[Clinical and pharmacological data in COVID-19 hospitalized nonagenarian patients]. / Variables clínicas y farmacológicas de pacientes nonagenarios hospitalizados por COVID-19.

OBJECTIVE: Despite the impact of SARS-CoV-2 infection in geriatrics, data on nonagenarian patients is scarce. The aim of this study is to describe the clinical features of COVID19-diagnosed nonagenarians, as well as its clinical evolution and therapeutic response. METHODS: Retrospective observational study of nonagenarians, admitted for COVID-19. Sociodemographic and clinical variables were registered, including previous polypharmacy. Blood analysis data and COVID-19-specific treatment were registered. RESULTS: A total of 79 patients were included, with 50.6% (40 patients) of mortality. None of the comorbidities registered correlated with mortality, which was significantly higher among patients with moderate/complete functional dependence, compared to those mild-dependents/independents (59.5% vs 40.5%; p=0.015). Most prescribed drugs were hydroxychloroquine/chloroquine and azithromycin. Non-survivors presented higher counts of leukocytes and neutrophils, and higher lymphopenia. CONCLUSIONS: Nonagenarians with functional dependence presented higher mortality, irrespective of comorbidities or treatment received. Implementing an integral geriatric evaluation would enhance the implementation of personalized therapeutic strategies for nonagenarians.

The Mexican consensus on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy. / Consenso mexicano sobre diagnóstico, prevención y tratamiento de la gastropatía y enteropatía por antiinflamatorios no esteroideos.

More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy.

The Mexican consensus on probiotics in gastroenterology. / Consenso mexicano sobre probióticos en gastroenterología.

INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.

¿Se puede evaluar la perspectiva de género en los proyectos de investigación? / Can the gender perspective be assessed in research projects?

Objetivo: La perspectiva de género es un enfoque teórico procedente de las teorías feministas, cuyo eje principal es el análisis de las desigualdades de género, y su incorporación es crucial para promover la equidad en salud. El objetivo de nuestra investigación fue elaborar un protocolo/cuestionario para evaluar si la perspectiva de género está presente en un proyecto de investigación, y con ello paliar la carencia de instrumentos de evaluación. Método: Se aplicó un diseño cualitativo con dos técnicas: grupo de discusión y encuentro grupal de expertas. El grupo de discusión realizó un análisis dialéctico de los conceptos base sobre investigación y género, e integró los resultados del discurso producido en el encuentro grupal de expertas. La elaboración del protocolo se organizó en torno a las preguntas relevantes a formularse en cada una de las etapas deun proyecto de investigación. Resultados: El protocolo elaborado consta de 15 cuestiones: 4 en la introducción, 2 en objetivos e hipótesis, 3 en metodología, 3 en finalidad del estudio y 3 para ser aplicadas a lo largo del proyecto deinvestigación. Conclusiones: Este protocolo es una herramienta que posibilita identificar aquellos proyectos que incluyan la perspectiva de género, y su utilización dará una mayor calidad a la investigación y ayudará a reducirlas inequidades por cuestiones de género (AU)

Objective: Gender perspective is a theoretical approach that developed from feminist theories and whose main focus is the analysis of gender inequalities. Integration of this perspective is central to promotingequity in health. The aim of our study was to devise a protocol/questionnaire to assess whether genderis present in research projects and thus help to fill the gap in assessment tools.Methods: We used a qualitative design with two techniques: group discussion and expert group meetings.The discussion group conducted a dialectical analysis of the basic concepts in research and genderand integrated the results of the discourse produced in the expert group meeting. The drafting of theprotocol was organized around the pertinent questions that should be asked at each stage of a researchproject.Results: The protocol consists of 15 questions: four in the introduction section, two in goals and hypotheses,three in methodology, three in purpose of the study and three to be implemented throughout theresearch project. Conclusions: The protocol identifies projects that include a gender perspective. Use of this protocol will improve the quality of research and will help to reduce gender inequities (AU)

[Can the gender perspective be assessed in research projects?]. / ¿Se puede evaluar la perspectiva de género en los proyectos de investigación?

