ABSTRACT
En los pacientes a los que se les ha realizado una cirugía gástrica en Y-de-Roux, la realización de una colangiopancreatografía retrógrada endoscópica (CPRE) es muy dificultosa. Debido al aumento de la prevalencia de la obesidad mórbida y a la realización de cirugías laparoscópicas para su tratamiento, la incidencia de problemas biliares en pacientes con anatomía modificada también es creciente. Presentamos una técnica quirúrgica laparoscópica para acceder a la vía biliar por endoscopio, a través del estómago excluido
Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach
Subject(s)
Female , Humans , Middle Aged , Cholangiopancreatography, Endoscopic Retrograde/methods , Laparoscopy/methods , Biliopancreatic Diversion/methods , Obesity, Morbid/surgery , Anastomosis, Roux-en-Y , Obesity, Morbid/complications , Arnold-Chiari Malformation/complications , Jaundice, Obstructive/etiologyABSTRACT
Las guías clínicas indican el estudio con cápsula endoscópica (CE) en pacientes con anemia ferropénica (AF) tras exploraciones endoscópicas convencionales normales, pero se precisan estudios que demuestren su rentabilidad, impacto clínico y coste en algunos subgrupos de pacientes. OBJETIVOS: 1. Determinar la rentabilidad diagnóstica de la CE en mujeres premenopáusicas con AF comparada con varones y mujeres posmenopáusicas. 2. Identificar la presencia de factores predictivos de patología en mujeres premenopáusicas. 3. Realizar una aproximación al gasto en esta indicación en relación con el impacto. MATERIAL Y MÉTODO: Estudio retrospectivo de 408 pacientes a los que se ha realizado CE. Se incluyeron pacientes con AF (mujeres en edad premenopáusica, posmenopáusica o varones), gastroscopia y colonoscopia previas. RESULTADOS: Incluimos 249 pacientes, 131 mujeres (52,6%), 51 premenopáusicas y 80 posmenopáusicas y 118 hombres, mediana de edad 60,7 ± 16 años. La rentabilidad global de la CE para el diagnóstico de AF fue 44,6% (IC 95% 39,9-50,8). Rentabilidad en varones vs. mujeres 50,8 vs. 38,9% (p = 0,05) y en mujeres posmenopáusicas vs. premenopáusicas 55 vs. 13,7% (p < 0,001). No se detectó ningún factor predictivo de patología en premenopáusicas. La lesión más frecuente en posmenopáusicas fueron angiodisplasias (70,5%) y en premenopáusicas lesiones erosivas (57,1%). El gasto aproximado en premenopáusicas supuso una inversión de 44.727 Euros El 86,3% no tuvo impacto clínico. CONCLUSIONES: La rentabilidad diagnóstica de la CE es baja en el estudio etiológico de AF en mujeres en edad fértil y poco costo-efectiva en relación con el impacto clínico. No detectamos factores predictivos de patología en ID en este subgrupo
Clinical practice guidelines recommend video capsule endoscopy (VCE) studies in patients with iron-deficiency anemia (IDA) after conventional upper and lower endoscopies but there is a need for studies demonstrating the diagnostic yield, clinical impact, and cost in some patient subgroups. OBJECTIVES: 1.To determine the diagnostic yield of VCE in premenopausal women with IDA compared with that in men and postmenopausal women. 2. To identify the presence of VCE predictors in premenopausal women. 3. To estimate the cost-clinical impact relationship associated with VCE in this indication. MATERIAL AND METHOD: We retrospectively analyzed 408 patients who underwent VCE. Patients with IDA were enrolled (premenopausal, postmenopausal women, and men), with previous normal work-up by conventional endoscopies. RESULTS: A total of 249 patients were enrolled: 131 women (52.6%), of which 51 were premenopausal and 80 were post-menopausal, and 118 men. The mean age was 60.7 ± 16 years. The diagnostic yield of VCE for the diagnosis of IDA was 44.6% (95% CI 39.9 - 50.8). Diagnostic yield was 50.8% vs 38.9% in men vs women (p = 0.05) and was 55% vs 13.7% in postmenopausal vs premenopausal women (p < 0.001). No predictors of small bowel lesions were found in premenopausal women. The most common findings in the postmenopausal group were angioectasias (70.5%) and erosions (57.1%) in the premenopausal group. The cost in premenopausal women was 44.727 Euros and 86.3% of the procedures had no clinical impact. CONCLUSIONS: The diagnostic yield of VCE is low in the etiological study of IDA in premenopausal women and there is no cost-effectiveness in relation to clinical impact. No predictors of small bowel lesions were found in this group
Subject(s)
Adult , Female , Humans , Male , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/etiology , Capsule Endoscopes/economics , Intestine, Small/pathology , Double-Balloon Enteroscopy , Angiodysplasia/diagnosis , Premenopause , Postmenopause , Gastrointestinal Hemorrhage/etiology , Crohn Disease/diagnosis , Cost-Benefit AnalysisABSTRACT
Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach.
