Revista Espanola De Enfermedades Digestivas最新文献

A 60-year-old male was admitted for obstructive jaundice secondary to a 2 cm retroperitoneal lesion. Ultrasound endoscopy (UES) with fine needle biopsy (FNB) was performed, as well as endoscopic retrograde cholangiopancreatography (ERCP) with placement of a metal stent for bile duct drainage. Initially IgG4-related disease was suspected from FNB. After 8 months of treatment the patient attended with a progression evidenced in computed tomography (CT) with retroperitoneal adenopathies and liver metastasis, with involvement of duodenum and fistulation towards hepatic angle of colon. Upper endoscopy and colonoscopy was performed. The patient underwent a cephalic duodenopancreatectomy with antrectomy and right hemicolectomy. The histological study of the specimen revealed cells of fascicular distribution, fusiform aspect, with ovoid nuclei, accompanied by a polymorphic inflammatory infiltrate with mononuclear cells. Immunohistochemistry (IHQ) was positive for S100, CD21, CD23, D2-40 and Bcl-2 and negative for CD1a, CD2, CD3, CD4, CD5, CD8, CD20, CD79a, PD1, desmine, langherin, c-kit, PDGFR. These findings were suggestive of interdigitating dendritic cell sarcoma (IDCS). Systemic chemotherapy with R-CHOP was initiated and after the first 4 cycles of treatment, retroperitoneal adenopathies regressed, with stability of metastatic liver disease.

Background: patients on opioid substitution therapy constitute a group with a high burden of hepatitis C and candidates for interventions aimed at microelimination.

Aims: to analyze the baseline prevalence of both previous contact and/or active infection, measure the response to current treatment provided through a simplified circuit and estimate the impact of this intervention on the reduction of the proportion of the viremic population.

Methods: people affiliated to an addiction treatment center underwent an in situ diagnostic sequence using saliva serological screening and viremia quantification with a dry blood spot test. Viremic patients were linked to care and treatment, which was administered in the first single appointment with pan-genotypic direct-acting antivirals. The McNemar test was used to compare the proportion of active infection before and after intervention.

Results: with a participation rate of 99.2 %, the seroprevalence for hepatitis C was 44.6 % (115/258) while active infection was present in 20.9 % of seropositive individuals (24/115). The response rate to treatment was 54.2 % by intention-to-treat and 61.9 % by per-protocol analysis. Successful treatment of 13 patients resulted in an estimated global reduction of the active infection rate from 9.3 % to 4.3 % (p = 0.0002), for a theorical scenario with no reinfections. By adjusting for the known reinfection rates, the prevalence of active infection also decreased to 4.2 % for individuals without assumed recent drug use (p = 0.0074), but no changes were found for estimates in patients with a supposed recent drug use (p = 0.2632).

Conclusions: focused efforts targeted to this high-risk group, including both screening and treatment initiatives, can potentially reduce the prevalence of active hepatitis C infections.

85-year-old patient who underwent endoscopic ultrasound (EUS)-guided radiofrequency ablation for a functioning pancreatic insulinoma and was previously treated with acenocoumarol due to a high thrombotic risk. Acenocoumarol was discontinued three days prior to the procedure and replaced with enoxaparin at 40 mg daily, with the basal anticoagulant therapy being restarted 24 hours after the procedure. Ten days later, the patient was diagnosed with an acute hematoma in the tail of the pancreas and gastric body, which led to clinical signs of hypotension and acute anemia, requiring the discontinuation of anticoagulation once again. Therefore, we believe that caution should be taken when managing anticoagulant therapy in patients undergoing endoscopic ultrasound (EUS)-guided radiofrequency ablation.

Flexible esophagogastroduodenoscopy is the gold standard for removing FB of the upper gastrointestinal tract. However large sharped FB are usually challenging to remove and are the subtype that most often requires surgery. We describe a case of a patient with a dental prothesis impacted in the proximal oesophagus. After a failed conventional approach, we made a successful attempt with two regular scopes with two independent operators.