OBJECTIVE: Gender perspective is a theoretical approach that developed from feminist theories and whose main focus is the analysis of gender inequalities. Integration of this perspective is central to promoting equity in health. The aim of our study was to devise a protocol/questionnaire to assess whether gender is present in research projects and thus help to fill the gap in assessment tools. METHODS: We used a qualitative design with two techniques: group discussion and expert group meetings. The discussion group conducted a dialectical analysis of the basic concepts in research and gender and integrated the results of the discourse produced in the expert group meeting. The drafting of the protocol was organized around the pertinent questions that should be asked at each stage of a research project. RESULTS: The protocol consists of 15 questions: four in the introduction section, two in goals and hypotheses, three in methodology, three in purpose of the study and three to be implemented throughout the research project. CONCLUSIONS: The protocol identifies projects that include a gender perspective. Use of this protocol will improve the quality of research and will help to reduce gender inequities.

Use of fully covered self-expanding metal stents for the management of benign biliary conditions.

BACKGROUND AND AIM: biliary self-expanding metal stents (SEMS) have the advantage of being inserted undeployed with very small sizes and provide, when fully opened, large diameters for biliary drainage. However, their use in benign conditions has been very limited, mainly because of difficulty in their extraction. We present our initial experience with a fully covered SEMS (Wallflex) for the management of benign problems of the bile duct. PATIENTS AND METHODS: in a prospective study, stents of 8 mm in diameter and 4, 6 or 8 cm long were inserted by means of ERCP. These SEMS were chosen when according to medical judgement it was thought that diameters greater than 10 French (3.3 mm) were needed for proper biliary drainage. Stents were extracted also endoscopically, several months later when deemed clinically appropriate. RESULTS: twenty biliary SEMS were inserted. Reasons for insertion were: large intrahepatic biliary fistula after hydatid cyst surgery (1), perforation of the papillary area following endoscopic sphincterotomy (2), coaxial insertion to achieve patency in obstructed uncovered stents inserted in benign conditions (3), benign strictures (7), multiple and large common bile duct stones that could not be extracted because of tapering and stricturing of the distal common bile duct (7). In all cases, successful biliary drainage was achieved and there were no complications from insertion. Stents were easily extracted after a mean time of 132 days (36-270) in place. Complete resolution of biliary problems was obtained in 14 patients (70%). CONCLUSIONS: in our initial experience, the fully covered Wallflex biliary stent was removed without any complication after being in place in the common bile duct for a mean time of over four months. Therefore, it could be used in the management of benign biliary conditions.

[Meningocele, glioma and optic nerve meningioma: differential diagnosis and treatment]. / Meningocele, glioma y meningioma del nervio óptico: diagnóstico diferencial y tratamiento.

PURPOSE: After studying 3 clinical cases, we have reviewed the clinical and radiological characteristics of meningocele, meningioma and optic nerve glioma. The differential diagnosis and therapeutic management are also discussed. METHODS: Review of three clinical reports of three patients seen in our unit and a bibliographic search concerning the diagnosis and therapeutic management of these three entities at the present time. RESULTS: Differential diagnosis has to be based on a wide range of parameters: epidemiologic (age, race, sex, prevalence of the tumors), clinical (visual acuity, perimetry, Hertel exophthalmometry and funduscopy) and radiologic (computed tomography and magnetic resonance). Anatomopathologic study is required only rarely. The therapeutic options are: observation, surgery and radiotherapy. CONCLUSION: A correct differential diagnosis is mandatory to be able to individualize the treatment for each entity (Arch Soc Esp Oftalmol 2009; 84: 563-568).

