Pathology results of endoscopic ultrasound-guided tissue acquisition in retroperitoneal masses: a multicenter study.

Background: Malignant etiologies are found in 70-80% of symptomatic retroperitoneal masses. Histology is required for diagnosis and treatment. Information about endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-GTA) is scant for retroperitoneal masses. This study aimed to assess the pathology results of EUS-GTA for diagnosing retroperitoneal masses. Methods: This retrospective, multicenter study involved patients from 5 care centers. All patients with retroperitoneal masses who underwent EUS evaluation were enrolled. We recorded demographic and clinical characteristics, location and size of the mass, type of needle (FNA/FNB), and complications related to the procedure. Results: A total of 43 patients were included. The median age was 50.5 (range: 23-83) years, and 22 (51.2%) were female. The initial symptom was abdominal pain in 23 (52.3%) cases and weight loss in 11 (25%). Initial imaging was by computed tomography in 33 (75%) patients. Diagnosis with EUS-GTA was reached in 67.5% (29/43) cases. The most frequent histological diagnosis was carcinoma, in 25.5% (11/43). A malignant etiology was found in 31 (72%): 20 were primary tumors from the retroperitoneum, and 11 were metastases. In patients with metastasis, surgery was avoided and medical treatment was indicated. No adverse events were reported. Conclusion: EUS and EUS-GTA can frequently provide accurate tissue diagnosis and significantly impact the subsequent management.

Endoscopic Ultrasound in Pediatric Patients With Pancreatobiliary Disease.

BACKGROUND: Endoscopic ultrasound (EUS) is one of the greatest advances of the last few decades for the diagnostic and therapeutic approach of gastrointestinal diseases in adults. However, there are limitations to the application of the procedure in the pediatric population. The aim of this study was to describe the diagnostic yield and therapeutic role of EUS in pediatric patients with pancreatobiliary disease. MATERIALS AND METHODS: A retrospective study was performed on a prospective database of pediatric patients who underwent diagnostic and therapeutic endosonographic procedures. All patients seen in a 12-year period were included. RESULTS: A total of 54 patients were included, including 32 (59.3%) female individuals, with an average age of 16 (9 to 17) years. EUS was abnormal in 46 (85%) patients. Of the abnormal procedures, 4 (7.4%) corresponded to therapeutic ones. The main indication of the study was recurrent acute pancreatitis in 29 (54%). The main endosonographic findings were microlithiasis in 14 (25.9%), chronic pancreatitis in 9 (16.7%), and pancreatic tumors in 6 (11.1%) patients. Follow-up was performed in 31 (57.4%) patients, 19/31 patients underwent surgery, and 4/31 patients had endoscopic retrograde cholangiopancreatography. The median follow-up was 910 (2 to 3916) days. In 100% of the patients with follow-up, the initial diagnosis of EUS was confirmed. CONCLUSION: EUS is a useful and safe tool in the pediatric population with pancreatobiliary diseases.

Biliary Drainage in Patients With Failed ERCP: Percutaneous Versus EUS-guided Drainage.

AIM: The goal of the study is to compare the efficacy and safety of bile duct drains guided by endoscopic ultrasound-guided biliary drainage (EGBD) versus percutaneous transhepatic biliary drainage (PTBD). MATERIALS AND METHODS: Retrospective comparative study. Patients with obstruction of the bile duct who underwent the EGBD or PTBD procedure and had at least 1 previous endoscopic retrograde cholangiopancreatography that failed or was inaccessible to the second duodenal portion were included. RESULTS: A total of 90 patients were initially evaluated and 28 were excluded. There were 39 (62.9%) women, with a median age of 55.6 years (range, 22 to 88 y). The etiology of biliary obstruction was malignancy in 35 (56.4%) patients. Differences between EGBD versus PTBD groups were in technical success (90% vs. 78%; P=0.3), clinical success (96% vs. 63%; P=0.04), complications (6.6% vs. 28%; P=0.04), length of stay [6.5 d (range, 0 to 11 d) vs. 12.5 d (range, 6.2 to 25 d)] (P=0.009), and costs 1440.15±240.94 versus 2165.87±241.10 USD (P=0.03). CONCLUSIONS: EGBD is associated with a higher clinical success rate and safety, shorter hospital stays, and lower cost compared with PTBD.

