Giant fibrovascular polyp of the esophagus causing sudden dyspnea: endoscopic treatment.

A 76-year-old man with sudden dyspnea was admitted to our department. A fleshy mass was visualized in the labial commissure, and the flexible esophagoscopy showed the polyp prolapsed into the oropharynx, partially obstructing the airway. The polyp was encircled with a large oval snare and Endoloop, which was adjusted to stalk-basis before tightening. Pure coagulation was used to transect the lesion, which was then retrieved. The polyp measured 10 x 2.5 cm. To our knowledge, our case is the first large esophageal giant fibrovascular polyps causing sudden dyspnea in the literature that has been resected endoscopically without complications.

[Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions]. / Valor de la punción aspirativa con aguja fina guiada por ultrasonografía endoscópica en el diagnóstico de las lesiones mediastínicas.

OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions. PATIENTS AND METHODS: A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated. RESULTS: EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm x 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P< .001). The diagnosis was obtained for 53 patients (90%) and 81 lesions (91%) with a mean of 2 (1) passes per lesion. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNA were 81%, 100%, 100%, 75%, and 88%, respectively, when analyzed by lesion, and 88%, 100%, 100%, 80%, and 92% when analyzed by patient. CONCLUSIONS: EUS-FNA is an effective technique for the diagnosis of mediastinal lesions. The likelihood of malignancy increases with size.

Valor de la punción aspirativa con aguja fina guiada por ultrasonografía endoscópica en el diagnóstico de las lesiones mediastínicas / Usefulness of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of mediastinal lesions

Objetivo: La punción aspirativa con aguja fina guiada por ultrasonografía endoscópica (USE-PAAF) es una técnica eficaz y segura en el diagnóstico de las lesiones focales del páncreas y las adenopatías intraabdominales. El objetivo de este estudio es describir su utilidad en el diagnóstico de las lesiones mediastínicas. Pacientes y métodos: Se han revisado todos los casos consecutivos a los que se realizó una USE-PAAF para estudio de una lesión mediastínica desde enero de 2001 hasta septiembre de 2003. Las exploraciones se efectuaron con un ecoendoscopio radial para estudio de las características de la lesión y un ecoendoscopio sectorial para realizar la punción transesofágica usando una aguja de 22 G. Se utilizó como referencia la cirugía en los pacientes operados y el resultado de la citología obtenida con la USE-PAAF en los casos en que el tratamiento quirúrgico no estaba indicado. Resultados: Se realizó USE-PAAF a 59 pacientes con un total de 89 lesiones, con diámetro medio ± desviación estándar de 2,4 ± 2 × 1,6 ± 1,4 cm. El tamaño de las lesiones malignas fue mayor que el de las benignas (diámetro corto: 2,7 ± 1,4 frente a 1 ± 0,9 cm, respectivamente; p < 0,001). El material obtenido permitió el diagnóstico en 53 pacientes (90%) y en 81 lesiones (91%), y el número de pases fue de 2 ± 1 por lesión. La sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la precisión para el diagnóstico fueron del 81, el 100, el 100, el 75 y el 88%, respectivamente (el 88, el 100, el 100, el 80 y el 92% al analizarlos por paciente). Conclusiones: La USE-PAAF es una técnica eficaz en el estudio de la patología mediastínica. La probabilidad de malignidad es mayor cuanto mayor es el tamaño de la lesión

Objective: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions. Patients and methods: A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated. Results: EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm × 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P<.001). The diagnosis was obtained for 53 patients (90%) and 81 lesions (91%) with a mean of 2 (1) passes per lesion. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of EUS-FNA were 81%, 100%, 100%, 75%, and 88%, respectively, when analyzed by lesion, and 88%, 100%, 100%, 80%, and 92% when analyzed by patient. Conclusions: EUS-FNA is an effective technique for the diagnosis of mediastinal lesions. The likelihood of malignancy increases with size

Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia.

OBJECTIVES: Preliminary studies suggested that octreotide may be therapeutic in bleeding angiodysplasia. Our aim was to investigate the efficacy of long-term octreotide therapy in the prevention of rebleeding from gastrointestinal angiodysplasia. METHODS: A cohort of 32 patients diagnosed with bleeding from angiodysplasia was treated with octreotide 50 mu 12 h subcutaneously for a 1-2 yr period. This cohort was compared with an external control group (38 patients who had received placebo [1 tablet/day] in a concurrent randomized clinical trial for the same period. RESULTS: Two patients of the octreotide group were lost to follow-up. Treatment failure occurred in seven of 30 (23%) patients in the octreotide group and in 17 of 35 (48%) in the placebo group (three dropouts before first visit) (P= 0.043). The actuarial probability of remaining free of rebleeding at 1 and 2 yr of follow-up was 77% and 68%, respectively, for the octreotide group and 55% and 36%, respectively, for the placebo group (log rank P= 0.030). Multivariate proportional hazards-regression analysis showed that octreotide therapy and previous bleeding episodes were positive and negative predictors of efficacy, respectively. No significant differences between the groups were observed according to number of bleeding episodes (0.4 +/- 0.7 vs 0.9 +/- 1.5, P= 0.070) and transfusion requirements (1.1 +/- 2.6 vs 0.7 +/- 1.5 units); however, iron requirements were lower in the octreotide than in the placebo group (22 +/- 62 vs 166 +/- 267 units; P < 0.001). Likewise, major adverse events (1 vs 1) and mortality (0 vs 1) were similar between groups. CONCLUSIONS: This study suggests that octreotide treatment may be beneficial in preventing rebleeding from gastrointestinal angiodysplasia.

Ciclosporiasis: estudio clinicoepidemiológico en viajeros con Cyclospora cayetanensis importada / Cyclosporiasis: a clinical and epidemiological study in travellers with imported Cyclospora cayetanensis infection

FUNDAMENTO: Conocer las características clínicas y epidemiológicas de la enteritis por Cyclospora cayetanenesis. PACIENTES Y MÉTODO: Protocolo clínico, epidemiológico y microbiológico de estudio en viajeros a países de renta baja. RESULTADOS: Se diagnosticó ciclosporiasis a 55 pacientes. El 96 por ciento consultaron por diarrea del viajero (DV). Las características más llamativas de la DV eran la persistencia de la diarrea (más de 2 semanas de evolución), que afectaba a 38 pacientes (69 por ciento), y una pérdida igual o superior a 3 kg de peso en el 38 por ciento de pacientes de la serie. En el 36 por ciento de los casos la DV se inició después del viaje. Aunque cosmopolita, C. cayetanensis se aisló con más frecuencia en viajeros a América Latina, el subcontinente indio y el sudeste asiático. Sólo en 5 viajeros se detectó algún factor de riesgo potencialmente específico: frambuesas en tres casos, leche de búfalo en uno y ceviche en uno. CONCLUSIONES: C. cayetanensis es un enteropatógeno emergente, que se aísla en un 2 a un 4 por ciento de los pacientes afectados de DV y debe formar parte del diagnóstico diferencial en esta enfermedad (AU)