Meningocele, glioma y meningioma del nervio óptico: diagnóstico diferencial y tratamiento / Meningocele, glioma and optic nerve meningioma: differential diagnosis and treatment

Objetivo: Estudiar a partir de 3 casos las característicasclínicas y radiológicas del meningocele,meningioma y glioma del nervio óptico (NO) paradiscutir su diagnóstico diferencial así como su enfoqueterapéutico.Método: Se revisaron las historias clínicas de trespacientes afectos de las patologías anteriormentemencionadas que fueron estudiados en nuestro servicio,y se realizó una revisión bibliográfica sobre eldiagnóstico y tratamiento actual de estas entidades.Resultados: El diagnóstico diferencial debe basarseen un amplio abanico de aspectos: edad, raza,sexo y frecuencia de la tumoración como factoresepidemiológicos a tener en cuenta. Clínicamentelos pilares fundamentales son: agudeza visual (AV),campimetría, exoftalmometría Hertel y funduscopia,que nos servirán para controlar la evolución delproceso. Las características radiológicas que nosaportan la resonancia magnética (RM) y la tomografíacomputerizada (TC) como técnicas de elecciónnos ayudan a diferenciar un cuadro de otro. Enraras ocasiones hay que recurrir al estudio anatomopatológicopara confirmar la entidad. Las opcionesterapéuticas son observación, cirugía, quimioterapiay radioterapia en función de las características del caso.Conclusión: El diagnóstico diferencial de estaspatologías es difícil, y hay que basarse en sus característicasclínicas y radiológicas para así orientarcorrectamente su tratamiento, individualizandocada caso y teniendo en cuenta el comportamientorelativamente benigno de estos tumores para evitaruna decisión terapéutica precipitada(AU)

Purpose: After studying 3 clinical cases, we havereviewed the clinical and radiological characteristicsof meningocele, meningioma and optic nerveglioma. The differential diagnosis and therapeuticmanagement are also discussed.Methods: Review of three clinical reports of threepatients seen in our unit and a bibliographic searchconcerning the diagnosis and therapeutic managementof these three entities at the present time.Results: Differential diagnosis has to be based on awide range of parameters: epidemiologic (age, race,sex, prevalence of the tumors), clinical (visualacuity, perimetry, Hertel exophthalmometry andfunduscopy) and radiologic (computed tomographyand magnetic resonance). Anatomopathologicstudy is required only rarely. The therapeuticoptions are: observation, surgery and radiotherapy.Conclusion: A correct differential diagnosis ismandatory to be able to individualize the treatmentfor each entity(AU)

[Palliative management of malignant gastric outlet obstruction with endoscopically inserted self-expanding metal stents].

AIM AND BACKGROUND: the insertion of self-expanding metal stents to palliate malignant gastric outlet obstruction is a minimally invasive procedure that is being increasingly used. We discuss experience with this technique in a level-II hospital in the Spanish National Health System. PATIENTS AND METHODS: a retrospective five-year study (2003-2007) was conducted in 23 patients who underwent 27 procedures aimed at resolving malignant gastric outlet obstruction (mean, 0.45 procedures per month) using endoscopically inserted noncovered stents (Wallstent and Wallflex). RESULTS: insertion was technically feasible in all 27 (100%) attempts, with satisfactory clinical results in 25 cases (92.5%). Endoscopy alone was used 10 times (37%), and both endoscopy and fluoroscopy on 17 (63%) occasions. After stent insertion, one patient was intervened for treatment, and a patient with an unsuccessful prosthesis received a palliative surgical bypass. Four stents became obstructed by tumoral ingrowth, and patency was reestablished by inserting a new stent. Obstructive jaundice caused by stents covering the papilla of Vater occurred in three cases. There were no other complications or mortality due to the procedure. Mean survival was 104 days (range 28-400, SD +/- 94). CONCLUSIONS: in our experience endoscopic insertion of self-expanding metal stents appears to be a safe and efficient palliative method for malignant gastric outlet obstruction, and can be performed successfully in a center with our characteristics.

[Non-infectious systemic diseases and uveitis]. / Enfermedades sistémicas no infecciosas y uveítis.