Diagnostic yield and therapeutic impact of rectal retroflexion: a prospective, single-blind study conducted in three centers.

BACKGROUND/AIMS: No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination. METHODS: A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included. RESULTS: A total of 934 patients (542 women, 58%) were included. The mean age was 57.4±14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact. CONCLUSIONS: Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.

Vascular invasion in pancreatic cancer: predictive values for endoscopic ultrasound and computed tomography imaging.

OBJECTIVES: To evaluate the accuracy of endoscopic ultrasound (EUS) to determine vascular invasion in patients with pancreatic cancer. METHODS: Data were obtained prospectively from patients with a pancreatic lesion who underwent EUS, computed tomographic (CT) imaging, and surgery from March 2005 to March 2010. RESULTS: Fifty patients were included with a mean ± SD age 61 ± 11.5 years; 27 (54%) were women. The sensitivity, specificity, positive predictive value, and negative predictive value for EUS were the following: 61.1 (95% CI, 38.6-79.7), 90.3 (95% CI, 75.1-96.7), 78.6 (95% CI, 52.4-92.4), and 80 (95% CI, 64.1-90), respectively. The area under the curve for EUS and that for CT were 0.80 (95% CI, 0.68-0.92) and 0.74 (95% CI, 0.61-0.86), respectively. The positive predictive value for arterial invasion was 100% (95% CI, 61-100) for EUS and 60% (95% CI, 31.3-83.2) for CT. There were no complications associated with the EUS or the CT. CONCLUSION: Endoscopic US is a very good option to detect vascular invasion in patients with pancreatic cancer and is especially sensitive for arterial invasion. When it is available, we recommend that it be performed in addition to CT staging.

Utility of a simplified predictive model to predict rebleeding in patients with high-risk stigmata ulcers.

AIM: To evaluate a simplified Predictive Model (sPM) to predict rebleeding in patients with high-risk stigmata ulcers. PATIENTS AND METHODS: Retrospectively, patients seen from March 2002 to September 2007 with peptic ulcers Forrest Ia, Ib, IIa and/or IIb were included. A sPM based on modified Blatchford Score Risk System (mBRS) was used. RESULTS: One hundred and seven patients were included. The positive and negative predictive values for rebleeding with mBRS ≤1 were 15% [95% confidence interval (CI): 4-42] and 72% (95% CI: 61-80), respectively; for sPM ≤1 these values were 16% (95% CI: 8-29) and 65.3% (95% CI: 52-76), respectively. The odds ratio for rebleeding in patients with sPM ≤1 was 0.77 (95% CI: 0.6-0.97, P=0.03) and odds ratio for mBRS ≤1 was 0.84 (95% CI: 0.64-1.1, P=0.3). CONCLUSIONS: In patients with high-risk stigmata ulcers with sPM and mBRS ≤1 the risk of rebleeding is low and their early discharge could be considered.

PPIs are not associated with a lower incidence of portal-hypertension-related bleeding in cirrhosis.

