Search

Resumen Introduccion A pesar de los avances en las tecnicas de imagen, en muchos casos son insuficientes para establecer el diagnostico de las lesiones quisticas pancreaticas (LQP). Son escasas las publicaciones en nuestro medio que evaluan la combinacion de varios metodos obtenidos mediante la puncion aspirativa con aguja fina con ultrasonografia endoscopica (USE-PAAF). El objetivo del estudio fue evaluar la utilidad global de la USE-PAAF en el diagnostico de las LQP. Material y metodos Estudio retrospectivo a partir de una base de datos actualizada prospectivamente de una cohorte de pacientes remitidos para USE-PAAF por LQP. Se estudio la sensibilidad, la especificidad, el rendimiento diagnostico del antigeno carcinoembrionario (CEA), la citologia y la viscosidad para detectar lesiones mucinosas. Resultados Desde noviembre de 2013 a abril del 2018 se realizaron 122 USE por LQP. Se realizo USE-PAAF en 94/122 (77%) y se intervinieron 21/122 (17,2%) pacientes. Se incluyeron 33/122 pacientes que tuvieron confirmacion diagnostica mediante histologia, imagen (quiste seroso con patron tipico) o evolucion clinica. El estudio de la curva ROC determino el punto de corte ≥ 419 ng/ml para diferenciar lesion quistica mucinosa/no mucinosa. El rendimiento diagnostico del CEA fue del 87,5% (21/24), de la citologia del 81,8% (27/33) y de la viscosidad del 84,4% (27/32). Los 3 parametros en combinacion obtuvieron el mejor resultado (30/33, 90,9%). Conclusion La combinacion del analisis del CEA, la citologia y la viscosidad del liquido pancreatico obtenido mediante USE-PAAF aumenta el rendimiento en el diagnostico de las lesiones quisticas pancreaticas mucinosas, siendo superior al 90%.

Nodular gastropathy (NG) is an inflammatory condition of the gastric mucosa characterized by the endoscopic detection of multiple millimeter protrusions. A strong association between NG and Helicobacter pylori and a possible role of NG as a risk factor for undifferentiated gastric cancer have been described. The aim of this study was to characterize the pathogenic and inflammatory profile of patients with NG. Adult patients referred for upper gastrointestinal endoscopy were prospectively enrolled in this study. H. pylori infection status was determined by rapid urease test. Biopsies were stained with hematoxylin–eosin. Sydney and OLGA scores were used to assess gastritis characteristics and gastric cancer risk. PCR analysis was performed to determine bacterial load and virulence factors CagA (and its EPIYA motifs) and VacA alleles. Finally, gastric mucosa cytokine gene expression (IL-8, IL-1β, and TNF-α) was determined by real-time RT-PCR. Forty-eight patients, mean age of 36 years, were recruited. All NG patients were infected by H. pylori. OLGA score was similar in both groups (NG patients and non-NG patients). NG patients had higher bacterial load in the gastric corpus (p = 0.01) and significantly less pro-inflammatory cytokine levels than non-NG infected patients (p = 0.01). In our study, NG is not associated with preneoplastic lesions. An increase in bacterial load without a concomitant increase in mucosal inflammatory cytokine responses in H. pylori-infected subjects with NG may represent a general dampening of immune responses or an additional mechanism of H. pylori active immune evasion.

Background The presence of hepatolithiasis (HL) is prevalent in eastern countries. It is a clinical entity which is rarely reported in non-surgical series because the standard treatment is the surgical option. Currently, treatment has evolved, with the use of endoscopic techniques being increased and the number of hepatectomies being decreased. SpyGlass™ is a small-calibre endoscopic direct cholangiopancreatoscopy developed to explore and perform procedures in the bile and pancreatic ducts. Single-operator peroral cholangioscopy (POC) is an endoscopic technique useful for treating difficult bile duct stones. Aims To assess the usefulness, efficacy, and safety of POC with the SpyGlass™ system in patients with HL. Primary objectives: to achieve technical success of the procedure and clinical success of patients with HL. Study design and patients Retrospective, single-centre cohort study of patients with HL from April 2012 to August 2018. SpyGlass™ was chosen in symptomatic patients referred from the surgery unit as the first-line procedure. To perform electrohydraulic lithotripsy (EHL), we used a Northgate Autolith IEHL generator with a 0.66-mm biliary probe. Results We performed a total of 13 procedures in 7 patients with HL. The mean age was 46 years (range 35–65) and 3/7 of patients were female. We achieved technical success in 5/7 cases (71.4%) and clinical success in 4/7 cases (57%). Discussion SpyGlass™ is safe and effective in the treatment of HL. With these results, we confirm the need for management of patients with HL in a multidisciplinary team. When the endoscopic approach is the option, this procedure must be performed by experts in advanced endoscopy.

