Endoscopic management of pancreatic collections. Endoscopic Ultrasound Group from the Spanish Society of Digestive Endoscopy (GSEED-USE) Clinical Guidelines.

Acute pancreatitis is associated with significant morbidity and mortality. It can develop complications such as fluid collections and necrosis. Infection of necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with organ failure and worse prognosis. In the past years, the treatment of pancreatic collections has shifted from open surgery to minimally invasive techniques, such as endoscopic ultrasound guided drainage. These guidelines from a selection of experts among the Endoscopic Ultrasound Group from the Spanish Society of Gastrointestinal Endoscopy (GSEED-USE) have the purpose to provide advice on the management of pancreatic collections based on a thorough review of the available scientific evidence. It also reflects the experience and clinical practice of the authors, who are advanced endoscopists or clinical pancreatologists with extensive experience in managing patients with acute pancreatitis.

Concurrent hepatic and renal angiomyolipomas in tuberous sclerosis complex

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Concurrent hepatic and renal angiomyolipomas in tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is a rare disease which is characterized by widespread of a variety of benign tumors in multiple organs. Renal angiomyolipomas (AMLs) are the primary cause of morbidity in TSC due to anemia, renal failure or spontaneous bleeding. In contrast, the hepatic involvement is unusual and it is infrequently described in literature.

Effectiveness of rectal indomethacin in the prevention of acute pancreatitis after endoscopic retrograde cholangiopancreatography in unselected patients

BACKGROUND AND AIMS: several studies have shown that rectal indomethacin decreases the risk of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, in recent studies, its effectiveness is being questioned, especially in average risk patients. Our principal aim was to evaluate the efficacy of rectal indomethacin prophylaxis in the development of post-ERCP pancreatitis (PEP). METHODS: a retrospective cohort study was conducted at a third-level university hospital. Data was collected from every patients who underwent ERCP between January 2014 and June 2016. After February 2015, all patients received 100 mg of rectal indomethacin prior to ERCP. We analyzed groups, with indomethacin and without indomethacin, in unselected patients. RESULTS: a total of 524 patients were analyzed, with a mean age of 71.1 ± 17.0 (standard deviation [SD]) years. Of the total number of patients, 393 (75%) had an average risk; 277 received rectal indomethacin prior to ERCP, while 247 did not. In the group with indomethacin, 12 patients developed PEP (4.33%) versus ten in the indomethacin-free group (4.04%) (OR 1.33; 95% confidence interval [CI], 0.52-3.40; p = 0.56). Severe-moderate PEP developed in seven patients (2.52%) in the indomethacin group and in two patients (0.81%) in the indomethacin-free group (p = 0.24). Previous sphincterotomy was a protective factor (OR 0.02; 95% CI, 0.02-0.2; p = 0.001) and age < 45 years was a risk factor: (OR 3.43; 95% CI, 1.14-10.32; p = 0.03). CONCLUSIONS: rectal indomethacin does not appear to decrease the risk of developing PEP in unselected patients

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Effectiveness of rectal indomethacin in the prevention of acute pancreatitis after endoscopic retrograde cholangiopancreatography in unselected patients.

BACKGROUND AND AIMS: several studies have shown that rectal indomethacin decreases the risk of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). However, in recent studies, its effectiveness is being questioned, especially in average risk patients. Our principal aim was to evaluate the efficacy of rectal indomethacin prophylaxis in the development of post-ERCP pancreatitis (PEP). METHODS: a retrospective cohort study was conducted at a third-level university hospital. Data was collected from every patients who underwent ERCP between January 2014 and June 2016. After February 2015, all patients received 100 mg of rectal indomethacin prior to ERCP. We analyzed groups, with indomethacin and without indomethacin, in unselected patients. RESULTS: a total of 524 patients were analyzed, with a mean age of 71.1 ± 17.0 (standard deviation [SD]) years. Of the total number of patients, 393 (75%) had an average risk; 277 received rectal indomethacin prior to ERCP, while 247 did not. In the group with indomethacin, 12 patients developed PEP (4.33%) versus ten in the indomethacin-free group (4.04%) (OR 1.33; 95% confidence interval [CI], 0.52-3.40; p = 0.56). Severe-moderate PEP developed in seven patients (2.52%) in the indomethacin group and in two patients (0.81%) in the indomethacin-free group (p = 0.24). Previous sphincterotomy was a protective factor (OR 0.02; 95% CI, 0.02-0.2; p = 0.001) and age < 45 years was a risk factor: (OR 3.43; 95% CI, 1.14-10.32; p = 0.03). CONCLUSIONS: rectal indomethacin does not appear to decrease the risk of developing PEP in unselected patients.

Enfermedad celíaca no respondedora: crisis celíaca vs. enfermedad celíaca refractaria con respuesta a corticoides / Non-responsive coeliac disease: Coeliac crisis vs. refractory coeliac disease with response to corticosteroids

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Colitis ulcerosa asociada a pancreatitis autoinmune, sialoadenitis y vasculitis leucocitoclástica / Ulcerative colitis associated with autoimmune pancreatitis, sialadenitis and leukocytoclastic vasculitis

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[Prospective validation of the Rockall Scoring System in patients with upper gastrointestinal bleeding in Cayetano Heredia Hospital Lima- Peru]. / Estudio prospectivo de validacion del Sistema de Score de Rockall en pacientes con hemorragia digestiva alta en el Hospital Nacional Cayetano Heredia De Lima- Peru.

