Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study.

BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency, clinical presentation, diagnostic/therapeutic work-up, and endoscopic appearance of small-bowel tumors in a large population of patients undergoing VCE. PATIENTS AND METHODS: Identification by a questionnaire of patients with VCE findings suggesting small-bowel tumors and histological confirmation of the neoplasm seen in 29 centers of 10 European Countries. RESULTS: Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm (6), diarrhea with malabsorption (1). The main primary small-bowel tumor type was gastrointestinal stromal tumor (GIST) (32%) followed by adenocarcinoma (20%) and carcinoid (15%); 66% of secondary small-bowel tumors were melanomas. Of the tumors, 80.6% were identified solely on the basis of VCE findings. 55 patients underwent VCE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5% of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VCE, 54/124 patients underwent 57 other examinations before treatment; in these patients enteroscopy, when performed, showed a high diagnostic yield. Treatment was surgery in 95% of cases. CONCLUSIONS: Our data suggest that VCE detects small-bowel tumors in a small proportion of patients undergoing this examination, but the early use of this tool can shorten the diagnostic work-up and influence the subsequent management of these patients.

Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas.

INTRODUCTION: argon-plasma coagulation (APC) has been used safely and efficaciously in multiple settings including colon polyp treatment. The aim of this study was to evaluate APC efficacy and safety in the treatment of flat colorectal adenomas. MATERIALS AND METHODS: APC ablation was prospectively performed and evaluated in 22 consecutive patients with colorectal adenomas, 11 of which had large sessile adenomas that were treated with piecemeal polypectomy and APC ablation of residual adenomatous tissue, whereas the remaining eleven patients with flat or carpet-like adenomas were only treated with APC. The mean initial longitudinal extension of adenomas to be treated with APC was 22 mm (range, 20 to 40 mm). RESULTS: the mean age of patients was 70 years. Adenomas were found most frequently in the rectum (50%) and cecum (23%). Complete ablation was achieved in 90.9% of adenomas. Recurrence was observed in 20% of patients, all of them in the rectum, after a mean follow-up period of 16.3 months (range, 8 to 35). All recurrences were managed satisfactorily. No major complications were seen. CONCLUSIONS: argon plasma coagulator ablation of flat colorectal adenomas is an efficacious and safe technique, specially in the right colon, but results must be confirmed in controlled trials with a higher number of patients.

Seguridad y eficacia de la ablación de pólipos colorrectales con argón plasma / Safety and efficacy of argon plasma coagulator ablation therapy for flat colorectal adenomas

Introducción: el argón plasma (AP), como terapia endoscópica, ha sido utilizado en diferentes lesiones digestivas, incluyendo la ablación de tejido adenomatoso de pólipos colorrectales. El objetivo del presente estudio fue evaluar la seguridad y efectividad del tratamiento con AP de pólipos colorrectales. Material y métodos: se valoró de forma prospectiva la aplicación en la práctica clínica de AP en el tratamiento de 22 pacientes con pólipos colorrectales, de los cuales 11 pacientes con pólipos de gran tamaño fueron tratados con polipectomía endoscópica fragmentada más ablación del tejido adenomatoso con AP, y los otros 11 pacientes, con pólipos planos o en alfombra, solamente con AP. La extensión inicial de tejido adenomatoso a tratar tenía un diámetro medio de 22 (20-40) mm. Resultados: la edad media de los pacientes era de 70 años. Las localizaciones más frecuentes de los pólipos fueron recto (50 por ciento) y ciego (23 por ciento). Se observó respuesta completa al tratamiento endoscópico de pólipos colorrectales con AP en el 90,9 por ciento de los casos. Se produjo recurrencia en el 20 por ciento, en todos los casos pólipos rectales, tras un seguimiento medio de 16,3 (8-35) meses. Todas las recurrencias fueron tratadas satisfactoriamente. No se observaron complicaciones mayores derivadas del tratamiento con AP. Conclusiones: el tratamiento de pólipos colorrectales mediante ablación con AP es seguro y efectivo, principalmente en pólipos localizados en el colon derecho, aunque estos resultados debieran ser confirmados por estudios controlados con mayor número de pacientes (AU)

[Characteristics of bleeding from esophageal-gastric varices in patients with HIV infection]. / Características de la hemorragia digestiva por varices esofagogástricas en pacientes con infección por el VIH.

