Hematoma subcapsular hepático tras colangiopancreatografía retrógrada endoscópica. Una complicación rara y con elevada morbimortalidad / Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography. A rare complication with high morbidity and mortality

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Cavitación y fístula enterocólica de gran calibre secundaria a adenocarcinoma de colon izquierdo / Rectosigmoid carcinoma presenting with a large small bowel fistula

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Esófago hipercontráctil Jackhammer / Hypercontractile "Jackhammer esophagus"

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Pseudomelanosis gástrica y duodenal: a propósito de dos casos / Gastric and duodenal pseudomelanosis: a propos of two cases

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Utilidad del Flexible Spectral Imaging Enhancement de cápsula endoscópica en el diagnóstico de lesiones de intestino delgado / Utility of capsule endoscopy with flexible spectral imaging color enhancement in the diagnosis of small bowel lesions

Introducción: La cápsula endoscópica (CE) es la técnica de elección para detectar lesiones de intestino delgado (ID). En la versión 6.0 de la estación de trabajo RAPID se ha implementado el software de realce de imagen flexible spectral imaging color enhancement [FICE]) para cápsula endoscópica (FICE-CE), que permite visualizar la mucosa con 3 patrones diferentes según distintas longitudes de onda. El objetivo de este trabajo es valorar si las lesiones halladas en CE mejoran con la imagen modificada del FICE-CE con respecto a la visualización estándar. Pacientes y métodos: Se recogieron 50 lesiones encontradas en CE en 41 pacientes consecutivos del año 2010 a los que se administró PillCamTM SB2 en nuestro centro, siendo clasificadas en 3 grupos: a) lesiones vasculares y (..) (AU)

Introduction: Capsule endoscopy (CE)is the technique of choice to detect small bowel lesions. Flexible spectral imaging color enhancement (FICE) software has recently been incorporated into the new RAPID 6.0 workstation, which allows three distinct patterns to be visualized in the mucosal structure according to different wavelengths. The aim of this study was to evaluate whether CE-FICE is more effective in detecting lesions than standard visualization. Patients and methods: Fifty lesions were detected by CE in 41 consecutive patients in 2010. These patients were administered PillCamTM SB2 in our center and were classified into three groups: 1) vascular lesions and (..) (AU)

[Utility of capsule endoscopy with flexible spectral imaging color enhancement in the diagnosis of small bowel lesions]. / Utilidad del Flexible Spectral Imaging Enhancement de cápsula endoscópica en el diagnóstico de lesiones de intestino delgado.

INTRODUCTION: Capsule endoscopy (CE) is the technique of choice to detect small bowel lesions. Flexible spectral imaging color enhancement (FICE) software has recently been incorporated into the new RAPID 6.0 workstation, which allows three distinct patterns to be visualized in the mucosal structure according to different wavelengths. The aim of this study was to evaluate whether CE-FICE is more effective in detecting lesions than standard visualization. PATIENTS AND METHODS: Fifty lesions were detected by CE in 41 consecutive patients in 2010. These patients were administered PillCamTM SB2 in our center and were classified into three groups: 1) vascular lesions and angiodysplasias (18 lesions), 2) erosions and ulcers (18 lesions) and 3) polyps and tumors (14 lesions). Subsequently, these lesions were independently analyzed with the available FICE patterns by three endoscopists, who assigned them a score according to the changes in the visualization of each FICE mode: +2, strong improvement; +1, slight improvement; 0, no relevant changes; -1, slight worsening; -2, clear worsening. When the sum of the scores of the three observers was 3 or more, visualization was considered to have improved; a score of 2 to -2 indicated no change; and a score of from -3 to -6 indicated poorer visualization. RESULTS: The FICE 1 mode improved visualization of angiodysplastic and vascular lesions in 16/18 patients (88.9%) and that of erosions/ulcers in 14/18 patients (77.8%). The FICE 2 mode improved these lesions in 88.9% and 55.5%, respectively. The FICE 3 mode only improved visualization of these lesions in 5/18 (27.7%) and 1/18 patients (5.5%), respectively. Likewise, the distinct FICE modes improved visualization of polyps/tumors in 2/14 (14.2%), 3/13 (21.4%) and 4/14 (28.5%) for FICE 1, 2 and 3, respectively. CONCLUSIONS: The application of CE-FICE modes 1 and 2 could improve the characterization of angiodysplastic/vascular lesions and erosions or ulcers in small bowel lesions. However, FICE 3 seems to provide no significant advantages. None of the CE-FICE modes seems to improve the characterization of polyps and tumors.

