Choledochoduodenostomy with LAMS (Hot-Axios type) for malignant obstructive jaundice - An increasingly used technique.

An 82-year-old woman who presented with obstructive jaundice and constitutional syndrome was diagnosed with pancreatic adenocarcinoma. Palliative management was decided with endoscopic ultrasound drainage as it was impossible to perform ERCP due to anatomical alterations, a consequence of the neoplastic lesion.

Lenvatinib in severe hypoglycemia associated with hepatocellular carcinoma.

We present the case of a 24-year-old male with multicentric hepatocellular carcinoma (HCC) over HBV-related compensated liver cirrhosis, on treatment with sorafenib and tenofovir. He had multiple admissions in recent months for severe hypoglycemia episodes with neurological symptoms.

Cardiorespiratory complications of digestive endoscopy not related to sedation.

Although digestive endoscopy is considered to be a safe procedure, both the growing complexity of the techniques and the underlying diseases of patients increase the risk of adverse events during the procedure. Cardiorespiratory events are the most frequent complications, and can occur in patients with or without sedation, although they appear more often when the patient is sedated. The body's physiological response to stress is what causes these adverse events, which are generally mild and transient, although they can be serious. They are more frequent in patients with cardiopulmonary diseases, which logically increase risk. The autonomic nervous system, through its sympathetic and parasympathetic branches, is primarily responsible for these alterations. Patients with asthma or chronic obstructive pulmonary disease have a higher risk of hypoxemia, bronchospasm, and arrhythmia during the endoscopic procedure. Patients with arrhythmia and ischemic heart disease have a higher risk of myocardial ischemia and heart rhythm disturbances. The risk of adverse events during the procedure can be reduced by reviewing the patient's medical history along with a basic clinical examination before endoscopy. A brief interrogation about symptom control can also help the safety of endoscopy.

Gastrostomía endoscópica percutánea. Indicaciones, cuidados y complicaciones / Percutaneous endoscopic gastrostomy. Indications, care and complications

La gastrostomía endoscópica percutánea resulta un método eficaz y seguro para el soporte nutricional en pacientes con desnutrición e imposibilidad para la ingesta oral, con una supervivencia estimada superior a 2 meses que requieran nutrición enteral más allá de 4 semanas. Las principales indicaciones incluyen las neoplasias de tracto aéreo-digestivo superior y las enfermedades neurológicas, considerándose actualmente la demencia una indicación discutida. Las alteraciones anatómicas y los procesos infecciosos suponen las contraindicaciones más frecuentes. Existen distintas técnicas endoscópicas, siendo el método por tracción el más utilizado, teniendo en común todas ellas una baja mortalidad. Las complicaciones ocurren con mayor frecuencia en pacientes pluripatológicos y de edad avanzada, siendo las más prevalentes la infección de la herida, la extracción y obstrucción de la sonda y la neumonía broncoaspirativa. Una adecuada preparación previa del paciente y un exhaustivo cuidado y mantenimiento de la sonda pueden reducir la aparición de estas

Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these

Percutaneous endoscopic gastrostomy. Indications, care and complications. / Gastrostomía endoscópica percutánea. Indicaciones, cuidados y complicaciones.

Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method for nutritional support in patients with malnutrition and impossibility of oral intake with an estimated survival higher than the months that require enteral nutrition beyond four weeks. The main indications include neoplasms of the upper air-digestive tract and neurological diseases, with dementia currently considered a controversial indication. Anatomical alterations and infectious diseases are the most frequent contraindications. There are different endoscopic techniques; the most widely used being the "pull" method, with a low mortality. Complications are more frequent in patients with multiple pathologies and the elderly. Wound infection, extraction of the tube, tube blockage and bronchoaspiratory pneumonia are the most prevalent complications. Adequate prior preparation of the patient and exhaustive maintenance of the tube can reduce the appearance of these.