AIM: To determine if proton pump inhibitor use in cirrhotic patients with endoscopic findings of portal hypertension is associated with a lower frequency of gastrointestinal bleeding. METHODS: Patients with cirrhosis and endoscopic findings related to portal hypertension, receiving or not receiving proton pump inhibitor (PPI) therapy, were included retrospectively. We assigned patients to two groups: group 1 patients underwent PPI therapy and group 2 patients did not undergo PPI therapy. RESULTS: One hundred and five patients with a median age of 58 (26-87) years were included, 57 (54.3%) of which were women. Esophageal varices were found in 82 (78%) patients, portal hypertensive gastropathy in 72 (68.6%) patients, and gastric varices in 15 (14.3%) patients. PPI therapy was used in 45.5% of patients (n = 48). Seventeen (16.1%) patients presented with upper gastrointestinal bleeding; in 14/17 (82.3%) patients, bleeding was secondary to esophageal varices, and in 3/17 patients bleeding was attributed to portal hypertensive gastropathy. Bleeding related to portal hypertension according to PPI therapy occurred in 18.7% (n = 9) of group 1 and in 14% (n = 8) of group 2 (odds ratio: 0.83, 95% confidence interval: 0.5-1.3, P = 0.51). CONCLUSION: Portal hypertension bleeding is not associated with PPI use. These findings do not support the prescription of PPIs in patients with chronic liver disease with no currently accepted indication.

Endoscopic treatment with argon plasma coagulation in postradiation proctopathy.

INTRODUCTION: Postradiation proctopathy (PP) is a major complication in patients who receive radiotherapy for cancer. Medical treatments of this entity are unsatisfactory. Argon plasma coagulation (APC) had been shown to be successful with low complications. The aim was to describe our experience with APC in the management of PP. METHODS: We conducted a retrospective analysis of electronic- and paper-based records of patients with PP managed with APC. RESULTS: Nineteen patients with PP were included, nine were women. Median age was 64 years, and follow-up was 29 months. The most frequent cause of radiotherapy for cancer was cervicouterine and prostate ENDOSCOPIC FINDINGS: Moderate disease was observed in nine patients; mild and severe diseases were observed in five patients each. At endoscopy, telangiectasias were present in 15, ulcers in five, and active bleeding in two patients. Median of APC sessions was two (one to seven). Mean dose of APC was 30 W (30-40 W) and 1.7 l (1.5-2.0 l). Median time for relief of symptoms was 3 months. All patients were asymptomatic at the end of treatment, and bleeding was controlled at the end of treatment in all patients. Recurrence of bleeding presented in one patient at 4 months. No complications were related to the APC treatment. CONCLUSIONS: According to our data, APC is successful in treatment of PP, with few sessions and low morbidity and null mortality.

Salmonella sp group A: a rare cause of bacterascites. A case report.

Bacterascites (BA) is a minimally studied and defined entity. Its prognosis and clinical course are not well defined, and currently there are no management guidelines. We present a rare cause of BA in which Salmonella sp group A was isolated in a 44 year old man with cirrhosis who had diarrhea and fever three days earlier. Treatment with intravenous ceftriaxone was effective.

Prevalence of metabolic syndrome, obesity and diabetes type 2 in cryptogenic cirrhosis.

AIM: To evaluate the prevalence of metabolic syndrome (MS), obesity and type 2 diabetes mellitus (T2DM) in a group of Mexican Mestizo patients with cryptogenic cirrhosis (CC) and to compare this group with patients with cirrhosis secondary to other causes (disease controls). METHODS: Patients with CC, diagnosed between January, 1990 and April, 2005, were included in a retrospective study. Patients with cirrhosis caused by chronic hepatitis C, alcohol abuse or autoimmune hepatitis (AIH) served as disease controls. RESULTS: A total of 134 patients with CC were analyzed. Disease controls consisted of 81 patients with chronic hepatitis C, 33 with alcohol abuse and 20 with AIH. The median age of patients with CC was 57 years (range, 16-87); 83 (61.9%) patients were female; 53 (39.6%) were Child A, 65 (48.5%) Child B, and 16 (11.9%) were Child C cirrhosis. The prevalence of MS (29.1% vs 6%; P<0.001), obesity (16.4% vs 8.2%; P=0.04) and T2DM (40% vs 22.4%; P=0.013) was higher in CC patients than in disease controls. There were no differences in sex, age or liver function tests between the two groups. CONCLUSION: The prevalence of MS, obesity and T2DM were higher in patients with CC than in patients with cirrhosis secondary to others causes. Our findings support the hypothesis that non-alcoholic steatohepatitis (NASH) plays an under-recognized role in CC.