Optimización del cultivo de líquido ascítico en el contexto clínico de la peritonitis bacteriana espontánea / Optimization of ascitic fluid culture in spontaneous bacterial peritonitis

Introducción y objetivosLa peritonitis bacteriana espontánea (PBE) es la infección del líquido ascítico (LA) en ausencia de foco infeccioso intraperitoneal en pacientes con enfermedad hepática e hipertensión portal. El objetivo del estudio fue la evaluación de la rentabilidad de los cultivos microbiológicos tras la optimización de la sistemática en su recogida en la práctica clínica habitual.MétodosSe analizaron 2 series, la primera retrospectiva con datos de 156 episodios de PBE consecutivos de enero de 2003 a diciembre de 2005 (grupo R), y la segunda con un grupo prospectivo desde octubre de 2007 a octubre de 2008, constituido por 79 episodios, en los que se optimizó el protocolo diagnóstico de PBE (grupo P), con la recogida sistemática de 10ml de LA por bote de hemocultivo.ResultadosLas características basales epidemiológicas y clínicas entre los episodios fueron similares, salvo mayor incidencia de insuficiencia renal, ascitis a tensión e íleo adinámico, y en la etiología de la hepatopatía, más frecuente de origen etílico, en el grupo P. Se consiguió aislamiento microbiológico en LA en el 12,2% de los episodios del grupo R, frente al 53,2% del grupo P (p=0,001) y en hemocultivos en el 8,5 y 26,6% (p=0,001), respectivamente. Se obtuvo aislamiento microbiológico en el 65,8% de los episodios del grupo P frente al 19,2% del grupo R (OR 8; IC 95%: 4,4-14,9; p=0,001). El microorganismo más frecuentemente aislado en la en el grupo P fue Escherichia coli (42,9%).ConclusionesLa optimización en la realización de la sistemática diagnóstica en la práctica asistencial del paciente cirrótico con ascitis aumenta su rendimiento microbiológico diagnóstico (AU)

Introduction and aimsSpontaneous bacterial peritonitis (SBP) is ascitic fluid (AF) infection in the absence of an intraperitoneal source of infection in patients with liver disease and portal hypertension. The aim of this study was to evaluate the yield of microbiological cultures to optimize their collection and systematic implementation in routine clinical practice.MethodsWe analyzed two cohorts: the first consisted of retrospective data from the clinical records of 156 consecutive episodes of SBP from January 2003 to December 2005 (group R), and the second was composed of data collected prospectively from October 2007 to October 2008, consisting of 79 episodes (group P), with systematic inoculation of 10 cc of AF in each blood culture bottle.ResultsNo significant differences were demonstrated in baseline epidemiological or clinical characteristics among episodes, except the more frequent presence of alcoholic liver disease and the incidence of tense ascites, paralytic ileus and kidney failure at diagnosis in group P. Microbiological isolation in AF was achieved in 12.2% of the episodes in group R compared with 53.2% in group P (p=0.001) and 8.5 and 26.6% (p=0.001) in blood culture, respectively. Microbiological isolation was achieved in 65.8% of episodes in group P versus 19.2% in group R (OR 8; 95% CI: 4.4-14.9; p=0.001). The most frequently isolated organism in AF in group P was Escherichia coli (42.9%).ConclusionsOptimizing the diagnostic procedure in cirrhotic patients with ascites significantly increases diagnostic microbiologic performance(AU)

Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico / Descriptive study of hepatocellular carcinoma in noncirrhotic liver

