Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy.

BACKGROUND AND OBJECTIVES: There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS: We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS: In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS: The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.

GIST is not all that it seems.

We present a 41-year-old female who was admitted to our hospital with a history of 2-month epigastric pain and vomiting. Physical examination was normal. Upper gastrointestinal endoscopy showed a sessile submucosal tumor with central ulceration in the gastric body-antrum. Biopsies revealed a gastric mucosa without changes. Nevertheless, endoscopic ultrasound-guided biopsies showed interlacing bundles of spindle cells. The immunohistochemical study was negative for CD117 and smooth muscle actin and positive for S100 protein. A CT scan identified a heterogeneous mass in the stomach wall.

Balanced by iron. Hereditary hemochromatosis and celiac disease.

We present the case of a healthy 14-year-old adolescent who was referred to our hospital for an incidental alteration of the iron profile (Fe 225 ug/dl, transferrin 186 mg/dl, IST 63.93 %, ferritin 253 ng/ml). The blood count, proteinogram and renal, lipid and liver function tests were in the normal range. Abdominal ultrasound was requested with no findings of interest. The genetic analysis for hereditary hemochromatosis (HH) confirmed that the patient was homozygous for the C282Y mutation.

Acute hepatocellular drug-induced liver injury probably caused by doxazosin.

Drug-induced liver injury (DILI) is a diagnostic challenge, due to the hepatotoxic potential of drugs, herbs and dietary supplements, the variety of pathological phenotypes and the absence of specific biomarkers.

Biopsia hepática percutánea bajo sedación con propofol. Modelo de procedimiento seguro y eficaz / No disponible

INTRODUCCIÓN: la biopsia hepática percutánea es un procedimiento necesario para el diagnóstico de hepatopatías no exento de complicaciones y con malestar psicológico para el paciente. OBJETIVO: determinar el perfil de seguridad del propofol en la biopsia hepática percutánea, las complicaciones de la técnica per se y la satisfacción de los pacientes tras su realización. MÉTODOS: estudio observacional retrospectivo mediante recogida de datos de tolerancia y complicaciones en pacientes sometidos a biopsia hepática bajo sedación profunda con propofol. Valoración de la calidad y satisfacción percibida por los pacientes mediante una encuesta transversal. RESULTADOS: incluimos 97 pacientes con una dosis media de propofol de 170,46 mg. De las complicaciones derivadas de la sedación, se registraron seis desaturaciones leves (6,2 %) resueltas con maniobras posturales (50 %) y parada de la bomba de propofol (50 %) y once episodios de hipotensión (11,3 %) resueltos de forma espontánea (82,82 %) o fluidoterapia (18,18 %). De las complicaciones derivadas de la técnica, se registraron tres casos de dolor precoz (3,1 %) y uno tardío (1,03 %), todos resueltos con 1 g de paracetamol intravenoso. Todos los pacientes iniciaron tolerancia oral y fueron dados de alta a las 24 horas del procedimiento sin necesidad de analgesia ambulatoria. La satisfacción general, así como el malestar psicológico fueron evaluados como muy buenos/excelentes en el 100 % de los pacientes. DISCUSIÓN: el propofol presenta un adecuado perfil de seguridad en la biopsia hepática y mantiene el éxito de la prueba, con buena tolerancia de la misma por el paciente. Consideramos posible ampliar la utilidad de la sedación con propofol a este procedimiento

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Encuesta nacional on-line sobre el consentimiento informado para la realización de paracentesis. ¿Lo tenemos? ¿Lo utilizamos? / No disponible

INTRODUCCIÓN: el uso del consentimiento informado es necesario en los procedimientos invasivos como documento garantizador de la relación sanitaria ética y de la seguridad del paciente. OBJETIVO: analizar si se poseen y utilizan los documentos de consentimiento informado para paracentesis en los centros sanitarios, así como obtener algunos datos de interés sobre la técnica. MATERIAL Y MÉTODO: realizamos un estudio observacional descriptivo mediante una encuesta transversal on-line difundida por redes sociales, destinada a los especialistas y residentes de aparato digestivo durante diciembre de 2019. RESULTADOS: incluimos 203 encuestas anónimas (55,2 % adjuntos y 44,8 % residentes) de 74 centros sanitarios de 34 provincias españolas. Noventa encuestados (44,3 %) tenían dicho documento en sus centros; de estos, 29 (32,2 %) lo entregaban siempre; 31 (34,4 %), algunas veces; y 21 (23,3 %), nunca. Setenta y dos profesionales (35,5 %) contestaron no tenerlo y 41 (20,5 %), ser desconocedores; de entre ellos, 77 (68,1 %) consideraban necesaria su creación, 31 (27,4 %) no lo creían así y cinco (4,4 %) no contestaron. En cuanto a la técnica, 173 facultativos (85,2 %) realizan la punción bajo visión directa y 30 (14,8 %), ecoguiada en la mayoría de las ocasiones. Ciento nueve (53,7 %) aplican siempre anestésico local, 80 (39,4 %) lo aplican en algunas ocasiones y 14 (6,9 %) no lo utilizan. Ciento sesenta y siete encuestados (82,3 %) consideraron que es una técnica sencilla, frente a 36 (17,7 %) que la consideran de complejidad intermedia. En cuanto al riesgo, 150 (73,5 %) lo consideran bajo y 52 (25,6 %), medio. Noventa y nueve de ellos (48,8 %) refieren haber tenido complicaciones menores y 37 (18,2 %), mayores. CONCLUSIONES: la paracentesis es una técnica habitual en los servicios de digestivo y, a pesar de ser considerada sencilla y segura, entraña complicaciones. Por ello consideramos necesaria la formación reglada en esta técnica, así como la creación, difusión y utilización de los consentimientos informados dada la importante variabilidad intra e interhospitalaria que presenta

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Percutaneous hepatic biopsy under propofol sedation. A safe and effective procedure.