Uveitis can be defined as any inflammation affecting the uveal tract, although in clinical practice this term includes any intraocular inflammatory event. The etiology of this inflammation can be related to an endogenous mechanism in the clinical course of a systemic disease (sarcoidosis, Behçet's disease, multiple sclerosis, Vogt-Koyanagi-Harada disease, etc.), or an isolated ocular entity. Sometimes, ocular inflammation is the initial manifestation of an undiagnosed systemic disease. On the other hand, ocular involvement could be the main cause of morbidity of the disease, and early diagnosis and treatment is an important issue in order to avoid irreversible ocular damage. In this article, the authors review some relevant clinical, diagnostic and therapeutic topics related to the most common non-infectious systemic diseases associated with uveitis.

Enfermedades sistémicas no infecciosas y uveítis / Non-infectious systemic diseases and uveitis

La uveítis se define como la inflamación del tractouveal, aunque en la práctica clínica hace referencia acualquier proceso inflamatorio intraocular. El origen deesta inflamación puede atribuirse a un mecanismoendógeno, ya sea formando parte de una enfermedadsistémica (sarcoidosis, enfermedad de Behçet, esclerosismúltiple, síndrome de Vogt-Koyanagi-Harada, etc.) ode forma ocular aislada. En muchas ocasiones, la enfermedadocular constituye la forma de comienzo de unaenfermedad sistémica. Por otra parte, la afectaciónocular constituye, en ocasiones, la principal causa demorbilidad derivada de la enfermedad, por lo que sudiagnóstico y tratamiento precoz son de la máximaimportancia para evitar secuelas irreversibles. En esteartículo se revisan los aspectos clínicos, diagnósticos yterapéuticos más relevantes de la afectación ocular enel contexto clínico de las enfermedades sistémicas noinfecciosas más comúnmente asociadas a uveítis

Uveitis can be defined as any inflammationaffecting the uveal tract, although in clinical practicethis term includes any intraocular inflammatoryevent. The etiology of this inflammation can berelated to an endogenous mechanism in the clinicalcourse of a systemic disease (sarcoidosis, Behçet’sdisease, multiple sclerosis, Vogt-Koyanagi-Haradadisease, etc.), or an isolated ocular entity.Sometimes, ocular inflammation is the initialmanifestation of an undiagnosed systemic disease.On the other hand, ocular involvement could be themain cause of morbidity of the disease, and earlydiagnosis and treatment is an important issue inorder to avoid irreversible ocular damage. In thisarticle, the authors review some relevant clinical,diagnostic and therapeutic topics related to the mostcommon non-infectious systemic diseases associatedwith uveitis

Outcomes of bile duct drainage by means of ERCP in geriatric patients / Resultados del drenaje de la vía biliar por CPRE en pacientes con edad geriátrica.

BACKGROUND AND OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is usually the procedure of choice for relieving bile duct obstruction. a large number of patients undergoing this intervention are geriatric population (aged 75 years of age and older). Our aim was to assess the efficacy of ERCP in this group of patients as compared to younger ones. PATIENTS AND METHODS: A retrospective study. All patients in whom a therapeutic biliary endoscopy had been performed over a four-year period of time (2002-2005) were included. RESULTS: 178 geriatric patients and 159 younger ones underwent ERCP. No differences were found in successful biliary drainage (97.7 vs. 98.7%), complication number (11.8 vs. 14.4%), or mortality rate (1.1 vs. 0.6%). On the other hand, more common bile duct stones were found in geriatric patients (57.3 vs. 39.6%, p = 0.004), and also more self-expanding metal stents were employed to drain malignant obstructive jaundice (47 vs. 8%, p = 0.0035). In the youngest group, more ERCPs were repeated in the same patients (4 vs. 10%, p = 0.001). CONCLUSIONS: The geriatric population showed similar success and morbidity and mortality rates when compared to younger patients in draining their bile duct by means of ERCP. Common bile duct stones were more frequently found in geriatric patients. No patients needing an ERCP should be excluded only because of their age.

