[Needle-knife sphincterotomy for biliary access: a prospective study]. / Esfinterotomía de aguja como técnica de acceso a la vía biliar: estudio prospectivo.

OBJECTIVE: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. MATERIAL AND METHODS: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. RESULTS: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). CONCLUSIONS: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found.

Esfinterotomía de aguja como técnica de acceso a la vía biliar: estudio prospectivo / Needle-knife sphincterotomy for biliary access: a prospective study

Objetivo: La esfinterotomía de aguja es una técnica empleada para conseguir el acceso a la vía biliar, cuando los métodos de canulación habituales han fallado. El objetivo ha sido analizar los resultados de la realización de la esfinterotomía de aguja en pacientes con inaccesibilidad a la vía biliar (canulación difícil) mediante técnicas estándar en colangiopancreatografía retrógrada endoscópica, y los factores asociados con el éxito y complicaciones. Material y métodos: Estudio prospectivo que incluye a 72 pacientes entre enero de 1998 y diciembre de 2004, sometidos a esfinterotomía de aguja por canulación difícil de la vía biliar por el mismo endoscopista (J.E.). Los resultados se analizaron respecto al éxito en acceder a la vía biliar, su consecución en una o más sesiones, su posible relación con la enfermedad de base y la incidencia y gravedad de las complicaciones. Resultados: Se realizaron 72 esfinterotomías de aguja de un total de 1.062 esfinterotomías (6,7%). En el 77,7% de los pacientes se colocó previamente una prótesis pancreática. El diagnóstico final fue: coledocolitiasis en el 31,9%; cáncer de páncreas en el 16,6%; colangiocarcinoma en el 13,8%; estenosis benigna en el 8,3%; disfunción del esfínter de Oddi en el 6,9%; normal en el 6,9%, y miscelánea en el 13,8%. Se obtuvo éxito en la canulación en el 87,5% (63/72), y se consiguió en la primera sesión en el 73% (46/63). Se logró el acceso biliar en el 72,7% de los casos (16/22) de neoplasia biliopancreática, frente al 94% (47/50) en pacientes con otros diagnósticos (p = 0,03). Once pacientes (15,2%) presentaron 12 complicaciones (16,6%) (6 pancreatitis, 4 colangitis, 1 hemorragia papilar y 1 relleno de la vena porta). El uso de prótesis pancreática se relacionó con un porcentaje mayor de éxito y menor de complicaciones, alcanzando significación estadística en esta última (p = 0,03).Conclusiones: La esfinterotomía de aguja con prótesis pancreática puede ser un procedimiento seguro en pacientes con canulación difícil de la vía biliar. La presencia de neoplasia biliopancreática es un factor de riesgo de no consecución del acceso biliar frente a otros diagnósticos. La incidencia de complicaciones está en consonancia con otros estudios, y no se han hallado pancreatitis graves ni perforaciones

Objective: Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications. Material and methods: We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications. Results: Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03). Conclusions: NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found

[Enteral prostheses for palliative treatment of gastroduodenal obstruction: endoscopic procedure]. / Prótesis enterales en el tratamiento paliativo de la obstrucción gastroduodenal: técnica endoscópica.

Malignant gastroduodenal obstruction may cause significant morbidity. Insertion of enteral prostheses as a palliative treatment is an acceptable option to achieve an appropriate gastric voiding without the morbidity associated to palliative surgery, with a lesser procedure-related mortality and a lower cost, while providing a better quality of life. Its is important to unify and consolidate the endoscopic procedure for the placement of enteral prostheses, avoiding variations that may preclude an adequate analysis of this procedure outcome.

Prótesis enterales en el tratamiento paliativo de la obstrucción gastroduodenal: técnica endoscópica / Enteral prostheses for palliative treatment of gastroduodenal obstruction: endoscopic procedure

La obstrucción gastroduodenal neoplásica puede causar una significativa morbilidad. La inserción de prótesis enterales como tratamiento paliativo es una aceptable opción para conseguir un adecuado vaciamiento gástrico sin la morbilidad asociada a la cirugía paliativa, con menor mortalidad relacionada con el procedimiento y menor coste, proporcionando una mejor calidad de vida. Es importante unificar y consolidar la técnica endoscópica de colocación de las prótesis enterales evitando variaciones que impidan un adecuado análisis de los resultados de esta técnica (AU)

Malignant gastroduodenal obstruction may cause significant morbidity. Insertion of enteral prostheses as a palliative treatment is an acceptable option to achieve an appropriate gastric voiding without the morbidity associated to palliative surgery, with a lesser procedure-related mortality and a lower cost, while providing a better quality of life.Its is important to unify and consolidate the endoscopic procedure for the placement of enteral prostheses, avoiding variations that may preclude an adequate analysis of this procedure outcome (AU)

[Primary hepatic leiomyosarcoma in a patient with gastric non-Hodgkin lymphoma]. / Leiomiosarcoma hepático primario en un paciente con linfoma no hodgkiniano gástrico.

