a decrease in mortality caused by AP in the last 10 years, probably associated with a better interdisciplinary management of these patients.

Colangiografía retrograda endoscópica (CPRE) con gadolinio en pacientes con alergia a medios de contraste iodado / Retrograde cholangio-pancreatography (ERCP) with gadolinium in patients with allergic reactions to iodinated contrast MEDIUM

La reacción alérgica grave al contraste iodado durante colangiopancreatografía retrógrada endoscópica (CPRE) es un evento poco frecuente. En pacientes con antecedentes claros de reacción anafiláctica durante otros exámenes radiológicos, el uso de mismo producto para CPRE representa un riesgo elevado. En nuestro centro, usamos Gadolinio® como medio de contraste para CPRE en 3 pacientes quienes previamente presentaron anafilaxia severa al medio de contraste iodado con requerimiento demaniobras de reanimación. La indicación de CPRE fue coledocolitiasis en dos de ellos, mientras el tercer paciente tuvo siete episodios de pancreatitis aguda sin poder precisar la etiología. El Gadolinio® fue inyectado en todos los pacientes en el colédoco, realizando pancreatografía sólo en uno de ellos. El contraste permitió localizar y posteriormente extraer el cálculo en los dos pacientes. En el tercer caso la pancreatografía contribuyó en el diagnóstico de una anomalía congénita atípica del páncreas, un páncreas anular incompleto, comprobado también con otros métodos diagnósticos. No se observó ningún efecto adverso, se encontró amilasa normal en el suero en todos los casos después del procedimiento. Recomendamos el uso de Gadolinio® como alternativa para CPRE con esta indicación poco frecuente, siendo seguro y permitiendo una calidad aceptable de imágenes radiológicas.

Severe allergic reactions to contrast media in endoscopic retrograde cholangiopancreatography (ERCP) is a rare event. However, in patients with a severe anaphylactic reactions in medical history, the injection of a similar product into the bile-pancreatic ducts can represent a high risk. In our Center, Gadolinium was used for ERCP in 3 patients with previous severe anaphylactic reaction to iodinated contrast medium that required reanimation manoeuvres in an intensive care unit. ERCP was necessary in two of them for choledocholithiasis and for seven bouts of recurrent pancreatitis in the third case. Gadolinium was injected in the common bile duct in the three patients, while pancreatography was performed in only one of them. Thanks to the images obtained, we could localize and retrieve the bile-duct stone in both patients. In the third case, the pancreatography contributed in the diagnosis of an atypical congenital abnormality of pancreas, an incomplete annular pancreas, which was confirmed by other methods. We did not observe any adverse effect of Gadolinium, even the amilasemia remained normal after the ERCP in the three cases. On the base of our experiences, we recommend the Gadolinium as an alternative contrast medium for ERCP with this rare indication, being safe and allowing an acceptable quality of radiological images.