Revista Espanola De Enfermedades Digestivas最新文献

Eosinophilic esophagitis (EoE) is an immune-mediated disorder of the esophagus with a broad spectrum of clinical presentations. Dysphagia and food impaction are the cardinal symptoms; however, their diagnostic utility remains controversial in pediatric populations. This study evaluates the clinical-pathological association of different symptoms with EoE. We conducted an analytical study of patients under 15 years of age who underwent esophagoscopy at a pediatric hospital between 2015 and 2022 due to suspected EoE (Reg. 341E/2023). The prevalence of various symptoms and medical histories was compared, along with their association with histopathological abnormalities, between patients with EoE and those without the disease (NEoE). A total of 24 EoE patients and 17 NEoE children were included.

The past decade has witnessed an increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) owing to robust evidence of its benefits in type 2 diabetes and obesity. However, delay gastric emptying effect of GLP-1RAs has raised concerns for risk of gastric food retention and pneumonia aspiration during upper endoscopy. There have been observation studies reporting an increased incidence of gastric food retention among patients on GLP-1RAs, especially long-acting one like semaglutide. But the association between GLP-1RAs use and pneumonia aspiration during EGD remains unclear due to lack of high-level evidence. We report a case of pulmonary aspiration during EGD in a patient prescribed semaglutide.

Acute pancreatitis is an uncommon adverse effect of sodium-glucose linked transporter 2 inhibitors (SGLT2is). Their use has notably increased in recent years, hence clinical suspicion is key in patients recently started on these drugs. We report the case of an 83-year-old male patient who was admitted for a first acute pancreatitis episode of unclear etiology that eventually was attributed to dapaglifozin, a SGLT2i in widespread use.

Background and aim: Patients with achalasia face an increased risk of dysplasia and squamous cell carcinoma due to chronic inflammation. We demonstrated the feasibility of performing endoscopic submucosal dissection (ESD) and well-designed peroral endoscopic myotomy (POEM) within a single operation, aiming to reduce trauma and enhance recovery.

Methods: A 65-year-old male with progressive dysphagia was diagnosed with type II achalasia and suspected esophageal lesions. Our treatment plan involved addressing both achalasia and the lesions using POEM and ESD during one operation. POEM was initiated with a 2-cm longitudinal incision at 5 o'clock, establishing a submucosal tunnel from 32 cm from the incisors to 2 cm distal to the gastroesophageal junction. A 4 cm myotomy of the esophageal segment was performed, extending 2 cm into the proximal stomach. Subsequently, ESD was conducted on the suspicious lesion in the mid-esophagus.

Results: En-bloc resection was achieved and histology revealed high-grade dysplasia with horizontal margin showed low-grade dysplasia. Follow-up assessments demonstrated decreased Eckardt's scores and no evidence of recurrence.

Conclusions: By carefully planning the direction and length of the myotomy, we successfully managed POEM and ESD in a single operation. Individualized modifications to endoscopic procedures are crucial for achieving minimally invasive and cost-effective treatment for patients presenting with achalasia combined with esophageal early cancer.

In this work we review the approach to difficult cannulation situations during ERCP. Among the known options to solve this problem, we suggest a technical variant that we believe can be useful to successfully complete ERCP with complication rates similar to a conventional ERCP, at least in our experience. To do this, we reviewed 1488 ERCPs and the 23 cases in which we applied this technical variant with its results and complications.

Although the etiology of UC is not clear, some studies show that the appendix may be the starting point of UC, and the incidence of appendicitis is high in patients with UC. We performed a MR analysis to examine whether there is a potential causal relationship between UC and acute appendicitis. Our MR study revealed that the genetic liability of UC (OR, 0.9362; 95% CI 0.9014 - 0.9723; p = 0.00064) was associated with a decreased risk of acute appendicitis. More research is needed in the future to support our findings and better explain why UC reduces the risk of acute appendicitis.

The removal of a metal stent with proximal displacement was challenging. We present a case where a needle knife was used to incise the duodenal papilla to remove the displaced metal stent.

Background: Cecal perforation from barotrauma is a rare complication of colonoscopy, even with the use of CO₂ insufflation, which is generally preferred over room air due to its rapid absorption and reduced patient discomfort.

Case report: A 64-year-old woman with hypertension and dyslipidemia underwent a routine colonoscopy with CO₂ insufflation. Multiple diverticula were noted, and upon reaching the cecum, several parallel linear lesions with spontaneous bleeding, consistent with "cat scratch" colon, were observed. Hemostasis was achieved with 10 endoscopic clips. A subsequent CT scan revealed pneumoperitoneum and the clips in the cecum. The patient was managed conservatively with bowel rest and intravenous antibiotics, showing a favorable clinical course and was discharged on the fifth day.

Discussion: This case highlights the potential for cecal perforation due to barotrauma even with CO₂ insufflation during colonoscopy, emphasizing the need for awareness and prompt management of such complications.

Acute variceal bleeding is a life-threatening condition and a common cause of cirrhosis-related death, severe acute bleeding is difficult to treat and has a high mortality rate, drug treatment is often ineffective. We encountered a patient with cirrhosis with ruptured and bleeding gastroscopic varices requiring emergency endoscopic surgical treatment. However, in the routine left lateral position the treatment was interfered with by a fresh blood clot obscuring the gastric fundus. We were able to expose the gastric fundus by turning the patient to the right lateral position and eventually successfully treated the patient. This provides a new idea for the endoscopic treatment of acute gastric varices and may improve the success rate of treatment.

A 57-year-old woman presented to our hospital with chest distension, sore throat and back discomfort beginning the previous day after taking 5 panax notoginseng capsules. She had a history of hypertension for more than 2 years. Physical examination was unremarkable. Blood tests revealed results: A red blood cell count of4.27T/L, a platelet count of 296G/L, a hemoglobin count of 130 g/L (130-175 g/L), and a D-dimer count of0.252 mg/L. Endoscopy showed a longitudinal dark red submucosal hematoma (SH) extending from 20 cm down to 36 cm, with no active bleeding. The next day an enhanced CT of the chest showed uneven thickening of esophageal wall suggestive of intramural esophageal hematoma. A second endoscopy was performed 6 days later, and it showed an esophageal ulcer where the hematoma had been seen at the previous part. The patient was treated with a proton pump inhibitor (PPI) and nutritional support while oral intake was completely prohibited. Her symptoms gradually improved and disappeared. She was discharged one week after the second Upper GI endoscopy when she was able to eat liquid diet. After discharge, she continued the PPI and Kang Fuxin for 2 months. During the 4-month follow up, the symptoms did not recur.