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Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than that achieved by single-shot ablation techniques. In addition, it is associated with significant risk of oesophageal injury. The POWER-FAST pilot study evaluated the feasibility and safety of PVI by high-power short-duration (HPSD) PPRF.HPSD PPRF around the PVs was done in 48 consecutive patients with atrial fibrillation. Fifty watts was delivered until a predefined lesion index value was reached (LSI ≥ 5 or Abl-I ≥ 350) and 60 W during 7-10 s in the first 18 and last 30 patients, respectively. A control group of 47 consecutive patients who had undergone PVI before the HPSD group with conventional PPRF (30 W for 30 s) was included for reference. Echocardiography and oesophageal endoscopy was performed shortly after ablation in all patients.PVI of all targeted veins was achieved in 98% and 100% of patients of the conventional and HPSD groups, respectively (p = 0.59). Total radiofrequency time was 34 ± 11, 24 ± 8, and 15 ± 5 min in groups 30 W, 50 W, and 60 W (p0.001). Audible steam pops occurred in 4 out of 48 (8%) patients in the HPSD group, accounting for 4 (0.08%) out of 5 269 HPSD radiofrequency applications. No patient in the HPSD group developed pericardial effusion. The incidence of oesophageal lesions was 28%, 22%, and 0% in groups 30 W, 50 W, and 60 W, respectively (p = 0.007) CONCLUSIONS: PVI can be achieved with HPSD PPRF in most patients. This approach appears safe and associated with low risk of esophageal damage.

BACKGROUND there is controversy about the need to maintain vasoconstrictor treatment after adequate haemostasis is achieved through endoscopic band ligation (EBL) in bleeding esophageal varices (BEV). Measuring a "before and after urgent-EBL" hepatic venous pressure gradient (HVPG) in acute variceal hemorrhage is very difficult. Thus, the goal of this study was to determine hemodynamic variations after an EBL session. A "before" HVPG (PRE) was performed and another one 24 hours "after-ligation" (POST), in cirrhotic patients undergoing endoscopic band ligation as BEV prophylaxis. PATIENTS AND METHODS this was a single-center, cohort, prospective study. Patients followed a program of repeated sessions of EBL until eradication of their varices and underwent a basal hepatic venous pressure gradient (PRE HVPG), without changing their usual treatment with beta-blockers. Subsequently, an endoscopic ligation session was performed, following the clinical practices guidelines. A second pressure measurement (POST HVPG) was taken 24 hours after the endoscopic treatment. RESULTS 30 patients were included. PRE and POST HVPG median results were 16.5 mmHg (14-20) and 19.5 mmHg (17-21), respectively, with a significant increase after the procedure (p < 0.001). Percentage variations in portal pressure, based on the baseline gradient values (12, 16 and 20 mmHg), were higher for patients with a lower basal HVPG versus a higher HVPG for any of the categories compared (p = 0.087, p = 0.016 and p < 0.001, respectively). In our series, 36.7 % of patients showed a ≥ 20 % gradient increase after ligation. CONCLUSION endoscopic band ligation causes an increase in portal pressure, at least for a transitional period, determined by the hepatic venous pressure gradient.

Background and Aims TC-325 (Hemospray, Cook Medical, Winston-Salem, NC) is an inorganic hemostatic powder recently approved by the U.S. Food and Drug Administration. This study aimed to examine the effectiveness, safety, and predictors of TC-325 failure in a large real-life cohort. Methods This was a retrospective study conducted at 21 Spanish centers. All patients treated with TC-325 until September 2018 were included. The primary outcome was treatment failure, defined as failed intraprocedural hemostasis or recurrent bleeding within the first 30 postprocedural days. Secondary outcomes included safety and survival. Risk and predictors of failure were assessed via competing-risk models. Results The cohort comprised 261 patients, of whom 219 (83.9%) presented with upper gastrointestinal bleeding (GIB). The most common causes were peptic ulcer (28%), malignancy (18.4%), and therapeutic endoscopy-related GIB (17.6%). TC-325 was used as rescue therapy in 191 (73.2%) patients. The rate of intraprocedural hemostasis was 93.5% (95% confidence interval [CI], 90%-96%). Risks of TC-325 failure at postprocedural days 3, 7, and 30 were 21.1%, 24.6%, and 27.4%, respectively. On multivariate analysis, spurting bleeding (P = .004), use of vasoactive drugs (P = .02), and hypotension (P = .008) were independent predictors of failure. Overall 30-day survival was 81.9% (95% CI, 76%-86%) and intraprocedural hemostasis was associated with a better prognosis (adjusted hazard ratio, 0.29; P = .006). Two severe adverse events were noted. Conclusion TC-325 was safe and effective for intraprocedural hemostasis in more than 90% of patients, regardless of the cause or site of bleeding and its use as rescue therapy. In this high-risk cohort treated with TC-325, the 30-day failure rate exceeded 25% and was highest with spurting bleeding or hemodynamic instability.