[Factors associated with microalbuminuria in non-hypertensive type-2 diabetes patients]. / Factores asociados con microalbuminuria en pacientes diabéticos tipo 2 no hipertensos.

INTRODUCTION: Microalbuminuria is a well known risk factor for renal damage and for cardiovascular disease in type-2 diabetic patients. OBJECTIVE: To evaluate anthropometric, laboratory, and diet factors related to the presence of microalbuminuria in non-hypertensive type 2 diabetic subjects. MATERIAL AND METHODS: We carry-out an assessment of a group of non-hypertensive diabetic patients with or without microalbuminuria. Some anthropometric measures, physical fitness, tobacco and alcohol consumption, creatinine clearance, HbA1c, lipid profile, the mean fast serum glucose levels in last two years, 24 h urine protein, and caloric intake were all measured. RESULTS: From 86 included patients, 19 had microalbuminuria; it was related with the length of diabetes mellitus duration (114 +/- 55 vs. 84 +/- 67 months; p = 0.03), higher HbA1c level (8.9 vs. 7.1%; p = 0.001), and lower HDL-cholesterol levels (37.7 +/- 11 vs. 42.9 +/- 12 mg/dL; p = 0.03). In the multivariate analysis HbA1c level, and mean fast glucose remained significant. CONCLUSIONS: In non-hypertensive diabetic subjects, poor glucose control, and longer disease duration were both related with microalbuminuria. Moreover, caloric intake, exercise, tobacco or alcohol consumption, or BMI did not show association with microalbuminuria.

[Critical analysis of awards in gastroenterology research. The Mexican experience]. / Análisis de los premios a la investigación en gastroenterología. Experiencia en México.

The impact of Mexican gastrointestinal research worldwide is limited and the outcome of the best research papers awarded by the Asociación Mexicana de Gastroenterología (AMG) is unknown. The objective of this study was to analyze the publication pattern of the research work, awarded by the AMG and their impact in international journals. The abstracts accepted for the annual meeting of the AMG from 1998 to 2006 were reviewed. Those presented in a plenary session or awarded were included. Their abstracts were searched in electronic databases. When not found, the main author was contacted by e-mail. In those papers published in a journal with an impact factor, the times it was cited were assessed. 35 abstracts were identified, mainly in gastroenterology (57.1%) and hepatology (34.3). Only in 5.7% (n=2) some of the authors were members of the governing board of AMG. The awarded institutions were Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Universities (Universidad Autónoma de Nuevo León, Universidad Nacional Autónoma de México and the Benemérita Universidad Autónoma de Puebla) (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Private hospital (2.9%). Most of the papers were published within a year (73.7%). Only 2 papers had more than 10 citations in another international journal with impact factor, with a median for all paper of 5 citations (0-45). Considering all institutions, the rate of publication is 48%. Only half of the awarded works were published and mainly in journals of local distribution. The impact of these studies worldwide is limited.

Análisis de los premios a la investigación en gastroenterología: Experiencia en México / Critical analysis of awards in gastroenterology research: The Mexican experience

El impacto internacional de la investigación gastroenterológica mexicana es limitado. Se desconoce cuál ha sido el resultado final de los trabajos de mejor calidad a nivel nacional de acuerdo a la Asociación Mexicana de Gastroenterología (AMG). El objetivo de este trabajo fue analizar el patrón de publicación e impacto en las publicaciones periódicas internacionales de los trabajos premiados por la AMG. Se revisaron las memorias del congreso anual de la AMG, período 1998-2006. Se seleccionaron resúmenes donde se indicara premiación o presentación en sesión plenaria. Los trabajos identificados fueron buscados en bases de datos electrónicas, o bien se contactó alguno de los autores para solicitar la información relacionada. De aquellos trabajos publicados en revistas con factor de impacto se buscaron las citas relacionadas. Se localizaron 35 premios, 57.1% fueron en el área de gastroenterología y 34.3% en hepatología. Las instituciones con los premios son Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Instituciones de Educación Superior (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Hospital privado (2.9%). De estos se han publicado 19 (54.8%), la mayoría antes de un año (73.7%). Unicamente dos de los trabajos publicados tienen registradas <10 citas en revistas con factor de impacto. La mitad de los trabajos meritorios de premiación han sido publicados. La mayoría se publican en revistas de circulación nacional. El impacto de estos trabajos a nivel internacional es limitado.