Most extrahepatic cholangiocarcinomas are unresectable at the time of diagnosis and even in case of a resectable cancer, surgery is not an option for the elderly or patients with comorbidities (1). Current treatment alternatives in these scenarios are very limited. Biliary stenting with self-expanding metal stents (SEMS) is the mainstay palliative treatment for biliary obstruction (2). However, emerging experience with endoscopic RF ablation (RFA) in this setting has been reported in the literature.

A 54-year-old female patient was referred to our outpatient clinic in December 2017 due to unresolved epigastric pain. She underwent cholecystectomyin in October 2012 due to epigastric pain, without evidence of lithiasis or biliary sludge. Subsequently, the patient continued to present epigastric discomfort with episodes of epigastralgia and was admitted in August 2016. There was evidence of elevated transaminases AST 125, ALT 97 and GGT 47, with normal amylase and no specific diagnosis was made on discharge from hospital.

Background and aims: to assess the usefulness, efficacy and safety of single-operator cholangiopancreatoscopy (SOCP) with the SpyGlass(tm) system for the management of biliopancreatic diseases. Methods: a retrospective analysis of patients undergoing SOCP with the SpyGlass(tm) between September 2008 and April 2016 was performed. Data was obtained from a prospectively-maintained database at a tertiary referral center. The primary study outcomes were technical and complete endoscopic success of the procedure. Two different SpyGlass(tm) systems were employed; the former is called legacy and the latter, digital system (DS). Results: a total of 107 SOCP procedures in 93 patients performed by a single operator were analyzed. Technical success of the SpyGlass(tm) examination was achieved in 90/93 (97%) of patients and complete success by resolving the biliopancreatic condition in 82/93 (88%) cases. In indeterminate biliary strictures, a complete success was achieved in 45/52 (85%) of cases. With regard to stone treatment, technical success was achieved in 34/34 (100%) patients and complete success, in 31/34 (91%) cases. Electrohydraulic lithotripsy was applied in 16/34 (47%) of cases. There were a total of 7/93 adverse effects (7.5%). Conclusions: SOCP is a useful and safe technique for the treatment of biliopancreatic diseases with a low rate of adverse effects. The procedure seems technically demanding and dedication is required.

A 37-year-old woman had a history of cholelithiasis and choledocholithiasis in 2007, and cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy had been performed. Shewas admitted toour unitwith a10-day history of upper abdominal pain that radiated into the back. She reported noweight loss, no fever, and no change in bowel habit. On questioning, the patient reported that she had travelled to Peru 6months previously, and had probably ingested contaminated water. Laboratory tests showed minimal elevation of serum amylase, and normal findings for lipase, hepatic function, complete blood count, electrolyte levels, and blood chemistry. Abdominal ultrasound revealed hepatic steatosis. Mild pain persisted despite treatment with antispasmodics. After 5 days, upper gastrointestinal endoscopy was performed and showed antral chronic gastritis. Endosonography showed normal large blood vessels. The uncinate process, head, isthmus, body, and tail of the pancreas showed normal appearances, as did the size and shape of the papilla and pancreatic duct. The common bile duct was dilated to 9mm, and a tubular entity about 4mm in diameter was extending through it, from the duodenal lumen to the intrahepatic bile duct. Tubular structures that moved independently were observed (●" Fig.1). Because the endoscopic appearance was suspicious for parasitic infestation, we exchanged the echoendoscope for a duodenoscope, confirmed the diagnosis (●" Fig.2), and extracted the specimen completely using a Talon grasping device (US Endoscopy, Mentor, Ohio, USA), observing a parasite of 20cm in length (●" Video 1). Microbiological study confirmed Ascaris lumbricoides. After extraction of the parasite, the patient reported no abdominal pain. A single dose of albendazole (400mg) was administered [1] and the patient was discharged. Ascaris lumbricoides is an intestinal nematode (roundworm), producing a globally distributed helminthic infection. The majority of infections occur in the developing countries of Asia and Latin America [2]. The symptoms and complications of infection can be pulmonary and hypersensitivity manifestations [3], intestinal symptoms and obstruction [4], and hepatobiliary and pancreatic [5].