Resumen Objetivos Analizar las caracteristicas al ingreso, el curso evolutivo y el pronostico de la hemorragia digestiva alta (HDA) en el paciente anciano. Material y metodos Estudio prospectivo en el que se incluyeron 103 pacientes con edad igual o superior a 80 anos, que ingresaron en una Unidad de Sangrantes por un episodio de HDA en un ano. Analizamos los antecedentes personales, caracteristicas de la hemorragia, realizacion de la endoscopia urgente diagnostica y terapeutica y factores pronosticos asociados. Resultados La etiologia mas frecuente de la HDA fue el sangrado por ulcera gastroduodenal en el 65,1%, siendo el 60,2% consumidores cronicos de antiinflamatorios no esteroideos. Se realizo endoscopia diagnostica urgente en todos ellos, con una eficacia del 94,2% y terapeutica en el 28,2%. La tasa de resangrado fue del 8%, requiriendo cirugia urgente el 4,9%, con una mortalidad global del 5,8%. Conclusiones La realizacion de endoscopia urgente y la aplicacion de terapeutica endoscopica es un metodo seguro y eficaz para detener el sangrado por HDA en el anciano, lo cual ha reducido la necesidad de cirugia urgente, mejorando la supervivencia del enfermo anciano sangrante.

Fundamento y objetivo En pacientes con disfagia, la gastrostomia endoscopica percutanea (GEP) es superior a la sonda nasogastrica en cuanto a una mayor recuperacion de peso y masa corporal. Por su utilidad, seguridad, bajo coste y facil mantenimiento es, en estos momentos, de eleccion en pacientes con problemas de deglucion. Pacientes y metodo Se incluyo a 77 pacientes en este estudio, a quienes se administro profilaxis antibiotica previamente al procedimiento. Las indicaciones para la colocacion de la GEP fueron: enfermedad neurologica (46%), neoplasias de cabeza y cuello (26%) y un tercer grupo de miscelanea (29%). Resultados En el seguimiento posterior a la colocacion de la GEP se detecto la aparicion de complicaciones mayores en el 1,3% de los pacientes, y en el 18,18% de ellos aparecieron complicaciones menores; la infeccion del estoma represento el 15%. Conclusiones La gastrostomia endoscopica percutanea es el metodo de eleccion para facilitar una nutricion enteral prolongada.

Resumen El objetivo del presente estudio fue determinar la utilidad de la ligadura con bandas elasticas en la prevencion de la recidiva hemorragica por varices esofagogastricas. Se incluyo a 65 pacientes que sobrevivieron a un episodio hemorragico por varices. Veintinueve (45%) eran Child A, 25 (38%) B y 11 (17%) C; el virus C y el alcohol fueron la etiologia de la cirrosis en el 45 y el 31% de los casos, respectivamente. La primera sesion de ligadura se realizo entre el tercer y el quinto dia despues del episodio hemorragico, y las sesiones posteriores a intervalos de 3-4 semanas. Las sesiones de ligadura se realizaron con profilaxis antibiotica. Se aplico una media de 2,7 bandas por sesion (rango, 1-5), y la media de sesiones por paciente hasta erradicar las varices fue de 2,5 (rango, 1-6). La tasa de recidiva hemorragica fue del 24,6% (16 episodios). En conclusion, la ligadura endoscopica con bandas elasticas es una tecnica util para la erradicacion de varices esofagicas y en la prevencion de recidiva hemorragica.

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations.

The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis.

To evaluate the patient characteristics, outcome, and prognosis of upper gastrointestinal haemorrhage in the elderly.A prospective study was conducted on 103 patients aged 80 years and over, admitted to a Gastrointestinal Bleeding Unit after an episode of upper gastrointestinal bleeding. We analysed the personal history, the characteristics of the bleeding event, and whether an urgent diagnostic or therapeutic endoscopy was performed, in order to identify clinical data and endoscopic findings that may have an influence on the outcome of the haemorrhage.The major cause of the haemorrhage was peptic ulcer in 65.1%, and 60.2% of patients were on chronic treatment with non-steroidal anti-inflammatory drugs. An urgent diagnostic endoscopy was performed in all of them, identifying the source of bleeding in 94.2%, and treatment was carried out on 28.2%. The likelihood of rebleeding was 8%, and 4.9% of patients underwent emergency surgery, with an overall mortality rate of 5.8%.The performance of urgent endoscopy and the application of endoscopic haemostasis are safe and effective in stopping upper gastrointestinal bleeding in the elderly. This has significantly reduced the need for emergency surgery, improving the survival of the bleeding elderly patient and preventing recurrent bleeding.

In the course of inflammatory bowel disease (IBD) a number of extraintestinal manifestations are known to occur, being the dermatological ones often associated to both ulcerative colitis and Crohn's disease. Pyoderma gangrenosum and erythema nodosum are the most frequent, but there are other skin manifestations less frequently reported such as leukocytoclastic vasculitis. We present a case, in which Crohn's disease and leukocytoclastic vasculitis were simultaneously diagnosed, and corticoids treatment achieved complete remission of the both cutaneous and gastrointestinal manifestations.