The impact of Mexican gastrointestinal research worldwide is limited and the outcome of the best research papers awarded by the Asociación Mexicana de Gastroenterología (AMG) is unknown. The objective of this study was to analyze the publication pattern of the research work, awarded by the AMG and their impact in international journals. The abstracts accepted for the annual meeting of the AMG from 1998 to 2006 were reviewed. Those presented in a plenary session or awarded were included. Their abstracts were searched in electronic databases. When not found, the main author was contacted by e-mail. In those papers published in a journal with an impact factor, the times it was cited were assessed. 35 abstracts were identified, mainly in gastroenterology (57.1%) and hepatology (34.3). Only in 5.7% (n=2) some of the authors were members of the governing board of AMG. The awarded institutions were Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (48.6%), Universities (Universidad Autónoma de Nuevo León, Universidad Nacional Autónoma de México and the Benemérita Universidad Autónoma de Puebla) (31.4%), Instituto Mexicano del Seguro Social (8.6%), Fundación Clínica Médica Sur (5.7%), Hospital Juárez (2.9%), Private hospital (2.9%). Most of the papers were published within a year (73.7%). Only 2 papers had more than 10 citations in another international journal with impact factor, with a median for all paper of 5 citations (045). Considering all institutions, the rate of publication is 48%. Only half of the awarded works were published and mainly in journals of local distribution. The impact of these studies worldwide is limited.

Upper gastrointestinal dieulafoy's lesions and endoscopie treatment: first report from a mexican centre.

The aim was to evaluate the initial success, rebleeding rate, need for emergent surgery, and mortality rates of patients with Dieulafoy's lesion (DL) and endoscopic treatment (ET). Patients with DL from a tertiary center were included. We included 20 patients with follow-up of 90 (60-550) days. The lesser curvature was the most common localization. Initial success, rebleeding, and emergent surgery requirement were observed in 90%, 10%, and 15%, respectively. No objective variables were related with response to ET. In conclusion, ET is secure and useful in patients with DL and it must be considered as the first-line treatment modality.

Endoscopic treatment of high-risk bleeding ulcers: success, rebleeding and mortality.

INTRODUCTION AND AIMS: Endoscopic treatment of peptic ulcers with high-risk stigmata has been probed. The rates of recurrent bleeding, need for emergent surgery and death are related to Forrest Classification, Blatchford's modified risk score and the kind of endoscopic treatment used (monotherapy vs. dual). The aims of the present study were to report the success of endoscopic therapy in the reduction of the rate of initial success, recurrent bleeding, the need for surgery, and the mortality rate for patients with bleeding peptic ulcer and high-risk stigmata. PATIENTS AND METHODS: From a retrospective view, patients seen from September 2004 to March 2007 who had peptic ulcers Forrest Ia, Ib, IIa and/or IIb were included. RESULTS: Fifty-six patients were included (mean [SD] age 57.3 +/-16.6 years). The success rate was 91%, whilst the rest of the patients required immediate surgery. Recurrent bleeding was presented in 14 (27%) patients and eight (14.2%) required emergency surgery. The mortality rate was 3.6%. No factors were associated with the risk of failure to initial treatment, recurrent bleeding or need for surgery. The use of monotherapy by endoscopy was associated with the mortality. The variable "performed by a fellow alone" was not associated with any kind of outcome. CONCLUSION: Complication rate is similar to previous reports of general hospitals, but is higher than those of referral centers. Endoscopic monotherapy is associated with a major mortality risk.