Inflammatory cap polyps (ICP) are an extremely rare finding during digestive endoscopy, typically presenting as multiple polyps in the form of cap polyposis. Among the few reported cases of ICP, some have been associated with multiple polyposis forms, showing a clinical presentation similar to inflammatory bowel disease (IBD), which was subsequently ruled out following further diagnostic evaluation. In this report, we present an exceptionally rare case of two isolated ICPs (not in the form of cap polyposis) in a patient with a long-standing, well-established histological diagnosis of IBD located in atypical sites (specifically, the descending and transverse colon), with a characteristic endoscopic appearance. ICP can, therefore, manifest in patients with IBD and not merely be responsible for clinical presentations that require differential diagnosis from it.

Eosinophilic esophagitis is a chronic, immune-mediated esophageal condition characterized by eosinophilic infiltration of the esophageal mucosa. This report discusses the case of a patient with EoE who showed significant clinical and histological improvement following treatment with mometasone, a corticosteroid rare used for this disease. Mometasone has shown promise due to its enhanced mucosal absorption and potent anti-inflammatory properties. In this case, the patient exhibited resolution of symptoms and marked reduction in endoscopic and histological involvement, suggesting that mometasone could serve as a viable alternative therapy in specific clinical scenarios.

Case of a 24-year-old woman presenting due to edema in lower extremities. The patient had had infectious mononucleosis three weeks prior and had medical history of suspicion of Crohn's disease (CD) (due to a non-specific ileocolitis in a colonoscopy/EnteroRM). No ongoing medication. Laboratory evaluation unveiled hypoproteinemia with severe hypoalbuminemia, no renal abnormalities. A PLE was assumed, with post-infectious or CD being the most likely culprits. Alternative causes were extensively excluded. A videocapsule revealed white-tipped or granular villi, some white nodular villi and diffuse edema of the mucosa, and multiple extensive erosions and superficial ulcers in the jejunum and proximal ileum, not suggestive of CD. A push enteroscopy revealed unspecific histopathology. After incomplete response to enteral nutrition, corticotherapy was initiated resulting in sustained improvement. A follow-up Ileocolonoscopy and double balloon enteroscopy revealed no abnormalities. Six months post-treatment, the patient remains asymptomatic, with unremarkable laboratory results and no need for medication.

Adalimumab is a recombinant human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-alpha). It has become an important drug in the treatment of inflammatory bowel diseases (IBD)​, ​which do not respond to initial medical treatment. The​​ case of a patient with ulcerative proctitis is presented, who developed acute pleuropericarditis, after starting treatment with adalimumab.

The most prevalent tumor in women worldwide is breast cancer. Although liver metastases are relatively frequent, pancreatic involvement is unusual. In the case of jaundice in patients with a history of neoplasia, the initial diagnosis is focused on ruling out hepatic infiltration. However, it is essential to consider other, less common but related etiologies of biliary obstruction. The most frequent pancreatic metastatic involvement is usually as nodular lesions; nevertheless, diffuse parenchymal infiltration is also possible, as illustrated in the following case.

Dysphagia is a debilitating consequence for patients with esophageal cancer. Recanalization of the obstruction with esophageal stents is one of the palliative measures that can most improve the quality of life in these patients. Among patients with dysphagia due to obstructing esophageal cancer, stent insertion has a high technical and clinical success with rapid relief of dysphagia. Interventional radiologists typically insert esophageal stents under fluoroscopic guidance only, whereas endoscopists insert them exclusively under endoscopic monitoring or by endoscopy and fluoroscopy. In this editorial we discuss the study by Relvas, which compares endoscopic-only insertion with fluoroscopy-guided insertion in obstructive esophageal tumors. The difficulties encountered by endoscopists in using proper radiological facilities is probably the main reason for not employing fluoroscopy in esophageal stenting. Proper placement of a guidewire beyond the esophageal stricture is often the first and most critical step in esophageal stenting. The undeployed stent is then slid over the guidewire. Fluoroscopy offers a high degree of certainty that the guidewire has successfully passed through the stenosis, but it is generally assumed that it is not necessary for esophageal stent placement if the stenosis can be passed through with an endoscope. When fluoroscopy is not available, several endoscopic methods can be used for the insertion of esophageal stents. The study by Relvas confirms that the results of endoscopic and fluoroscopic guided insertion are similar. However, ideally, endoscopists should have their own high-quality radiological facilities, such as those available to interventional cardiologists.