Revista Espanola De Enfermedades Digestivas最新文献

Background and aims: Recent guidelines emphasized that not all patients with recurrent polyps benefit from post-polypectomy surveillance, except for advanced adenomas recurrence. Our study aimed to analyze the recurrence risk factors for advanced adenomas and investigating the difference from any polyp recurrence.

Methods: This retrospective observational study included patients who underwent colonoscopy and at least once post-polypectomy surveillance. Multivariate regression models identified risk factors for the recurrence of polyps and advanced adenomas. The Youden index determined the optimal cut-off value for risk factors. Kaplan-Meier curve estimated the cumulative recurrence rates, and the log-rank tests were compared the differences between these curves.

Results: A total of 1818 patients were detected polyps at baseline examination. During post-polypectomy surveillance, 1063 patients had recurrent polyps, and 64 patients experienced recurrent advanced adenomas. Multivariate logistic analysis identified age as an independent risk factor for both advanced adenoma [OR(95% CI): 1.028 (1.003-1.056)] and polyps [OR(95% CI): 1.019 (1.009-1.028)], with cut-off values of 57 years and 53 years, respectively. Cut-off value of 40 years can increase the predictive sensitivity to 95%. Polyps size [OR(95% CI):1.070 (1.014-1.147)] and high-risk pathology [OR(95% CI): 6.339 (2.057-23.919)] were significantly associated with the recurrence of advanced adenomas, but not with any polyps, with a size cut-off value of 7.5 mm. Except for high-risk pathology, neither hyperplastic polyps nor tubular adenomas with low-grade dysplasia increased the recurrence risk of advanced adenomas.

Conclusions: 40 years can increase the predictive sensitivity to 95% for both advanced adenomas and any polyps. Polyps size and high-risk pathology were associated with the recurrence of advanced adenoma, but not with any polyps.

Preoperative rehabilitation, or prehabilitation, plays a crucial role in improving outcomes for patients undergoing complex surgeries like pancreaticoduodenectomy. In the article "Prehabilitation in Patients Undergoing Pancreaticoduodenectomy: A Randomized Controlled Trial" by Ausania et al., valuable insights are provided into this emerging field. However, key methodological details, such as the randomization process and allocation concealment, were not fully described. Randomization and allocation concealment are essential in randomized controlled trials to prevent selection bias and ensure valid, unbiased results. Without proper allocation concealment, the trial's outcomes may be skewed, overestimating treatment effects. This paper underscores the importance of transparent reporting of these processes to maintain scientific rigor and enhance the reliability of study findings.

We present the case of a patient who presents a duodenal perforation after placement of a plastic biliary stent due to pancreatic head neoplasia, who underwent endoscopic removal of the biliary stent and closure of the perforation with OTSC.

A 71-year-old male patient with a history of bladder neoplasia underwent Bricker-type surgery, during which an iatrogenic rectal injury occurred. During surgery, an unsuccessful suture attempt was made, leading to the appearance of fecaluria after 48 hours. A computed tomography scan revealed a small continuity defect in the rectal wall, accompanied by a 25-mm adjacent collection. Percutaneous drainage was placed in an attempt to achieve spontaneous closure, but this was unsuccessful. A rectoscopy was performed, identifying a wall defect in the mid-rectum. A review with a paediatric gastroscope confirmed communication to a cavity drained by urethra (recto-urethral fistula). Endoscopic vacuum therapy (EVT) (Endo-SPONGE®, B.Braun; Melsungen, Hesse, Germany) was initiated, achieving negative pressures (KCI Acelity V.A.C.® ATS® Negative Pressure Wound Therapy Unit; -100 mmHg). An endoscopic review after 72 hours confirmed the appearance of granulation tissue and the initiation of cavity closure. After three replacements (a total of four sponges), cavity collapse was achieved, but complete closure of the orifice was not attained. An over-the-scope clip (OTSC® 11.5-14 mm type-t, Ovesco; Tübingen, Baden-Wurttemberg, Germany) was placed, but fecaluria persisted, albeit with lesser intensity. Ultimately, successful closure was achieved by placing a second over-the-scope clip, two conventional hemoclips (Novaclip-R3 16 mm, Vytil; Hangzhou, Zhejiang, China), and instilling endoscopic biodegradable cyanoacrylate adhesive (Glubran® 2, GEM; Viareggio, Lucca, Italy).

