Endoscopic biliary large-balloon dilation after endoscopic sphincterotomy for the treatment of large common bile duct stones. Case report.

Common bile duct (CBD) stones extraction is usually performed by endoscopic sphincterotomy followed by removal by either a Dormia basket or extraction balloon catheter. However, some stones due to their size are not amenable to these procedures and extracorporeal or mechanical lithotripsy devices need to be used. Mechanical lithotripsy involves usage of a basket that will be inevitably destroyed which increases cost to the patient and endoscopy unit. The use of extracorporeal wave shock lithotripsy is an alternative; however it is not available widely. Reports about the use of hydrostatic large caliber balloon dilator (HLCBD) aiding in the extraction of large caliber CBD stones have concluded that is a safe and feasible therapeutic alternative. We present the case of a 25 mm x 30 mm CBD stone that could not be extracted using conventional methods. CBD dilation using HLCBD was performed after endoscopic sphincterotomy in an attempt to avoid mechanical lithotripsy.

[Endoscopic resection of ampullary adenoma.]. / Resección endoscópica de adenoma del ámpula de Vater.

Ampullary adenomas can occur sporadically or as part of familial adenomatous polyposis syndrome. Most of them are asymptomatic. Current standard of management is complete surgical or endoscopic resection, depending on depth of invasion and/or biliary tract involvement. The last can be established by endoscopic ultrasound or endoscopic retrograde colangiopancreatography. Surgical resection has high morbidity (25% to 65%) and mortality (10%) in unexperienced hands compared to endoscopic therapy (12% and 1%, respectively). Complications of endoscopic therapy ranges from 7% to 10%. Recurrence of adenomatous lesions treated endoscopically is 30%. Endoscopic surveillance after resection is mandatory. We present the case of a patient with an ampulla of Vater s adenoma successfully resected endoscopically previous assessment of the lesion by endoscopic ultrasound.

[Endoscopic mucosal resection due to adenocarcinoma of the esophagus caused by Barrett's esophagus.]. / Resección endoscópica de la mucosa debido a adenocarcinoma de esófago originado en un esófago de Barrett.

The endoscopic therapy has been used in the treatment of early stage neoplastic esophageal lesions with great success. The endoscopic ultrasound is a useful tool for the correct staging of these lesions. The staging accuracy of esophageal cancer with endoscopic ultrasound reaches 80% for T stage and 77% for N stage. The endoscopic approach provides complete resection of lesions confined to the mucosal layer, is a safety procedure with complications reported to occur from 3% to 13%. The morbidity and mortality rates after an endoscopic mucosal resection have been reported to be less than those posterior to esophagectomy. We present a case of a patient with high surgical risk, who underwent an upper endoscopy because of long history of gastroesophageal reflux disease and uncontrollable hiccup with successful endoscopic mucosal resection with plastic cap and polipectomy loop of an early stage esophageal adenocarcinoma derived of Barrett s esophagus.

[Seropositivity for Chlamydia pneumoniae in patients with primary biliary cirrhosis]. / Seropositividad para Chlamydia pneumoniae en pacientes con cirrosis biliar primaria.

INTRODUCTION: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease characterized by inflammatory injury and bile duct destruction. Recent studies suggest that Chlamydia pneumoniae could be associated with the development of PBC. The aim of this study was to determine the seroprevalence of C. pneumoniae in a cohort of patients with PBC. PATIENTS AND METHODS: The presence of IgG antibodies against C. pneumoniae was investigated in 46 patients with PBC and in 105 subjects without cirrhosis. RESULTS: Twenty-one patients (46%) with PBC had antibodies against C. pneumoniae compared with 74 subjects (71%) in the control group (OR = 0.6; 95% CI, 0.3-1.2; p = NS). Subanalysis of the PBC group showed that patients with C. pneumoniae antibodies had a higher frequency of advanced Child-Pugh stages (24% A, 52% B and 24% C vs 64% A, 32% B and 4% C; p = 0.01), a higher score on the Mayo Clinic Prognostic Index (7.8 +/- 2.1 vs 5.6 +/- 1.2; p = 0.004), a higher frequency of ascites (29% vs 4%; OR = 9.6; 95% CI, 1-87; p = 0.02), higher total bilirubin levels (4.5 +/- 2.5 mg/dl vs 2.4 +/- 4.3 mg/dl, p = 0.001) and lower serum albumin levels (2.6 +/- 0.9 g/dl vs 3.3 +/- 0.6 g/dl, p = 0.02). CONCLUSION: No association was found between C. pneumoniae infection and PBC in this study. An association was found between the severity of PBC and C. pneumoniae, which may suggest a deleterious effect of C. pneumoniae infection or a predisposition in advanced stages of PBC to acquire infection with this microorganism.

