Hemobilia due to intracholecystic papillary neoplasm.

We report the case of a 39-year-old patient who presented an episode of upper gastrointestinal bleeding due to hemobilia. The imaging tests showed the gallbladder occupied by solid tissue, with a diagnosis of intracholecystic papillary neoplasm after the cholecystectomy. The intracholecystic papillary neoplasm of the gallbladder is a newly established entity and it is considered a subtype of intraductal papillary neoplasm of the bile duct. Its presentation in the form of hemobilia has barely been described in the literature.

Hemobilia por neoplasia papilar intracolecística / Hemobilia due to intracholecystic papillary neoplasm

Exponemos el caso de un paciente de 39 años que presentó un episodio de hemorragia digestiva alta secundario a hemobilia. Mediante las pruebas de imagen realizadas se objetivó ocupación de la vesícula biliar por tejido sólido, que tras colecistectomía se diagnosticó de neoplasia papilar intracolecística. Se trata una entidad recientemente establecida y se considera un subtipo de la neoplasia papilar intraductal de la vía biliar. La presentación en forma de hemobilia apenas ha sido descrita en la literatura (AU)

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Rentabilidad de la cápsula endoscópica en mujeres premenopáusicas con anemia ferropénica / Diagnostic yield of video capsule endoscopy in premenopausal women with iron-deficiency anemia

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

[Diagnostic yield of video capsule endoscopy in premenopausal women with iron-deficiency anemia]. / Rentabilidad de la cápsula endoscópica en mujeres premenopáusicas con anemia ferropénica.

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.