ABSTRACT
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP), with or without sphincterotomy, has been widely used in patients with severe biliary acute pancreatitis (BAP) or those with cholangitis and/or obstruction of the biliary tree. Its use in subjects with mild BAP is more controversial. AIM: To optimize use of ERCP in patients with mild pancreatitis due to gallstones by identifying clinical and biochemical predictors of choledocholithiasis. MATERIAL AND METHOD: The clinical and biochemical data, images, and outcomes of 83 patients with mild BAP hospitalized at the Instituto Nacional de Ciencias Medicas y Nutricion "Salvador Zubiran" from January 1, 1988 to May 30, 2000 were retrospectively analyzed. All patients received elective cholecystectomy at hospital admission. In 35 cases, ERCP was performed before cholecystectomy (group A). The remaining 48 were operated on without ERCP (group B). In 30, transcystic-cholangiography was done. Forty-seven (57%) were female. Mean age was 47 years (19-90). Mean time between onset of AP and hospital admission was 2.2 days (1-15), and between clinical onset and cholecystectomy, eight days (1-26). Statistical differences were evaluated by non-parametric methods. An univariated and multivariated analysis was performed looking for data to identify choledocholithiasis. RESULTS: Choledocholithiasis was found in 27 cases (32%), 18 from group A (51%), and nine for group B (19%) (RR = 4.58, IC 95% = 1.7-12.25, p = 0.004). ERCP was performed in all cases because of clinical suspicion of choledocholithiasis (jaundice, bilirubin, and alkaline phosphatase alteration and/or choledochal dilation); however, none of the patients of group B in whom choledocholithiasis was operatively diagnosed showed biochemical or radiologic alterations. Subjects with choledocolithiasis presented more frequently a history of biliary pain (RR = 5.75, IC 95% = 1.76-18.7), jaundice (RR = 3.07, IC 95% = 1.15-8.16) and/or alkaline phosphatase elevation (RR = 4.11, IC 95% = 1.3-12.7). CONCLUSION: The high frequency of choledocholithiasis in subjects with mild biliary pancreatitis warranted radiologic exploration of the biliary tree in all patients submitted to cholecystectomy. In those with jaundice, alkaline phosphatase elevation and/or a history of biliary pain, ERCP should be performed prior to the operation; in others, choledocholithiasis can be discharged by operative transcystic cholangiography. Therapeutic measures for treating choledocholithiasis should be adapted to hospital facilities.
Subject(s)
Cholangiography , Gallstones/complications , Gallstones/diagnosis , Pancreatitis/etiology , Acute Disease , Adult , Aged , Aged, 80 and over , Alkaline Phosphatase/blood , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy , Clinical Enzyme Tests , Data Interpretation, Statistical , Female , Gallstones/diagnostic imaging , Gallstones/surgery , Humans , Male , Middle Aged , Retrospective Studies , Statistics, NonparametricABSTRACT
BACKGROUND: Ulcerative colitis (UC) is a disease of unknown etiology characterized by chronic and superficial inflammation of colorectum. Chromoendoscopy has been informed as a method to improve evaluation of extension of UC. No reports on this issue have been published in Mexico to date. OBJECTIVE: To investigate usefulness of chromoendoscopy in determination of extension and severity of UC, as well as inter-observer variability. PATIENTS AND METHODS: Twenty five patients with diagnosis of UC were selected from March 2001 to January 2002 to enter this prospective study. Baron scale was used to evaluate UC endoscopic severity and was followed by randomization of patients to receive methylene blue 0.2% (14 cases) or indigo carmine 0.1% (11 cases) for chromoendoscopic assessment. Each case was presented for evaluation to five endoscopists with > 5 years experience in colonoscopy. Histopathologic report was considered gold standard. STATISTICAL ANALYSIS: Weighed Kappa coefficient for endoscopic-pathologic agreement among evaluators was used. RESULTS AND DISCUSSION: There was fair agreement among endoscopic and pathologic diagnoses of each observer with the two tinctures, particularly when using indigo carmine. Chromoendoscopy increased detection of areas affected by UC with minimal or silent activity. CONCLUSIONS: Chromoendoscopy with indigo carmine or methylene blue may increase endoscopic-pathologic agreement for assessment of severity of UC, thus being a helpful complementary technique in these patients.
Subject(s)
Colitis, Ulcerative/pathology , Colonoscopy/methods , Adolescent , Adult , Aged , Colonoscopy/statistics & numerical data , Coloring Agents , Female , Humans , Male , Middle Aged , Observer Variation , Prospective Studies , Severity of Illness IndexABSTRACT
La hemorragia es una complicación poco frecuente en pacientes con acalasia. La esofagitis por estasis es una causa rara de tal evento en la que las formas convencionales de tratamiento pueden asociarse con alto riesgo de complicaciones agudas. La toxina botulínica ha surgido como una alternativa terapéutica útil con muy pocos efectos secundarios. Presentamos un caso de hemorragia asociada a esofagitis por estasis en una paciente con acalasia y desnutrición grave que fue tratada en forma exitosa con toxina botulínica. Se discuten aspectos interesantes de la esofagitis por estasis y el papel de la toxina botulínica en el tratamiento de la acalasia.