[Association of adenocarcinoma of esophagus and breast cancer in a male with Madelung' disease]. / Asociación de adenocarcinoma de esófago y cáncer de mama en un varón con enfermedad de Madelung.

The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung' disease), who had received adjuvant radiotherapy three years before for breast cancer.

Asociación de adenocarcinoma de esófago y cáncer de mama en un varón con enfermedad de Madelung / Association of adenocarcinoma of esophagus and breast cancer in a male with Madelung´ disease

La aparición de un cáncer de esófago en mujeres que previamente han recibido radioterapia como tratamiento de un cáncer de mama es un hecho conocido aunque poco frecuente. El riesgo de aparición de la segunda neoplasia es mayor cuando han transcurrido diez o más años desde la exposición a la radiación. La estirpe histológica de la neoplasia de esófago más frecuente es la de carcinoma de células escamosas. Se presenta un caso de adenocarcinoma de esófago en un varón, diagnosticado de lipomatosis bilateral simétrica o enfermedad de Madelung, que recibió radioterapia tres años antes por presentar un cáncer de mama

The development of a cancer of the esophagus in women who previously had received radiotherapy for breast cancer is a known although infrequent event. The risk of apparition of the second neoplasia is greater in women who survive at least ten years after the exposition to the radiation. Squamous cell carcinoma is the histological subtype more frequent. We report a case of adenocarcinoma of the esophagus in a man diagnosed of benign symmetrical lipomatosis (Madelung’ disease), who had received adjuvant radiotherapy three years before for breast cancer

[Multiple malignant neoplasms in patients with prostate tumours in the health district of Leon]. / Neoplasias malignas múltiples en pacientes con cáncer de próstata en el área sanitaria de León.

OBJECTIVE: We analyze the characteristics of the patients with prostate tumours who developed a multiple malignant primary neoplasms (MMPN) in the health district of León, the impact on survival and the prognostic variables. MATERIAL AND METHODS: We have used the data from the Tumour Registry of the Hospital of León and we have selected all those patients who were diagnosed of a prostate tumor between 1993 and 2002. Later we made two groups: the first with 67 patients with MMPN and a second group with 145 patients with single prostate tumours diagnosed during 1996 and 1997. RESULTS: Prevalence of MMPM was of 5.57 percent. Patients with MMPN were 3 years younger than those with single tumours, with a high frequency (41 percent) of familial oncologic antecedents on first degree parents. The more frequent association was the synchronous urologic neoplasm. During the next two years from diagnosed of prostate tumour, 86 percent of patients with MMPN were diagnosed of their second neoplasm. Survival of metachronous MMPN patients was lower than synchronous MMPN patients, being the variables with prognosis significance the age, metachronous MMPN, stage of second neoplasms and if the second neoplasms was or not urologic. CONCLUSIONS: MMPN in patients with prostatic tumours are frequent in our medium. A genetic base may be associated in these patients. Prognosis of metachronous MMPN patients is worse. No differences were observed about prognosis with single tumour patients.

Neoplasias malignas múltiples en pacientes con cáncer de próstata en el área sanitaria de León / Multiple malignant neoplasms in patients with prostate tumors in the health district of Leon

Objetivos: Analizar las características de los pacientes con tumores prostáticos que desarrollaron una neoplasia primaria maligna múltiple (NPMM) en el área sanitaria de León, el impacto sobre la supervivencia y las posibles variables pronósticas. Material y métodos: Utilizando los datos del Registro de Tumores del Hospital de León se han seleccionado aquellos pacientes con tumores prostáticos diagnosticados entre 1993 y 2002, creando dos grupos: el primero constituido por 67 pacientes con NPMM y el segundo formado por 145 pacientes con tumores únicos diagnosticados entre 1996 y 1997. Resultados: La prevalencia de NPMM fue del 5,57%. Los pacientes con NPMM fueron 3 años más jóvenes que los pacientes con tumores únicos, con una elevada proporción (41%) de antecedentes familiares oncológicos en familiares de primer grado. La asociación más frecuente fue el cáncer urológico sincrónico. El 86% de los pacientes fueron diagnosticados del segundo tumor en los primeros dos años. La supervivencia de los pacientes con NPMM metacrónicas fue inferior a la de los pacientes con NPMM sincrónicas, siendo las variables con significación pronóstica la edad, el padecimiento de una NPMM metacrónica, el estadio del segundo tumor y el padecimiento de un segundo tumor urológico. Conclusiones: Las NPMM en pacientes con tumores prostáticos son relativamente frecuentes en nuestro medio. Parece existir una base genética en estos pacientes. El pronóstico de los pacientes con NPMM metacrónicas es peor. No existen diferencias significativas en cuanto al pronóstico con respecto a los pacientes con tumores únicos

