ABSTRACT
Cyanacrylate is not free of complications and a more commonly used alternative in clinical practice are prostheses that have the disadvantage of migrating in these cases where there is no stenosis; however, with their fixation using a specific device, migrations are greatly reduced. A good alternative to cyanacrylate, especially in cases of orifices or large tracts in which complications may appear, are the prostheses, which are also easier to handle in clinical practice. Sometimes cancer patients have upper gastrointestinal complications no subsidiary to surgical treatment, like a tumor fistula, that contraindicate chemotherapy. In situations like this, endoscopic intervention can be a potentially profitable alternative that impacts the patient's prognosis.
ABSTRACT
Follicular pancreatitis (FP) is an extremely odd entity characterized by the presence of a pseudotumor that histologically presents lymphoid aggregates and germinal centers. The authors present the case of a 67-year-old woman with epigastric pain and jaundice. Endoscopic ultrasonography (EUS) was performed, revealing a 14x15 mm hypoechoic area with irregular edges in the head of the pancreas. The in situ cytological study showed polymorphic lymphoid cellularity, without atypia suggesting neoplasia. The cell block and the immunohistochemical study showed a polyclonal population with a pattern suggestive of FP. The patient presented spontaneous clinical improvement. The EUS follow up three months later shown pancreatic parenchyma with homogeneous echogenicity and no space occupying lesions were indentified. Since the diagnosis of FP has been reached after surgery in most cases, the treatment is not well established. However, no recurrences have been reported after surgery and spontaneous resolution has been observed in incomplete resections, which suggests the indication for conservative management. Diagnostic EUS has a fundamental role in the differential diagnosis between FP and pancreatic neoplasms, two entities with very different prognosis, and makes it possible to avoid, in the case of FP, unnecessary surgeries with the associated morbidity and mortality.
ABSTRACT
MR1: ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2: ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3: ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4: ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5: ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6: ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7: ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8: ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9: ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10: ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11: ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.
Subject(s)
Anemia, Iron-Deficiency , Capsule Endoscopy , Crohn Disease , Intestinal Diseases , Humans , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/etiology , Anemia, Iron-Deficiency/therapy , Endoscopy, Gastrointestinal/methods , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Intestinal Diseases/diagnosis , Intestinal Diseases/therapyABSTRACT
A jejunal varix with high transfusion requirement is treated by double-balloon enteroscopy with cyanoacrylate/ lipiodol with radiological control. The patient had not gastrointestinal hemorrhage or transfusion requeriment after 8 months follow up. Our recent previous article in Rev Esp Enferm Dig on advanced therapeutics by enteroscopy is referenced, providing this new therapeutic possibility.
Subject(s)
Double-Balloon Enteroscopy , Varicose Veins , Humans , Cyanoacrylates , Jejunum/diagnostic imaging , Endoscopy, Gastrointestinal , Varicose Veins/diagnostic imaging , Varicose Veins/therapy , Gastrointestinal Hemorrhage/diagnostic imaging , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapyABSTRACT
The Revista Española de Enfermedades Digestivas (REED), the flagship journal for gastroenterology in the Spanish language, is now docking at a new port where this editor-in-chief (EiC), who began his trek in 2015, will now go ashore.
Subject(s)
Gastroenterology , Humans , Language , SpainABSTRACT
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.
Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Portugués de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores.
ABSTRACT
We have read with interest the article published by Pérez et al., we really appreciate their interesting comments and would like to qualify some points. With the except of the clinical practice, currently there is no recommendation based on scientific evidence about the use of apheresis in the treatment of ulcerative colitis (UC), and even less in Crohn's disease (CD). However, the results obtained in the case of Pérez et al. in relation to systemic inflammation and pulmonary clinical improvement are very interesting from a pathophysiological and clinical point of view.