Seropositividad para Chlamydia pneumoniae en pacientes con cirrosis biliar primaria / Seropositivity for Chlamydia pneumoniae in patients with primary biliary cirrhosis

Introducción: La cirrosis biliar primaria (CBP) es una enfermedad hepática colestásica crónica, que se caracteriza por lesión inflamatoria y destrucción de conductos biliares. Estudios recientes indican que Chlamydia pneumoniae podría estar asociada al desarrollo de CBP. El objetivo de este estudio ha sido determinar la seroprevalencia de C. pneumoniae en una cohorte de pacientes con CBP. Pacientes y métodos: Se buscaron anticuerpos antiinmunoglobulina G contra C. pneumoniae en 46 pacientes con CBP y 105 sujetos sin cirrosis hepática. Resultados: Entre los pacientes con CBP, 21 (46%) tuvieron anticuerpos, en comparación con 74 (71%) del grupo control, con una odds ratio de 0,6 (intervalo de confizanza del 95%, 0,3-1,2; p no significativa). El subanálisis del grupo con CBP mostró que los pacientes seropositivos presentaron mayor frecuencia de estadios avanzados de Child-Pugh (el 24% A, el 52% B y el 24% C, frente a un 64% A, un 32% B y un 4% C; p = 0,01), mayor puntuación en la escala pronóstica de la Clínica Mayo (7,8 ± 2,1 frente a 5,6 ± 1,2; p = 0,004), mayor frecuencia de ascitis (un 29 frente a un 4%; odds ratio de 9,6; intervalo de confianza del 95%, 1,1-87; p = 0,02), concentraciones mayores de bilirrubina total (4,5 ± 2,5 frente a 2,4 ± 4,3 mg/dl; p = 0,001) y valores menores de albúmina (2,6 ± 0,9 frente a 3,3 ± 0,6 g/dl; p = 0,02). Conclusión: No fue posible establecer una asociación entre C. pneumoniae y CBP. Encontramos una relación entre la gravedad de la CBP y la seropositividad para C. pneumoniae, lo que podría apuntar a un efecto perjudicial de esta infección o bien a una predisposición en etapas avanzadas para adquirir infecciones por C. pneumoniae

Introduction: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease characterized by inflammatory injury and bile duct destruction. Recent studies suggest that Chlamydia pneumoniae could be associated with the development of PBC. The aim of this study was to determine the seroprevalence of C. pneumoniae in a cohort of patients with PBC. Patients and Methods: The presence of IgG antibodies against C. pneumoniae was investigated in 46 patients with PBC and in 105 subjects without cirrhosis. Results: Twenty-one patients (46%) with PBC had antibodies against C. pneumoniae compared with 74 subjects (71%) in the control group (OR = 0.6; 95% CI, 0.3-1.2; p = NS). Subanalysis of the PBC group showed that patients with C. pneumoniae antibodies had a higher frequency of advanced Child-Pugh stages (24% A, 52% B and 24% C vs 64% A, 32% B and 4% C; p = 0.01), a higher score on the Mayo Clinic Prognostic Index (7.8 ± 2.1 vs 5.6 ± 1.2; p = 0.004), a higher frequency of ascites (29% vs 4%; OR = 9.6; 95% CI, 1-87; p = 0.02), higher total bilirubin levels (4.5 ± 2.5 mg/dl vs 2.4 ± 4.3 mg/dl, p = 0.001) and lower serum albumin levels (2.6 ± 0.9 g/dl vs 3.3 ± 0.6 g/dl, p = 0.02). Conclusion: No association was found between C. pneumoniae infection and PBC in this study. An association was found between the severity of PBC and C. pneumoniae, which may suggest a deleterious effect of C. pneumoniae infection or a predisposition in advanced stages of PBC to acquire infection with this microorganism