AIMS: Coinfection with human immunodeficiency virus (HIV) and hepatotropic viruses (hepatitis B and C) is frequent because the routes of infection are similar. Liver disease appears earlier in these patients and progression to cirrhosis and its complications is faster. The aim of this study was to determine the incidence and clinical characteristics of bleeding from esophageal-gastric varices in patients with HIV. METHODS: We retrospectively analyzed 258 consecutive episodes of bleeding from esophageal-gastric varices in cirrhotic patients between January 1996 and January 2001, of which 20 episodes occurred in patients with HIV (7.8%). RESULTS: The mean age was significantly lower in patients with HIV infection and all presented hepatitis C infection. The hepatic venous pressure gradient was higher in patients with HIV (22.8 3.4 mmHg vs 19.6 5,4 mmHg; p = 0.05). No differences in the severity of liver disease (Child-Pugh), transfusion requirements, treatment performed, initial hemostasis, early recurrence, or rescue treatment with dipeptidyl peptidase I (DPPI) were found. The development of complications (bacterial infections, hepatic encephalopathy and ascites), hospital stay and mortality were also similar. Mortality was not influenced by HIV stage. Bleeding from esophageal-gastric varices in patients with HIV infection has a similar form of presentation and clinical course with treatment to that in non-cirrhotic patients, despite a higher degree of portal hypertension. CONCLUSIONS: The presence of HIV infection should not modify diagnostic or therapeutic attitudes to bleeding from esophageal-gastric varices.

N-(3-(aminomethyl)benzyl)acetamidine, an inducible nitric oxide synthase inhibitor, decreases colonic inflammation induced by trinitrobenzene sulphonic acid in rats.

Gastrointestinal inflammation has been associated with an increased generation of nitric oxide (NO) and the expression of the inducible NO synthase (iNOS). Using an experimental model of colitis induced by trinitrobenzene sulphonic acid (TNBS), we sought to determine whether the administration of N-(3-(Aminomethyl)benzyl)acetamidine (1400W), a specific inhibitor of iNOS, has a beneficial action on the colonic injury. 1400W (0.4 and 2 mg/kg/day) was administered intraperitoneally from day 5 to 10 after intrarectal instillation of TNBS. TNBS led to colonic ulceration and inflammation, an increase of colonic myeloperoxidase activity and the expression of the calcium-independent NOS from days 1 to 15. 1400W reduced the macroscopic damage and the histological changes induced by TNBS as well as the calcium-independent NOS activity and myeloperoxidase activity determined over 30 min after sacrifice. These findings indicate that the expression of iNOS accounts for most of the damage caused by TNBS and that the administration of 1400W after the onset of colitis has a beneficial action on the colonic injury.

[Esophageal fibrovascular polyp: report of 2 cases]. / Pólipo fibrovascular esofágico: a propósito de 2 casos.

Fibrovascular esophageal polyps are benign intraluminal tumors that, although of slow growth, may become large. We describe the features of two cases, diagnosed in our department, and emphasize the endoscopic aspects of the lesion.

[The endoscopic placement of self-expanding metal prostheses as palliative treatment in colorectal stenosis of tumor origin]. / Colocación de prótesis metálicas autoexpandibles por vía endoscópica como tratamiento paliativo en estenosis colorrectales de origen tumoral.

BACKGROUND: The aim of this study was to retrospectively analyze the endoscopic placement of autoexpandible metallic prostheses of the colon carried out in our department as palliative treatment in patients with colorectal stenosis of tumoral origin. PATIENTS AND METHODS: From may, 1995 to august, 1998, autoexpandible metallic prostheses were placed in 14 patients (11 males and 3 females, mean age 64.5 years, range 41-92). All the patients presented tumoral stenosis by adenocarcinoma, 5 of which had been previously treated by surgery. RESULTS: All the stenoses were found in the rectum/sigma at less than 35 cm from the anal margin. In 7 patients endoscopic dilatation was performed prior to placement of the autoexpandible metallic prostheses. The prostheses used had a diameter of 18 mm and were of variable length. The placement of the prostheses was successfully achieved in all the patients except 2 (one due to technical difficulties and in the other because of early migration of the same, in both the autoexpandible metallic prostheses was placed without complications within 24 h). In two cases early complications were observed (14%): one case due to perforation and one to early migration. In two patients stenosis of the prostheses was observed during follow up and in a third patient late migration occurred. CONCLUSIONS: Endoscopic placement of autoexpandible metallic prostheses in patients with colorectal stenosis of tumoral origin is a simple technique with few complications and may be used as a definitive palliative treatment in these patients.