Introducción y objetivoEl carcinoma hepatocelular (CHC) es la sexta causa de cáncer. En el mundo occidental su incidencia está en aumento y la gran mayoría asientan sobre una cirrosis hepática. El objetivo del estudio fue evaluar las características del CHC en pacientes sin cirrosis.MétodosSe realizó una revisión retrospectiva de 469 pacientes con diagnóstico de CHC durante el periodo de enero de 2003 a diciembre de 2007. Se seleccionaron aquellos pacientes que cumplían criterios histológicos, o la conjunción de criterios clínicos, analíticos, radiológicos y/o de hemodinámica hepática, de ausencia de cirrosis hepática.ResultadosSe identificaron 29 pacientes con diagnóstico de CHC sobre hígado no cirrótico (6,2%). El 86,2% eran varones y con una mediana de edad de 61,6 (23 - 82) años. La enfermedad hepática fue hepatopatía crónica con fibrosis leve-moderada en el 68,9%. El 62,1% de los pacientes se encontraban asintomáticos al diagnóstico. El CHC era un nódulo único en el 86,2%, y la mediana del nódulo mayor fue 46 (20 - 150) mm. Se evidenció invasión vascular macroscópica en dos pacientes y metástasis óseas en otros dos. Se realizó tratamiento activo en 25 pacientes: 15 resección quirúrgica, 6 radiofrecuencia y 4 quimioembolización transarterial. La supervivencia acumulada a 1, 2 y 3 años, fue del 84,3; 67,2 y 50,1%, respectivamente.ConclusionesEl CHC sobre hígado no cirrótico es una patología poco frecuente, siendo tumores de gran tamaño al diagnóstico. A pesar de ello, se pueden aplicar tratamientos con intención curativa y alcanzar una supervivencia superior a la esperable en pacientes con cirrosis(AU)

Introduction and objectiveHepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. Methods: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included.ResultsWe identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3years was 84.3%, 67.2% and 50.1%, respectively.ConclusionHCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis(AU)

[Descriptive study of hepatocellular carcinoma in noncirrhotic liver]. / Estudio descriptivo de la experiencia sobre carcinoma hepatocelular en hígado no cirrótico.

INTRODUCTION AND OBJECTIVE: Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. METHODS: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included. RESULTS: We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively. CONCLUSION: HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis.

[Optimization of ascitic fluid culture in spontaneous bacterial peritonitis]. / Optimización del cultivo de líquido ascítico en el contexto clínico de la peritonitis bacteriana espontánea.

INTRODUCTION AND AIMS: Spontaneous bacterial peritonitis (SBP) is ascitic fluid (AF) infection in the absence of an intraperitoneal source of infection in patients with liver disease and portal hypertension. The aim of this study was to evaluate the yield of microbiological cultures to optimize their collection and systematic implementation in routine clinical practice. METHODS: We analyzed two cohorts: the first consisted of retrospective data from the clinical records of 156 consecutive episodes of SBP from January 2003 to December 2005 (group R), and the second was composed of data collected prospectively from October 2007 to October 2008, consisting of 79 episodes (group P), with systematic inoculation of 10 cc of AF in each blood culture bottle. RESULTS: No significant differences were demonstrated in baseline epidemiological or clinical characteristics among episodes, except the more frequent presence of alcoholic liver disease and the incidence of tense ascites, paralytic ileus and kidney failure at diagnosis in group P. Microbiological isolation in AF was achieved in 12.2% of the episodes in group R compared with 53.2% in group P (p = 0.001) and 8.5 and 26.6% (p = 0.001) in blood culture, respectively. Microbiological isolation was achieved in 65.8% of episodes in group P versus 19.2% in group R (OR 8; 95% CI: 4.4-14.9; p = 0.001). The most frequently isolated organism in AF in group P was Escherichia coli (42.9%). CONCLUSIONS: Optimizing the diagnostic procedure in cirrhotic patients with ascites significantly increases diagnostic microbiologic performance.

Peritonitis bacteriana espontánea en pacientes con cirrosis mayores de 65 años / Spontaneous bacterial peritonitis in cirrhotic patients over 65 years

