ABSTRACT
We have read the letter from García-Cano et al. regarding our Editorial and are very grateful for the response as it contributes to deepening the debate we aim to generate on the topic. We are aware that changing a paradigm is always difficult, takes years, and requires publication of good quality studies. However, the way to progress in medicine and provide the best for patients involves questioning existing paradigms and considering the possibility of changing them. Currently, the outcomes of endoscopic ultrasonography guided transmural biliary drainage (EUS-TBD) have been progressively improving and the rate of adverse events (AE) has considerably decreased. The data currently available suggest that primary EUS-TBD in a specific setting is not inferior to ERCP drainage and may even entail a lower rate of AE.
ABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) has been established as the first line therapy for the resolution of biliary and pancreatic diseases. The main disadvantage of the procedure is the rate of adverse events, around 10%1. So, despite being a minimally invasive procedure, ERCP has a non-negligible rate of adverse effects (AEs) and secondary mortality.
Subject(s)
Bile Duct Neoplasms , Cholestasis , Humans , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholestasis/diagnostic imaging , Cholestasis/etiology , Cholestasis/surgery , Endosonography/adverse effects , Bile Duct Neoplasms/complications , Drainage/adverse effects , Drainage/methodsSubject(s)
Humans , Male , Middle Aged , Lanthanum/adverse effects , Lanthanum/pharmacokinetics , Lanthanum/toxicity , Kidney Failure, Chronic/complications , Hematemesis/drug therapy , Hematemesis/surgery , Endoscopy, Digestive System , Treatment Outcome , Inpatients , Physical Examination , Symptom Assessment , GastroenterologyABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Hamartoma/diagnosis , Hamartoma/pathology , Incidental Findings , Colonoscopy , Colonic Polyps/pathology , Immunohistochemistry , Colonic Diseases/pathology , Schwann Cells/pathologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Adenocarcinoma/surgery , Colonic Polyps/pathology , Colonic Polyps/surgery , Adenocarcinoma/pathology , Adenocarcinoma/diagnosis , Colonoscopy/methods , Occult Blood , Feces , Intestinal Mucosa/pathology , Colorectal Neoplasms/pathologyABSTRACT
We report the case of a 59-year-old male who underwent a screening colonoscopy after a positive fecal occult blood test. Several polyps were removed during the colonoscopy: two pedunculated tubular adenomas of 7 mm, a tubular adenoma with high-grade dysplasia of 25 mm and a pedunculated polyp of 20 mm in the descending colon. Histopathological analysis of the pedunculated polyp revealed a well-differentiated adenocarcinoma (G1) with a mucinous component that invaded the submucosa (T1). The resection margins were less than 1 mm, lymphovascular invasion was present and high budding (10 or more) with an invasive component of 8 mm.
Subject(s)
Adenocarcinoma , Adenoma , Colonic Neoplasms , Colonic Polyps , Colorectal Neoplasms , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/surgery , Adenoma/diagnostic imaging , Adenoma/surgery , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/surgery , Colonic Polyps/diagnostic imaging , Colonic Polyps/surgery , Colonoscopy , Humans , Male , Middle AgedSubject(s)
Colonic Diseases/pathology , Colonoscopy , Hamartoma/pathology , Schwann Cells , Adult , Humans , Incidental Findings , MaleABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Intussusception/diagnostic imaging , Intussusception/surgery , Colonic Neoplasms/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Intussusception/etiology , Intussusception/physiopathology , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , ColonoscopyABSTRACT
No disponible
Subject(s)
Aged, 80 and over , Aged , Humans , Male , Lymphoma/diagnosis , Colonic Neoplasms/diagnosis , Intussusception/etiology , Diagnosis, Differential , ColonoscopyABSTRACT
INTRODUCCIÓN: el esófago hipercontráctil (EH) es un trastorno de hipercontractilidad primario del músculo esofágico poco frecuente. La manometría esofágica lo define como al menos una contracción de muy elevada amplitud y duración (ICD > 8.000 mmHg/s/cm) en pacientes con síntomas esofágicos. El objetivo de nuestro estudio fue valorar el contexto clínico y las variables manométricas de pacientes con diagnóstico de EH utilizando manometría de alta resolución (MAR). MÉTODOS: se revisaron 720 estudios de MAR realizadas desde junio de 2011 hasta junio de 2013 y se estudiaron las características clínicas y manométricas de los pacientes con EH. RESULTADOS: se encontraron siete pacientes con criterios de EH según la Clasificación de Chicago. El 100% fueron mujeres, con edad media de 64 años. Los síntomas principales fueron dolor torácico, disfagia y pirosis. En seis (86%) no hubo patología asociada y en un paciente (14%) se asoció a enfermedad por reflujo gastroesofágico (ERGE) y obstrucción al flujo