Primary leiomyosarcoma of the liver is a rare entity and fewer than 100 cases have been reported in the medical literature. Even more unusual is the association with another previous tumour. We report the case of a 84-year-old man who had been treated for a gastric non-Hodgkin lymphoma two years previously. He presented with a painful mass in the right upper abdomen. An ultrasound scan showed a large mass in the right lobe of the liver and chest radiography showed pulmonary metastases. Liver biopsy was performed and immunohistochemical analysis revealed a malignant leiomyosarcoma. We discuss this case and review the available literature.

[Current status of endoscopic retrograde cholangiopancreatography. What is the effect of the introduction of magnetic resonance cholangiography?]. / Estado actual de la CPRE. Cómo se refleja la introducción de la colangiorresonancia magnética?

AIM: To determine the current status of endoscopic retrograde cholangiopancreatography (ERCP) and the effects of the introduction of magnetic resonance cholangiography (MRC) on ERCP and to evaluate the diagnostic yield of MRC since its introduction in obstructive biliary disease. MATERIAL AND METHODS: We performed a retrospective analysis of the ERCP carried out between January 1998 and December 2000 and of the MRC performed for suspected obstructive biliary disease from May 1999 to December 2000. When both techniques were performed, the diagnostic yield of MRC was evaluated. RESULTS: We performed 927 ERCP. A total of 45.3% of the patients were men. Mean age was 69.2 14.6 years. Treatment was performed on 688 occasions (77%), mainly sphincterotomy (69.9%) and placement of polyethylene (21.8%) or self-expanding (9.9%) prostheses. The number of ERCP performed each year was 261, 330 and 336 in 1998, 1999 and 2000, respectively; of these 76.6%, 80% and 76.9% were therapeutic. MRC was performed in 63 patients with suspected biliary disease. In 27 of 59 patients (45.8%) MRC was sufficient for diagnosis, avoiding the need for ERCP. In the 35 patients in whom both techniques (MRC and ERCP) were performed, the diagnostic yield of MRC compared with that of ERCP was: sensitivity 100%, specificity 50%, positive predictive value 87.1%, negative predictive value 100% and overall value 89%. The cases responsible for the low specificity (all due to choledocholithiases) were analyzed and a significant time lapse was found between the performance of MRC and ERCP (range: 7-35 days) during which choledocholithiasis probably resolved spontaneously. CONCLUSIONS: a) Contrary to what could be expected, the number of ERCP seems to be increasing with a high percentage of endoscopic treatment; b) Because of its diagnostic sensitivity, MRC is the ideal technique for eliminating the need for diagnostic ERCP, thus allowing greater development of the therapeutic aspect of ERCP.

[Incidence of digestive tumors in the health district of Leon, Spain in 1993-1997: high incidence of colorectal carcinoma]. / Incidencia de los tumores digestivos en el Area de Salud de León en el quinquenio 1993-1997: alta incidencia del carcinoma colorrectal.

AIM: To determine the incidence of various digestive tumors in the health district of Leon. PATIENTS AND METHODS: All digestive tumors registered in the Hospital Tumor Registry in Leon from 1993-1997 were included. Unadjusted and adjusted incidence rates of each kind of tumor, using the ICD-9 classification, were calculated. RESULTS: A total of 9,913 cancer cases were included. Diagnosis was confirmed by the Department of Pathology in 93.4%. Of these, 25.38% originated primarily in the digestive system, which represents an unadjusted incidence of 151.73 new cases per 100,000 inhabitants/year. A total of 58.07% were male and 41.93% female. Colon cancer was the most frequent (31.5%), followed by gastric cancer (25.7%) and rectal cancer (20.3%). The highest incidence, both unadjusted and adjusted, was in colon cancer (52.8 and 25.9) followed by gastric cancer (47.4 and 24.3) and rectal cancer (36.1 and 18.3, all they 10(5)/year. CONCLUSIONS: Incidence of digestive cancer in Leon is very high and that of colorectal cancer is higher than in any other region in Spain. This is only partly due to the marked aging of our population.