Subject(s)
Colitis, Ulcerative , Severe acute respiratory syndrome-related coronavirus , Betacoronavirus , COVID-19 , Coronavirus Infections , Digestive System , Humans , Pandemics , Pneumonia, Viral , SARS-CoV-2ABSTRACT
No disponible
Subject(s)
Humans , Colitis, Ulcerative/therapy , Coronavirus Infections , Pneumonia, Viral , Betacoronavirus , Blood Component Removal , Leukapheresis , PandemicsABSTRACT
El objetivo de esta revisión rápida es una puesta al día sobre el impacto de la infección por SARS-CoV-2 en los servicios de Gastroenterología y Hepatología, en nuestros pacientes, y en nuestra nueva forma de trabajar. El tracto gastrointestinal y el hígado se ven afectados por el SARSCoV-2, especialmente en pacientes con terapias inmunosupresoras. Los pacientes con trasplante de hígado deben ser seguidos de cerca. La endoscopia digestiva es un procedimiento de alto riesgo para la transmisión de SARS-CoV-2. Mientras dure la pandemia, debemos adaptar sus indicaciones y promover medidas de protección para pacientes y profesionales de la salud. La pandemia de COVID-19 ha cambiado nuestras prioridades y nuestra forma de trabajar, aunque no sabemos cuáles serán las repercusiones después del regreso a la normalidad
No disponible
Subject(s)
Humans , Gastrointestinal Diseases/virology , Gastrointestinal Diseases/diagnosis , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Disinfection , Risk AssessmentABSTRACT
The purpose of this rapid review is to provide an update on the impact of SARS-CoV-2 infection on Gastroenterology and Hepatology departments, our patients, and our new way of working. The gastrointestinal tract and the liver are affected by SARS-CoV-2, especially in patients with immunosuppressive therapies. Patients with liver transplantation should be followed closely. Digestive endoscopy is a high-risk procedure for the transmission of SARS-CoV-2. While the pandemic lasts, we must adapt its indications and promote protective measures for patients and healthcare professionals alike. The COVID-19 pandemic has changed our priorities and the way we work, although we do not know what the repercussions will be after normality is reinstated.
Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/transmission , Digestive System Diseases/virology , Digestive System/virology , Pandemics , Pneumonia, Viral/transmission , COVID-19 , Coronavirus Infections/virology , Digestive System Diseases/diagnosis , Digestive System Diseases/therapy , Disease Transmission, Infectious/prevention & control , Endoscopy, Digestive System/adverse effects , Humans , Immunosuppressive Agents/adverse effects , Infection Control/methods , Liver Transplantation , Pneumonia, Viral/virology , SARS-CoV-2ABSTRACT
No disponible
Subject(s)
Humans , Endoscopy, Gastrointestinal/methods , Balloon Enteroscopy/methods , Intestine, Small/diagnostic imaging , Intestine, Small/anatomy & histologyABSTRACT
INTRODUCCIÓN: la lesión de Dieulafoy en intestino delgado es una causa infrecuente de hemorragia digestiva que recidiva frecuentemente tras su tratamiento endoscópico. MATERIAL Y MÉTODOS: se presenta un estudio observacional, descriptivo, retrospectivo y unicéntrico de 15 pacientes con hemorragia de intestino delgado, diagnosticados de lesión de Dieulafoy con cápsula endoscópica o enteroscopia doble balón, en los que se realizó tratamiento endoscópico combinado. Resultados y conclusiones: durante una mediana de seguimiento de 33,5 meses (rango 2-145), recidivaron tres de los 12 casos que se pudieron seguir (25 %) y todos ocurrieron precozmente en las primeras 48 horas tras la terapéutica. Se retrataron con éxito dos de ellos con una nueva enteroscopia
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Intestine, Small/blood supply , Intestine, Small/surgery , Gastrointestinal Hemorrhage/surgery , Recurrence , Retrospective Studies , Double-Balloon Enteroscopy , Capsule Endoscopy , Follow-Up StudiesABSTRACT
Standard therapy using device-assisted enteroscopy includes different hemostatic therapies, polypectomy, dilation and other possibilities. The most frequent indication is small bowel bleeding. However, other specific settings could require dedicated therapies such as desinvagination, percutaneous enteroscopic jejunostomy, stent placement, endoscopic mucosal resection in polypoid vascular lesions and foreign body extraction. The present review aimed to investigate and describe device-assisted advanced therapies in the small bowel, excluding conventional hemostatic therapies of vascular lesions
