Ligadura elástica complementada de esclerosis en el tratamiento de várices esofágicas: experiencia en la hemorragia activa y en el tratamiento electivo / Endoscopic ligation plus sclerotherapy in the treatment of bleeding esophageal varices

Background: Endoscopic ligation is the treatment of choice for bleeding esophageal varices. The usefulness of additional sclerotherapy is not clear. Aim: To assess the effectiveness of ligation followed by sclerotherapy in the treatment of variceal bleeding. Patients and methods: Forty eight patients with variceal bleeding admitted for emergency treatment and 73 patients admitted for elective treatment were studied. Varices were ligated until a significant reduction in size was achieved. Eradication was completed with the injection of 1 per cent polidocanol. Results: In 34 of 48 patients admitted for emergency treatment, the site of variceal rupture was identified. In all these subjects, and in 13 of 14 patients in whom the rupture site was not identified, hemorrhage was stopped with the procedure. Varices were eradicated in 108 of the 121 patients. Hemorrhage recidivated in 12.5 per cent of patients admitted for emergency treatment, in a period of 14 months of follow up and in 9.6 per cent of those admitted for elective treatment, in a period of 16 months follow up. Mortality was 14, 18 and 57 per cent among patients classified as Child Pugh A, B or C, respectively. Conclusions: Endoscopic ligation is effective in the treatment of variceal bleeding. Adding sclerotherapy, variceal eradication is achieved in a high percentage of patients. Survival depends on hepatic function

Hemorragia digestiva baja por úlceras de colon secundarias a antinflamatorios no esteroidales / Lower gastrointestinal bleeding from colonic ulcerations due to nonsteroidal antinflammatory drugs

Se presenta el caso de una mujer de 73 años, con hemorragia digestiva baja de etiología desconocida. Sus antecedentes previos confirman el uso de antinflamatorios no esteroidales por una cirugía de reemplazo total de cadera 7 días antes. Se discute la literatura disponible

Hemorragia por várices esofagogástricas: experiencia con cianoacrilato y polidocanol en 68 pacientes con hemorragia activa / Hemorrhage by esophageal gastric varices: experience with cianoacrylate and polidocanol in 68 patients

Background: Sclerosis, injection of cianoacrylate and rubber band ligation are the most commonly used endoscopic techniques for the treatment of bleeding esophageal varices. Aim: To assess the effectiveness of cianoacrylate and polidocanol in the treatment of bleeding esophageal varices. Patients and methods: Sixty eight patients with active variceal bleeding were studied. Bleeding varices were classified as thin, thick or gastric. Bleeding from thin varices was treated with polidocanol. Bleeding from thick or gastric varices was treated with cianoacrylate. Variceal erradication was done with polidocanol. Results: Bleeding came from thin esophageal varices in 23 percent of patients and endoscopic treatment stopped bleeding in 95 percent of them, from thick esophageal varices in 62 percent and endoscopic treatment was successful in 94 percent of these, and from gastric varices in 12 percent and treatment stopped bleeding in 87 percent of these (in 3 percent bleeding was considered subcardial). Twenty five percent of patients bled again during variceal erradication, 12 percent died due to uncontrollable bleeding and 20 percent died due to liver failure. During variceal erradication 59 percent of patients classified as Child Pugh C, died. Conclusions: Treatment of bleeding esophageal varices with cianoacrylate or polidocanol is effective. Patients classified as Child Pugh C have a bad prognosis

Instrumentación endoscópica del colédoco: un avance en la terapeutica de las enfermedades de la via biliar / Endoscopic intrumentation of the common duct: an advance in the treatment of the biliary tract diseases

Los autores destacan los progresos realizados en los últimos años en la exploración del hígado y de las vías biliares haciendo especial hincapié en la colangiografía retrógrada. Se precisan sus indicaciones y sus ventajas entre las cuales se señalan exploración endoscópica de estómago, duodeno y papila; visualización de vías biliares y pancreáticas; posibilidad de papilotomía y tratamiento de litiasis, (disolución, extracción y litotripsia) y de estenosis benignas y malignas del colédoco. Se mencionan las limitaciones y riesgos del procedimiento que tiene muy baja mortalidad (0,9%) y mortalidad (0,09%)