Objetive: We analize the characteristics of the patients with prostate tumours who developed a multiple malignant primary neoplasms (MMPN) in the health district of León, the impact on survival and the prognostic variables. Material and methods: We have used the data from the Tumour Registry of the Hospital of León and we have selected all those patients who were diagnosed of a prostate tumor between 1993 and 2002. Later we made two groups: the first with 67 patients with MMPN and a second group with 145 patients with single prostate tumours diagnosed during 1996 and 1997. Results: Prevalence of MMPM was of 5.57 percent. Patients with MMPN were 3 years younger than those with single tumours, with a high frecuency (41 percent) of familial oncologic antecedents on first degree parents. The more frequent association was the synchronous urologic neoplasm. During the next two years from diagnosed of prostate tumour, 86 percent of patients with MMPN were diagnosed of their second neoplasm. Survival of metachronous MMPN patients was lower than synchronous MMPN patients, being the variables with prognosis significance the age, metachronous MMPN, stage of second neoplasms and if the second neoplasms was or not urologic. Conclusions: MMPN in patients with prostatic tumours are frequent in our medium. A genetic base may be associated in these patients. Prognosisof metachronous MMPN patients is worse. No differences were observed about prognosis with single tumour patients

Success rate of complete extraction of common bile duct stones at first endoscopy attempt.

BACKGROUND AND AIM: ERCP with biliary sphincterotomy is the usual method to extract common bile duct stones. However, after sphincterotomy and by means of balloons and Dormia baskets not all stones may be extracted during the first endoscopy session. We present our experience regarding success rate after first ERCP. PATIENTS AND METHODS: 100 consecutive patients were included. All were diagnosed with choledocholitiasis by using ERCP. After biliary sphincterotomy, attempts to extract stones by means of balloons and Dormia baskets only were made. Billroth II gastrectomies and bile duct strictures of any origin were excluded. RESULTS: During the first attempt at ERCP, complete stone clearance was achieved in 73 patients. Of the remaining 27 patients: 3 underwent surgery for choledocholithiasis, 20 had a plastic stent inserted, and 4 needed another ERCP for stones having been left in place. Mean extracted stone size was 9.4 mm (+/- 3.8), and mean non-extracted stone size was 17 mm (+/- 7.3): p < 0.001. Male/female ratio was 35/38 in the extracted group and 6/21 in the non-extracted group (p < 0.05). There were 11 complications (one patient underwent surgery because of duodenal perforation not related to sphincterotomy). There was no mortality. CONCLUSIONS: In our experience, after endoscopic biliary sphincterotomy and by means of balloons and Dormia baskets a complete stone clearance has been achieved in 73% of patients at first endoscopy attempt. Failed extraction seems to be related to stone size and was more frequently found in women.

[Therapeutic biliary endoscopy in patients over 90 years of age]. / Terapéutica biliar endoscópica en pacientes con más de 90 años de edad.