INTRODUCTION: the percutaneous hepatic biopsy is a necessary procedure for the diagnosis of liver diseases which can cause complications and psychological discomfort for the patient. AIMS: to determine the safety profile of propofol in percutaneous hepatic biopsy, the complications of the technique per se and patients satisfaction once completed. METHODS: a retrospective observational study was performed via the acquisition of data of tolerance and perceived quality by the patients using a transversal survey. RESULTS: ninety-seven patients were included with an average propofol dose of 170.46 mg. Of the complications resulting from the sedation, there were six slight desaturations (6.2 %) resolved with a forehead maneuver (50 %) or cessation of the propofol infusion pump (50 %) and eleven hypotension episodes (11.3 %) resolved without intervention (82.82 %) or with fluid replacement (18.18 %). Of the complications resulting from the technique, there were three cases of early-onset pain (3.1 %) and one delayed (1.03 %); all were resolved with 1 g of intravenous paracetamol. All patients were discharged with oral tolerance and without the need for analgesia 24 hours after the procedure. General satisfaction, as well as psychological discomfort, were evaluated as "very good/excellent" in 100 % of the patients. DISCUSSION: propofol demonstrated a favorable safety profile in hepatic biopsy, aiding in the ultimate success of the procedure and tolerance for the patient. We propose the expansion of the use of sedation with propofol to this procedure.

Spanish online survey on informed consent for the performance of paracentesis. Do we have it? Do we use it?

INTRODUCTION: informed consent is necessary for invasive procedures as a document that guarantees the ethical health relationship and patient safety. AIMS: to analyze whether we have and use informed consent documents for paracentesis in our hospitals and to obtain data on the technique. METHODS: a descriptive observational study was performed during December 2019, via a cross-sectional survey disseminated through social networks, aimed at specialists and residents of gastroenterology. RESULTS: two hundred and three anonymous surveys were included (55.2 % gastroenterologist and 44.8 % residents) from 74 hospitals in 34 Spanish provinces. Ninety respondents (44.3 %) stated that they had the document in their centers. Of these, 29 (32.2 %) always provided it, 31 (34.4 %) provided it sometimes and 21 (23.3 %) never. Seventy-two professionals (35.5 %) answered that they did not have it and 41 (20.5 %) selected "unknown". Of these, 77 (68.1 %) considered it was necessary to create this document, 31 (27.4 %) did not think it was necessary and five (4.4 %) did not answer. With regards to the technique, 173 (85.2 %) performed paracentesis under direct visualization and 30 (14.8 %) were eco-guided on most occasions. One hundred and nine (53.7 %) always applied local anesthetic, 80 (39.4 %) sometimes and 14 (6.9 %) did not. One hundred and sixty-seven respondents (82.3 %) considered it to be a simple technique versus 36 (17.7 %) who thought that it was of intermediate complexity. In terms of risk, 150 (73.5 %) considered it was low and 52 (25.6 %), medium. Ninety-nine (48.8 %) experienced minor complications and 37 (18.2 %) experienced major complications. CONCLUSIONS: paracentesis is a common technique in digestive services and could be associated with complications, even though it is considered to be simple and safe. Due to the important intra- and inter-hospital variability that this technique presents, we consider standardized training in this technique is necessary, as well as the creation, spread and use of informed consents.

Complicaciones vasculares tras paracentesis / No disponible

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Hemorrhagic complications following paracentesis.

Paracentesis is a common and well accepted technique for its diagnostic-therapeutic profitability. This procedure is considered rapid, minimally invasive and safe, but we must not forget that it can lead to severe complications. In this letter we present two patients with hemorrhagic complications following paracentesis. Both cases were treated by percutaneous transarterial embolization. Likewise, in the absence of consensus on the prevention of complications and on their optimal management, we make some recommendations.

Desgarro de mucosa gástrica secundario a extracción de prótesis biliar / Tear of the secondary gastric mucous membrane to the extraction of the biliary prosthesis

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Tear of the secondary gastric mucous membrane to the extraction of the biliary prosthesis.

The extraction of a biliary prosthesis can be done by various techniques. It is usually simple, but it can be difficult for granulation tissue to adhere to the bile duct or its migration. In our case, it was complicated by an iatrogenic injury from the exit of the instruments for extraction.

Fístula gastrogástrica como complicación de un bypass gástrico / The gastro-gastric fistula as a complication of a gastric bypass

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