A 67-year-old male was admitted to our hospital with a diagnose of a <1-cm clear dehiscence orifice at the gastroesophageal anastomosis. Considering of the cachexia state and the size of fistula, a new endoscopic clipping therapy, called mucosal incision-assisted closure with clips, was performed. The procedure as follows: First, used electrotome to puncture and destroy the epithelium of the fistula mouth. Then, mucosal incision was performed at the the proximal end of the fistula. Finally, one leg of the clip inserted into the dissected mucosa, and another leg was clamped to the fistula's opposite side to directly close the anastomotic defect. The whole process was finished in just a few minutes. After the operation, adequate nutrition and antibiotic support were given. The patient recovered rapidly and was discharged after 14 days without any complication. This successful case confirmed that mucosal incision-assisted closure with clips is a potentially viable and tight option for sealing esophageal leak, with excellent clamping and closing force.

This case involves a 69-year-old female with a history of Roux-en-Y gastric bypass who presented with gastric outlet obstruction of the excluded stomach, secondary to pancreatic cancer with malignant duodenal stenosis and confirmed liver metastasis. The excluded stomach was significantly dilated, posing a high risk of perforation.

Amoebiasis is an infection caused by the intestinal protozoan Entamoeba histolytica. It is transmitted via the faecal-oral route and primarily affects the intestinal tract and the liver. It is prevalent in tropical countries but is uncommon in Europe, where it is typically diagnosed in immigrants and tourists from endemic regions. However, an increase in autochthonous cases is being observed in Spain. A case is presented of a 56-year-old Spanish male with no relevant epidemiological history who attended the Emergency Department due to right hypochondrial pain and fever. An abdominal CT scan revealed circumferential mural thickening in the caecum and a large cystic mass in the right hepatic lobe. The study was completed with a colonoscopy, which showed ulcers with an infectious appearance in the caecum and right colon (biopsies were non-diagnostic), and an abdominal ultrasound, which characterised the hepatic lesion as an abscess. An ultrasound-guided drainage was performed and a sample was sent to Microbiology, which tested positive for Entamoeba histolytica. He received empirical antibiotic therapy with ceftriaxone and metronidazole, resulting in a favourable clinical outcome.

Introduction: Diagnosing perihilar cholangiocarcinoma can be challenging. Previous studies suggest that the sensitivity of taking three cholangioscopy-guided biopsies is approximately 70%. We hypothesized that obtaining four or more biopsies might improve the sensitivity for diagnosing perihilar cholangiocarcinoma.

Objective: To determine the acceptable number of cholangioscopy-guided biopsies to improve sensitivity for diagnosing perihilar cholangiocarcinoma.

Methods: This retrospective study analyzed clinical records of adults with perihilar stenosis who underwent cholangioscopy-guided biopsies. Patients with gallbladder cancer or metastatic bile duct obstruction were excluded. Data were grouped based on the number of biopsies taken: Group A (1 to 3 biopsies), Group B (4 to 6 biopsies), and Group C (7 to 10 biopsies). Results from each group were compared against a composite standard, including clinical follow-up and/or biopsies performed by alternative methods.

Results: The group that underwent 4 to 6 biopsies had a sensitivity of 77.4%, while the group with 7 to 10 had a sensitivity of 70.8%. The group with 1 to 3 biopsies had a sensitivity of 34.5%. Statistically significant differences were observed between the groups, with comparisons showing improved sensitivity in the 4 to 6 biopsy group versus the 1 to 3 biopsy group (χ² = 14.42, P = 0.0001), and the 7 to 10 biopsy group versus the 1 to 3 biopsy group (χ² = 6.56, P = 0.010).

Conclusions: Performing 4 to 6 cholangioscopy-guided biopsies significantly improves sensitivity for diagnosing perihilar cholangiocarcinoma compared to 1 to 3 biopsies. Further studies are needed to validate these findings.

Pneumatosis intestinalis is a rare disorder that can be secondary to a variety of causes among which includes oncological treatment. Most cases due to oncological treatment are reported with targeted therapy but there is growing number of cases secondary to tyrosin kinase inhibitors that includes Lenvatinib which it can be used in the treatment of hepatocarcinoma.

The incidence of hilar cholangiocarcinoma is (1-2) / 100,0001. Due to the high location of obstruction, the treatment of hilar cholangiocarcinoma is complicated, especially for patients with gastrointestinal surgery. The traditional ERCP technique is to find a way to place more stents to treat obstructive jaundice. When ERCP fails, (Percuteneous transhepatic cholangial drainage, PTCD) is often chosen, but the effect is not ideal. The reason is that patients do not want to carry a drainage tube, which affects the quality of life of patients. Secondly, PTCD technology is bile external drainage technology, which will affect the balance of water and electrolytes in the patient's body, and the patient's appetite will also decrease. Here, we provide a bridge technique of EUS-BD to solve the problem of simultaneous drainage of left liver and right liver with a stent, in order to provide a new treatment idea for endoscopists.