de la unión esófago-gástrica (UEG). Tres pacientes (43%) presentaron más de una onda hipercontráctil. Cuatro (57%) tenía patrón multipico (esófago de Jackhammer) y en dos de ellos las contracciones estuvieron sincronizadas con la respiración. Dos pacientes (29%) fueron diagnosticados de hernia de hiato. La presión integrada de relajación (PIR) no fue mayor en las contracciones hipercontráctiles, en comparación con las contracciones normales; sólo un paciente presentó alteración leve de la relajación (PIR-4s = 15 mmHg) con peristalsis conservada, obstrucción al flujo de la UEG y patrón no multipico. Un paciente presentó una exposición ácida patológica (EAP) en la pHmetría de 24 horas. CONCLUSIONES: el EH es un trastorno de muy baja frecuencia. La MAR es indispensable para su diagnóstico y caracterización. El tratamiento del EH debe estar orientado a resolver o mejorar la sintomatología de los pacientes y evitar la realización de estudios innecesarios
BACKGROUND: Hypercontractile esophagus (HE) is a primary hypercontractile disorder of the esophageal musculature not frequently seen in the general population. It is characterized by the presence of at least one contraction with a very high amplitude and duration (DCI > 8,000 mmHg/s/cm) in patients with esophageal symptoms. The aim of our study was to assess the clinical context and manometric characteristics in patients with HE using high-resolution manometry (HRM). METHODS: We thoroughly reviewed the clinical features and manometric findings of a total of 720 patients with esophageal symptoms that were attended in the Department of Gastroenterology of our hospital between June 2011 and June 2013. RESULTS: We found seven patients that met criteria for HE according to the Chicago Classification (2012). All of the patients were women (100%). Mean age was 64 years old. Most frequent symptoms were: Chest pain, dysphagia and heartburn. In one patient (14%) the HE was related to a gastroesophageal reflux disease (GERD) and gastroesophageal junction (GEJ) outflow obstruction. Three patients (43%) had more than one hypercontractile contraction in the study. Four patient (57%) hade multipeaked pattern (Jackhammer esophagus) and y two of them were synchronized with respiration. Two patients (29%) were diagnosed with hiatus hernias. Integrated relaxation pressure (IRP) was not higher in hypercontractile contractions than in normal contractions. Only one patient presented a slight alteration of the relaxation (IRP-4s = 15 mmHg) with normal peristalsis, GEJ outflow obstruction and not multipeakeded pattern. One patient presented pathological acid exposure (PAE) in 24-hours pH-metry. CONCLUSIONS: HE is a rare disorder and HRM is essential for its correct diagnosis and characterization. The treatment of HE should achieve the disappearance or at least improvement of the patient's symptoms and avoid unnecessary diagnostic testing
Subject(s)
Humans , Esophageal Motility Disorders/diagnosis , Manometry , Chest Pain/etiology , Deglutition Disorders/etiology , Heartburn/etiology , Risk FactorsABSTRACT
BACKGROUND: Hypercontractile esophagus (HE) is a primary hypercontractile disorder of the esophageal musculature not frequently seen in the general population. It is characterized by the presence of at least one contraction with a very high amplitude and duration (DCI > 8,000 mmHg/s/cm) in patients with esophageal symptoms. The aim of our study was to assess the clinical context and manometric characteristics in patients with HE using highresolution manometry (HRM). METHODS: We thoroughly reviewed the clinical features and manometric findings of a total of 720 patients with esophageal symptoms that were attended in the Department of Gastroenterology of our hospital between June 2011 and June 2013. RESULTS: We found seven patients that met criteria for HE according to the Chicago Classification (2012). All of the patients were women (100%). Mean age was 64 years old. Most frequent symptoms were: Chest pain, dysphagia and heartburn.In one patient (14%) the HE was related to a gastroesophageal reflux disease (GERD) and gastroesophageal junction (GEJ) outflow obstruction. Three patients (43%) had more than one hypercontractile contraction in the study. Four patient (57%) hade multipeaked pattern (Jackhammer esophagus) and y two of them were synchronized with respiration. Two patients (29%) were diagnosed with hiatus hernias. Integrated relaxation pressure (IRP) was not higher in hypercontractile contractions than in normal contractions. Only one patient presented a slight alteration of the relaxation (IRP-4s = 15 mmHg) with normal peristalsis, GEJ outflow obstruction and not multipeakeded pattern. One patient presented pathological acid exposure (PAE) in 24-hours pH-metry. CONCLUSIONS: HE is a rare disorder and HRM is essential for its correct diagnosis and characterization. The treatment of HE should achieve the disappearance or at least improvement of the patient´s symptoms and avoid unnecessary diagnostic testing.