Subject(s)
Laparoscopy , Biliopancreatic Diversion , Cholangiopancreatography, Endoscopic Retrograde , Gastric Bypass , Humans , Obesity, Morbid/surgeryABSTRACT
UNLABELLED: Clinical practice guidelines recommend video capsule endoscopy (VCE) studies in patients with iron-deficiency anemia (IDA) after conventional upper and lower endoscopies but there is a need for studies demonstrating the diagnostic yield, clinical impact, and cost in some patient subgroups. OBJECTIVES: 1.To determine the diagnostic yield of VCE in premenopausal women with IDA compared with that in men and postmenopausal women. 2. To identify the presence of VCE predictors in premenopausal women. 3. To estimate the cost-clinical impact relationship associated with VCE in this indication. MATERIAL AND METHOD: We retrospectively analyzed 408 patients who underwent VCE. Patients with IDA were enrolled (premenopausal, postmenopausal women, and men), with previous normal work-up by conventional endoscopies. RESULTS: A total of 249 patients were enrolled: 131 women (52.6%), of which 51 were premenopausal and 80 were post-menopausal, and 118 men. The mean age was 60.7±16 years. The diagnostic yield of VCE for the diagnosis of IDA was 44.6% (95% CI 39.9 - 50.8). Diagnostic yield was 50.8% vs 38.9% in men vs women (p=0.05) and was 55% vs 13.7% in postmenopausal vs premenopausal women (p<0.001). No predictors of small bowel lesions were found in premenopausal women. The most common findings in the postmenopausal group were angioectasias (70.5%) and erosions (57.1%) in the premenopausal group. The cost in premenopausal women was 44.727 and 86.3% of the procedures had no clinical impact. CONCLUSIONS: The diagnostic yield of VCE is low in the etiological study of IDA in premenopausal women and there is no cost-effectiveness in relation to clinical impact. No predictors of small bowel lesions were found in this group.
Subject(s)
Anemia, Iron-Deficiency/etiology , Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnostic imaging , Premenopause , Adult , Aged , Angiodysplasia/complications , Angiodysplasia/diagnostic imaging , Capsule Endoscopy/economics , Cost-Benefit Analysis , Crohn Disease/complications , Crohn Disease/diagnostic imaging , Female , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/diagnosis , Humans , Intestine, Small/diagnostic imaging , Male , Middle Aged , Peptic Ulcer/complications , Peptic Ulcer/diagnostic imaging , Postmenopause , Predictive Value of Tests , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Patient Education as Topic/methods , Patient Education as Topic/trends , Health Services/standards , Health Services , Information Services/standards , Information Services , Foreign Bodies/complications , Foreign Bodies/diagnosis , Foreign Bodies/therapy , Esophagus/injuries , Esophagus , Emergencies , Risk GroupsABSTRACT
La enfermedad de Crohn (EC) se puede complicar con la aparición de estenosis intestinal. Las estenosis que no responden al tratamiento médico habitualmente requieren cirugía. La dilatación endoscópica con balón es una alternativa a la cirugía.A continuación se presenta el caso de un paciente con EC y una estenosis de la válvula ileocecal asintomática que se manifestó como un cuadro oclusivo secundario a la impactación de un cuerpo extraño (semilla de níspero). Se realizó una dilatación endoscópica y la extracción del cuerpo extraño. En este trabajo se lleva a cabo una revisión de la literatura médica en relación al tratamiento endoscópico de las estenosis intestinales secundarias a la EC (AU)
Crohn's disease is often complicated by intestinal strictures. Symptomatic strictures refractory to medical therapy usually require surgery. Endoscopic balloon dilatation is an alternative to surgery. We report the case of a patient with Crohns disease with asymptomatic ileocecal stricture, which was identified after intestinal obstruction due to an impacted foreign body. The patient underwent endoscopic dilatation and the foreign body was extracted. We provide a review of the literature on endoscopic balloon dilatation of intestinal strictures in Crohn's disease (AU)