[Idiopathic esophageal ulcer with fistulization to the bronchial tree in a HIV-positive patient]. / Ulcera esofágica idiopática fistulizada a arbol bronquial en paciente VIH-positivo.

Idiopathic esophageal ulcerations (IEUs) associated with human immunodeficiency virus (HIV) infection are now recognized as an important cause of esophageal disease in this population. We report one case of IEU complicated with a fistula to the bronchial tree. Given his variable appearance, which may mimic other causes of esophageal ulceration and the high response rate to oral corticosteroid therapy, all HIV infected patients with esophageal ulceration should undergo endoscopy with biopsy to obtain a definitive diagnosis. We review the literature about the etiology, pathogenesis, management and treatment of the IEU.

[Tracheoesophageal fistula secondary to endoscopic sclerotherapy of esophageal varices]. / Fístula traqueoesofágica secundaria a escleroterapia endoscópica de varices esofágicas.

Over the past 15 years, endoscopic variceal sclerotherapy (EVS) has become the main therapy for patients with bleeding esophageal varices. EVS has the advantage of a low associated mortality and morbidity, but may lead to serious complications. We report a case of esophagotracheal fistula complicating sclerotherapy that resolved with nonsurgical management.

[Hypertensive colopathy: its endoscopic evaluation and evolution following a liver transplant]. / Colopatía hipertensiva: valoraciíon endoscópica y evolución tras trasplante hepático.

In the last decade the association between intestinal vasculopathy and Portal Hypertension (PH) has been established on the basis of endoscopic, histological and histomorphometric examinations. We report the case of a patient with cirrhosis secondary to hepatitis C virus, in whom colonoscopy demonstrated the presence of colonic vascular lesions with cherry spots appearance in the rectum and left colon that vanished two weeks after liver transplantation. The disappearance of mucosal lesions after liver grafting suggest a relation ship among them and portal hypertension.

[Hydrogen peroxide-induced lesions in the digestive tract. Apropos 4 cases]. / Lesiones por agua oxigenada en el tracto digestivo. A propósito de cuatro casos.

Gastrointestinal injury caused by caustic products a are relatively infrequent, occurring mainly in the upper gastrointestinal tract. Accidental ingestion accounts for most of the cases, and the severity and extent of damage produced, depends on the composition and volume of the caustic agent ingested; endoscopy is a safe and effective diagnostic procedure. We report four unusual cases of caustic injury of the gastrointestinal tract due to hydrogen peroxide, two cases due to oral ingestion and another two due to the accidental administration of enemas, there was a good clinic and endoscopic recovery with conservative treatment.

Esophageal lymphangioma: case report and review of the literature.

We report a 66-year-old patient with an esophageal lymphangioma. Five other cases have been reported previously. Clinical features, diagnosis, and therapy are discussed.

[Endoscopic management of foreign bodies in the digestive tract]. / Manejo endoscópico de los cuerpos extraños del tubo digestivo.

From 1983 to 1989, the Unidad de Endoscopias has attended 424 cases of foreign bodies located in the gastrointestinal tract, most of them in the esophagus. The mean age of the patients was 49 years. The commonest foreign bodies were food particles and the most common symptom was acute dysphagia. The most frequent localization of impaction was the cricopharyngeal sphincter (Killian's mouth). In 89% of the cases the foreign body could be removed endoscopically. The most common underlying pathology was hiatal hernia. There were severe complications related to the presence of the foreign body in 4.5% of the cases; one death was due to aorto-esophageal fistula. Foreign bodies, mainly impacted food particles (p less than 0.001), are most frequent in patients over 65, mainly females (p less than 0.01).

[Angiodysplasia of the colon. Experience in 60 cases]. / Angiodisplasias de colon. Experiencia en 60 casos.

A review was made of 60 angiodysplasias of the colon (AD) found retrospectively among 2,750 colonoscopies. The most frequent clinical manifestation was rectal bleeding (65%); mean patient age was 63 years. More than a fourth of the angiodysplasias (26.6%) was located in the left colon, as compared to 66.6% in the cecum and ascending colon. Most of the lesions were multiple and less than 5 mm in diameter. Twenty-two percent of the patients were cirrhotics and 15% had an aortic valvular lesion. The most outstanding aspects of the process are reviewed.

[Colonoscopic approach in the therapy of sigmoid volvulus]. / Abordaje colonscópico en el tratamiento del vólvulo sigmoide.

We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.