Endoscopic retrograde cholangiopancreatography (ERCP) is an established method to treat bile duct obstruction. Besides, ERCP is one of the most stricking parts of interventional endoscopy and takes advantage of its minimal invasive condition to be applied to a wide variety of patients. We present five patients over 90 years of age who underwent successfully and without complications six therapeutic ERCPs. Endoscopic biliary sphincterotomy, common bile duct stone extraction and plastic stent insertion all were performed uneventfully and solving the biliary obstruction. Therapeutic ERCP is a safe and effective modality to treat bile duct obstruction in patients over 90 years of age.

Terapéutica biliar endoscópica en pacientes con más de 90 años de edad / Therapeutic biliary endoscopy in patients over 90 years of age

La colangiopancreatografía retrógrada endoscópica (CPRE) es un método consolidado para el tratamiento de la obstrucción de la vía biliar. Además, la CPRE ocupa un lugar importante en el intervencionismo endoscópico y por su condición mínimamente invasiva puede aplicarse a una gran variedad de pacientes. Presentamos cinco enfermos con más de 90 años de edad a los que se realizaron 6 CPRE terapéuticas. En todos ellos se drenó la vía biliar sin complicaciones relevantes. Según fuera preciso se realizaron: esfinterotomía biliar, extracción de cálculos coledocianos e inserción de prótesis plásticas. La CPRE terapéutica es una modalidad eficaz y segura de tratar la obstrucción biliar en pacientes por encima de los 90 años (AU)

Endoscopic retrograde cholangiopancreatography (ERCP) is an stablished method to treat bile duct obstruction. Besides, ERCP is one of the most stricking parts of interventional endoscopy and takes advantage of its minimal invasive condition to be applied to a wide variety of patients. We present five patients over 90 years of age who underwent succesfully and witout complications six therapeutic ERCPs. Endoscopic biliary sphincterotomy, common bile duct stone extraction and plastic stent insertion all were performed unventfully and solving the biliary obstruction. Therapeutic ERCP is a safe and effective modality to treat bile duct obstruction in patients over 90 years of age (AU)

Tasa de extracción completa de coledocolitiasis al primer intento endoscópico / Success rate of complete extraction of com monbile duct stones at first endoscopy attempt

Antecedentes y objetivo: la colangiopancreatografía retrógrada endoscópica (CPRE) con esfinterotomía biliar es el método habitual para extraer los cálculos coledocianos. Sin embargo, tras la esfinterotomía y con la ayuda de balones y cestas de Dormia no puede lograrse la limpieza completa del colédoco en todos los casos. Presentamos nuestra experiencia en la tasa de extracción completa al primer intento endoscópico. Pacientes y métodos: se han incluído 100 pacientes consecutivos diagnosticados de coledocolitiasis mediate CPRE en los que pudo realizarse una esfinterotomía biliar endoscópica. Se excluyeron gastrectomías Billroth II y estenosis coledocianas de cualquier origen. Para extraer los cálculos se utilizaron exclusivamente balones y cestas de Dormia. Resultados: en la primera sesión de CPRE pudieron extraerse todos los cálculos coledocianos en 73 pacientes. De los 27 restantes, en 20 se introdujo una prótesis biliar plástica para realizar después nuevos intentos endoscópicos de extracción, 3 pacientes fueron remitidos directamente para cirugía y en 4 pacientes los cálculos quedaron retenidos de forma inadvertida y fueron extraídos en nuevas sesiones de CPRE. El tamaño medio de los cálculos en el grupo de extracción completa fue 9,4 mm (ñ3,8) y en el de no extracción 17 mm (ñ7,3) -p<0,001-. La relación hombre/ mujer en el grupo de extracción fue 35/38 y en el de no extracción 6/21 -p<0,05-. Hubo 11 complicaciones (una peforación duodenal no relacionada con la esfinterotomía precisó cirugía) pero no hubo mortalidad. Conclusiones: en nuestra experiencia, tras esfinterotomía biliar endoscópica y por medio de balones y cestas de Dormia se logró la extracción del 73 por ciento de las coledocoliatiasis en la primera exploración. El fallo en la extracción se relacionó con el mayor tamaño de las coledocolitiasis y fue más frecuente en mujeres (AU)