Fundamento y objetivo: Estudiar los episodios de peritonitis bacteriana espontánea (PBE) en pacientes cirróticos mayores de 65 años y comparar sus características y su evolución clínica dentro de una cohorte de pacientes cirróticos con PBE. Material y métodos: Se realizó un estudio observacional y retrospectivo sobre todas las altas hospitalarias con diagnóstico de PBE en el período de enero de 2003 a diciembre de 2005, con un total de 158 episodios. Se valoró el episodio de PBE desde su diagnóstico hasta la muerte o el fin de seguimiento por otras causas del paciente. Se dividió la cohorte en 2 grupos, según edad superior a 65 años (grupo 1: 73 episodios) o edad inferior o igual a 65 años (grupo 2: 86 episodios). Se realizó un estudio descriptivo y comparativo de ambos grupos y posteriormente se realizó un análisis de supervivencia mediante curvas de Kaplan-Meier (comparadas mediante el test log-rank) y valoración de los factores predictivos independientes mediante regresión de Cox en la cohorte global. Resultados: En el grupo 1 el 74% de los pacientes eran varones y la edad media (desviación estándar) fue de 72,8 (5,6) años, y la distribución según la clasificación de Child-Pugh fue del 8,2 (A), del 68,5 (B) y del 23,3% (C). La etiología de la cirrosis fue vírica en el 65,8% de los casos. Comparado con el grupo 2, se observó mayor frecuencia de insuficiencia renal al ingreso, prevalencia de hepatocarcinoma y etiología vírica, mientras que las cifras de bilirrubina eran superiores en el grupo 2. La mortalidad intrahospitalaria fue del 23,3%. Se observó una supervivencia a los 3 y a los 6 meses del 69,5 y del 54,8% y en el grupo 2 del 80,3 y del 78,4%, respectivamente (p=0,001). La edad superior a 65 años, la existencia de hepatocarcinoma y la presión arterial media superior a 75mmHg al ingreso fueron factores predictivos independientes de mortalidad (AU)

Aims: Our aim was to study the episodes of spontaneous bacterial peritonitis (SBP) in cirrhotic patients older than 65 years. Their clinical characteristics were compared with a cohort of cirrhotic patients with SBP. Methods: We conducted a retrospective study on all hospital discharged patients diagnosed with SBP in the period from January 2003 to December 2005, obtaining a total of 158 episodes. Two groups of patients were created: those over 65 (group 1: 73 episodes) and those aged }65 years (group 2: 86 episodes). A descriptive study, an analysis of survival by Kaplan Meier curves (compared with log-rank test) and a Cox regression analysis was conducted comparing the two groups. Results: In Group 1, males were 74%, the average age was 72.4 (SD 4.2) years, and the Child-Pugh distribution was 8.2% (A), 68.5% (B) and 23.3% (C).The most usual etiology of cirrhosis was viral (65.8%). In comparison with group 2, there was a superior frequency of renal impairment at admission, hepatocellular carcinoma and a viral etiology. Yet the bilirubin levels were higher in group 2. In-hospital mortality rate was 23.3%. The survival at 3 and 6 months was of 69.5% and 54.8%, while in group 2 it was 80.3% and 78.4% respectively (p=0001). An age> 65 years, the existence of hepatocellular carcinoma and a Mean Arterial Pressure <75mm Hg at admission, in the overall cohort, were independent predictors of mortality. Conclusion: An age above 65 years is an independent predictor of mortality following the development of an episode of spontaneous bacterial peritonitis in cirrhotic patients (AU)

[Spontaneous bacterial peritonitis in cirrhotic patients over 65 years]. / Peritonitis bacteriana espontánea en pacientes con cirrosis mayores de 65 años.

AIMS: Our aim was to study the episodes of spontaneous bacterial peritonitis (SBP) in cirrhotic patients older than 65 years. Their clinical characteristics were compared with a cohort of cirrhotic patients with SBP. METHODS: We conducted a retrospective study on all hospital discharged patients diagnosed with SBP in the period from January 2003 to December 2005, obtaining a total of 158 episodes. Two groups of patients were created: those over 65 (group 1: 73 episodes) and those aged 65 years (group 2: 86 episodes). A descriptive study, an analysis of survival by Kaplan Meier curves (compared with log-rank test) and a Cox regression analysis was conducted comparing the two groups. RESULTS: In Group 1, males were 74%, the average age was 72.4 (SD 4.2) years, and the Child-Pugh distribution was 8.2% (A), 68.5% (B) and 23.3% (C).The most usual etiology of cirrhosis was viral (65.8%). In comparison with group 2, there was a superior frequency of renal impairment at admission, hepatocellular carcinoma and a viral etiology. Yet the bilirubin levels were higher in group 2. In-hospital mortality rate was 23.3%. The survival at 3 and 6 months was of 69.5% and 54.8%, while in group 2 it was 80.3% and 78.4% respectively (p=0001). An age> 65 years, the existence of hepatocellular carcinoma and a Mean Arterial Pressure <75 mm Hg at admission, in the overall cohort, were independent predictors of mortality. CONCLUSION: An age above 65 years is an independent predictor of mortality following the development of an episode of spontaneous bacterial peritonitis in cirrhotic patients.