Colangitis aguda asociada a hemobilia en un paciente con cirrosis hepática y cavernomatosis portal / Acute cholangitis and hemobilia in a patient with liver cirrhosis and portal vein cavernomatous transformation

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Ionizing radiation in patients with Crohn´s disease. Estimation and associated factors.

INTRODUCTION: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn's disease (CD) usually require multiple imaging tests using this type of radiation. OBJECTIVES: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn's disease during their course and to identify the factors associated with higher radiation doses. METHODS: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer. RESULTS: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED ≥ 50 mSv. The following factors were identified as independent predictors associated with an ED ≥ 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years. CONCLUSIONS: a substantial proportion of patients with Crohn's disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients' exposure to potentially carcinogenic ionizing radiation.

Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections.

INTRODUCTION: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. OBJECTIVES: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. MATERIAL AND METHODS: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett's esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett's esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. RESULTS: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett's esophagus, 6 complete Barrett's esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. CONCLUSIONS: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples.

Radiación ionizante en pacientes con enfermedad de Crohn. Estimación y factores asociados / Ionizing radiation in patients with Crohn's disease. Estimation and associated factors

Introducción: la exposición a radiación ionizante se asocia a un mayor riesgo de desarrollar tumores. Los pacientes con enfermedad de Crohn requieren habitualmente múltiples pruebas de imagen que utilizan este tipo de radiación. Objetivos: los objetivos de este estudio son estimar la dosis total de radiación ionizante recibida por pacientes con enfermedad de Crohn a lo largo de su evolución e identificar los factores asociados a dosis de radiación más altas. Métodos: se incluyeron 235 pacientes con enfermedad de Crohn diagnosticados entre 1972 y 2010. Se calculó retrospectivamente la dosis efectiva (DE) recibida por cada paciente, teniendo en cuenta los tránsitos gastrointestinales y las tomografías computarizadas que se habían realizado. Basados en estudios epidemiológicos previos, se consideró un valor umbral de DE ≥ 50 mSv de mayor riesgo de desarrollar cáncer. Resultados: la media de DE recibida por paciente fue 33,4 mSv (IC 95% 29,3-37,5). Un total de 49 (20,8%) pacientes recibió una DE >= 50 mSv. Se identificaron como factores predictivos independientes asociados a una DE >= 50 mSv: edad mayor de 40 años, necesidad de cirugía, edad al diagnóstico menor 16 años y tiempo de evolución mayor de 8 años. Conclusiones: un porcentaje considerable de pacientes con enfermedad de Crohn recibe dosis elevadas de radiación ionizante potencialmente carcinogénicas. La identificación de los pacientes mas susceptibles a recibir dosis altas de radiación, la monitorización de la dosis efectiva recibida y la utilización de pruebas de imagen que no utilizan radiación ionizante (enterorresonancia, ecografía abdominal), podrían contribuir a reducir la exposición a la radiaciones ionizantes potencialmente carcinogénicas(AU)

Introduction: exposure to ionizing radiation is associated with an increased risk of developing tumors. Patients with Crohn’s disease (CD) usually require multiple imaging tests using this type of radiation. Objectives: the objectives of this study were to estimate the total dose of ionizing radiation received by patients with Crohn’s disease during their course and to identify the factors associated with higher radiation doses. Methods: two hundred thirty-five CD patients diagnosed between 1972 and 2010 were included. The effective dose (ED) received by each patient was calculated retrospectively based on the number of gastrointestinal transit studies and computed tomography scans performed. Considering recent epidemiological studies, an ED greater than or equal to 50 mSv was used as the cut-off point for increased risk of developing cancer. Results: the mean ED received per patient was 33.4 mSv (95% CI 29.3-37.5). A total of 49 (20.8%) patients received an ED >= 50 mSv. The following factors were identified as independent predictors associated with an ED >= 50 mSv: Age older than 40 years, need for surgery, age under 16 years at diagnosis and disease duration over 8 years. Conclusions: a substantial proportion of patients with Crohn’s disease receive high doses of potentially carcinogenic ionizing radiation. Identification of the most susceptible patients to receive high doses of radiation, monitoring of effective doses received and the use of imaging techniques that do not require ionizing radiation (MR enterography, abdominal ultrasound) could contribute in reducing patients’ exposure to potentially carcinogenic ionizing radiation(AU)

Resección endoscópica mucosa de lesiones superficiales altas: estudio de su eficacia y seguridad en 59 resecciones consecutivas / Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections

Introducción: la resección endoscópica mucosa es una técnica aceptada en el tratamiento de lesiones superficiales del tracto digestivo. Objetivos: evaluar la eficacia y seguridad de dicho procedimiento en el tracto digestivo superior. Material y métodos: se incluyeron en nuestro estudio 41 pacientes consecutivos (23 hombres y 18 mujeres, edad media de 60,6 años) a los que se les realizaron 59 resecciones en 69 sesiones. Se trataron las siguientes patologías: lesiones sobreelevadas con displasia de alto grado sobre esófago de Barrett (grupo A), displasia de alto grado en biopsias aleatorias del seguimiento de esófago de Barrett (grupo B) y lesiones superficiales gastroduodenales (grupo C). Las técnicas utilizadas fueron la resección con asa tras inyección submucosa, la asistida por bandas o por capuchón. Resultados: se resecaron 7 lesiones sobreelevadas con displasia de alto grado sobre esófago de Barrett, 6 esófagos de Barrett con displasia de alto grado de forma completa en 16 sesiones secuenciales de resección mucosa y 46 lesiones superficiales gastroduodenales (10 adenomas, 9 carcinomas gástricos superficiales, 18 carcinoides y 9 lesiones de diferente estirpe). Las resecciones se realizaron con éxito en el 100% de los dos primeros grupos y en el 97,9% del grupo C. Como complicaciones tuvimos 2 sangrados diferidos autolimitados (grupos A y B) y dos casos de estenosis con escasa relevancia clínica en el grupo B. Conclusiones: a) la resección endoscópica mucosa es una técnica eficaz en el tratamiento de lesiones superficiales del tracto digestivo superior; b) se trata de un procedimiento seguro, con un porcentaje de complicaciones muy bajo y que generalmente pueden ser manejadas de forma endoscópica; y c) al contrario que otras técnicas ablativas, permite el estudio anatomopatológico de las muestras(AU)

Introduction: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. Objectives: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. Material and methods: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett’s esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett’s esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. Results: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett’s esophagus, 6 complete Barrett’s esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. Conclusions: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples(AU)