INTRODUCTION: The present study intends to validate the Rockall Score in patients with upper gastrointestinal bleeding (UGB) in our current medical setting and to find the value that best discriminates between patients with high or low risk of mortality, rebleeding and the need of more than two units of packed red blood cells (PRBC). MATERIALS AND METHODS: A descriptive prospective study was made from patients who arrived to Cayetano Heredia Hospital's emergency department between February 2007 and January 2008 due to UGB symptoms (hematemesis, coffe ground remit melena or hematoquezia). The Rockall score was used to determine severity of UGB and to stratify patients with higher risk of mortality or rebleeding. All patients were interviewed and any additional information was gathered from medical history records and emergency and hospitalization endoscopic procedure reports. During the study all patients were evaluated for rebleeding, the number of units of PRBCs needed and mortality rate. RESULTS: 163 patients were included in our study, 107 (65.64%) were male and 56 (34.36%) female, 8 were excluded due to lack of an endoscopic procedure. The remaining 155 patients were studied to evaluate the discriminative ability of the scoring system, and to determine which value best distinguishes high and low severity patients using Receiver Operating Characteristic curve (ROC) and calculated area under the curve. The data analysis showed patients with a Rockall Score e 5 had an increased mortality rate compared to lower score with an area under the curve of 0.807, meaning an accurate relationship between mortality and a score e 5. For rebleeding and the need of two packed red blood cells for transfusion, the area under the curve were 0.65 and 0.64 respectively showing a low predictive value. CONCLUSION: The Rockall scoring system is useful to identify patients with high mortality risk, but not to predict rebleeding or the need for blood transfusion in our hospital.

Validación del Score de Rockall en pacientes con hemorragia digestiva alta en un hospital de Lima - Perú / Rockall Scoring in patients with upper gastrointestinal bleeding in hospital Lima - Peru

INTRODUCCIÓN: El presente estudio pretende validar el score de Rockall en nuestro medio y encontrar el valor que mejor discrimine entre el paciente con alto y bajo riesgo de mortalidad, resangrado y necesidad de transfusión de más de 2 paquetes globulares en pacientes con hemorragia digestiva alta.MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo, prospectivo en pacientes que acudieron a la emergencia del Hospital Nacional Cayetano Heredia entre febrero del 2007 y enero del 2008 por presentar hemorragia digestiva alta (melena, hematemesis, vómito tipo bona de café, rectorragia o hematoquezia), se utilizó el score de Rockall para determinar su severidad y estratificar a los pacientes con mayor riesgo de fallecer o presentar resangrado. Para el estudio se entrevistó al paciente, se recolectaron datos de las historias clínicas, de los informes endoscópicos en emergencia y en los pisos de hospitalización, se evaluó en el seguimiento la ocurrencia de resangrado, el número de paquetes globulares transfundidos y la mortalidad.RESULTADOS: En total fueron 163 pacientes los incluidos en el estudio, 107 (65.64 por ciento) casos fueron varones y 56 (34.36 por ciento) mujeres, pero se debió excluir a 8 de ellos porque no contaban con endoscopía de emergencia. Entre los 155 restantes se buscó establecer el punto de corte para determinar a los pacientes severos y no severos utilizando la curva de ROC (Receiver Operating Characteristic). Luego del análisis, se encontró que al comparar el Score de Rockall con la mortalidad (12.9 por ciento), los pacientes con un score mayor igual de 5 presentaban más riesgo de fallecer que los pacientes con puntaje menor, con un área bajo la curva de ROC de 0.8037 que indica una alta capacidad de discriminación de este score para predecir mortalidad...

INTRODUCTION: The present study intends to validate the Rockall Score in patients with upper gastrointestinal bleeding (UGB) in our current medical setting and to find the value that best discriminates between patients with high or low risk of mortality, rebleeding and the need of more than two units of packed red blood cells (PRBC). MATERIALS AND METHODS: A descriptive prospective study was made from patients who arrived to Cayetano Heredia Hospital¢¥s emergency department between February 2007 and January 2008 due to UGB symptoms (hematemesis, coffe ground remit melena or hematoquezia). The Rockall score was used to determine severity of UGB and to stratify patients with higher risk of mortality or rebleeding. All patients were interviewed and any additional information was gathered from medical history records and emergency and hospitalization endoscopic procedure reports. During the study all patients were evaluated for rebleeding, the number of units of PRBCs needed and mortality rate.RESULTS: 163 patients were included in our study, 107 (65.64 percent) were male and 56 (34.36 percent) female, 8 were excluded due to lack of an endoscopic procedure. The remaining 155 patients were studied to evaluate the discriminative ability of the scoring system, and to determine which value best distinguishes high and low severity patients using Receiver Operating Characteristic curve (ROC) and calculated area under the curve. The data analysis showed patients with a Rockall Score ¡Ã 5 had an increased mortality rate compared to lower score with an area under the curve of 0.807, meaning an accurate relationship between mortality and a score ¡Ã 5. For rebleeding and the need of two packed red blood cells for transfusion, the area under the curve were 0.65 and 0.64 respectively showing a low predictive value...