No disponible
Subject(s)
Humans , Intestine, Small/injuries , Intestine, Small/surgery , Intestinal Obstruction/surgery , Foreign Bodies/surgery , Gastrointestinal Hemorrhage/surgery , Double-Balloon Enteroscopy , Endoscopy, GastrointestinalABSTRACT
The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly
No disponible
Subject(s)
Humans , Balloon Enteroscopy/methods , Intestine, Small/surgery , Gastrointestinal Hemorrhage/surgery , Capsule Endoscopy/methods , 16595/etiology , Crohn Disease/surgery , Intestinal Polyposis/surgery , Celiac Disease/surgery , Practice Guidelines as Topic , Occult Blood , Portugal , SpainABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Abdominal Injuries/diagnostic imaging , Intestine, Small/injuries , Crohn Disease , Double-Balloon Enteroscopy , Computed Tomography Angiography , Abdominal Injuries/surgery , Intestine, Small/surgeryABSTRACT
INTRODUCTION: Dieulafoy's lesion of the small bowel is an uncommon cause of gastrointestinal (GI) bleeding that often recurs after endoscopic treatment. MATERIAL AND METHODS: we report an observational, descriptive, retrospective, single-center study in 15 patients with small bowel bleeding who were diagnosed with a Dieulafoy's lesion by capsule endoscopy or double-balloon enteroscopy. RESULTS AND CONCLUSIONS: all patients underwent combined endoscopic treatment. During a median follow-up of 33.5 months (range, 2-145), three of the 12 cases that stayed in follow-up (25 %) recurred, all within 48 hours after treatment. Two were successfully re-treated with a repeat endoscopic procedure.
Subject(s)
Capsule Endoscopy , Gastrointestinal Hemorrhage , Combined Modality Therapy , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Intestine, Small/diagnostic imaging , Intestine, Small/surgery , Retrospective StudiesABSTRACT
The small bowell (SB) is a very long organ hardly accessible to conventional endoscopy. The revolution entailed by its complete diagnostic exploration with capsule endoscopy (CE) has led to a change in traditional surgical management and its related gold standard - intraoperative enteroscopy. CE is currently the first-line diagnostic strategy for the SB. An emergent technique in its wake has played a key role in the management of patients with SB conditions: to wit, device-assisted enteroscopy (DAE). Thus were developed first double-balloon enteroscopy (DBE), then single-balloon enteroscopy, and most recently motorized spiral enteroscopy.
Subject(s)
Capsule Endoscopy , Laparoscopy , Single-Balloon Enteroscopy , Double-Balloon Enteroscopy , Endoscopy, Gastrointestinal , Humans , Intestine, SmallABSTRACT
A 40-year-old male presented to the Emergency Department after a driving accident with blunt abdominal trauma. An abdominal computed tomography (CT) scan revealed a mesenteric injury in the right lower quadrant. He was admitted two months later due to a one-day history of abdominal pain and diarrhea, without fever or blood. The CT angiography showed a pseudoaneurysm located in the proximal ileum and several rigid small bowel (SB) loops with segmental wall thickening of mucosa.
Subject(s)
Abdominal Injuries , Crohn Disease , Wounds, Nonpenetrating , Abdominal Injuries/complications , Abdominal Injuries/diagnostic imaging , Adult , Constriction, Pathologic , Crohn Disease/complications , Crohn Disease/diagnostic imaging , Double-Balloon Enteroscopy , Humans , Male , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imagingABSTRACT
Standard therapy using device-assisted enteroscopy includes different hemostatic therapies, polypectomy, dilation and other possibilities. The most frequent indication is small bowel bleeding. However, other specific settings could require dedicated therapies such as desinvagination, percutaneous enteroscopic jejunostomy, stent placement, endoscopic mucosal resection in polypoid vascular lesions and foreign body extraction. The present review aimed to investigate and describe device-assisted advanced therapies in the small bowel, excluding conventional hemostatic therapies of vascular lesions.
