Revista Espanola De Enfermedades Digestivas最新文献

A 56-year-old female with class 3 obesity, was previously submitted to laparoscopic sleeve gastrectomy (LSG) two weeks before current admission. The patient was admitted due to fever, abdominal pain and vomiting. CT revealed a 13.5cm collection between the gastric wall and left hepatic lobe. Piperacillin-Tazobactam was initiated, and percutaneous drainage of the purulent collection was performed. The upper endoscopy showed pus in the gastric lumen and a 10-mm leak at the esophago-gastric junction with contrast extravasation. Argon plasma coagulation (40W, 2L/min) was applied at the orifice margins to promote healing. After 0,038'' guidewire placement through the proximal jejunum, a Niti-S™-MEGA™ (Mega-Stent) 28x230mm (Taewoong Medical™) was deployed under fluoroscopic control. CT at 72h showed absence of leakage. Oral nutrition was started uneventfully. Ambulatory endoscopy was scheduled for eight weeks later to remove the stent, which was easily accomplished with a foreign body forceps. Granulation tissue was observed in the previous leak location and no extraluminal contrast was observed at fluoroscopic evaluation, confirming complete healing and successful endoscopic treatment. Three weeks after stent removal, the patient presented with dysphagia. Upper endoscopy revealed a short and narrowed lumen stenosis at 28cm from the incisives, which was easily manage through TTS balloon dilation. No additional complications were observed.

We report the case of a 39-year-old man with long-standing ileocolonic Crohn's disease, with a history of prior ileocecal resection and secondary loss of response to infliximab and ustekinumab, who initiated treatment with upadacitinib (UPA) 45 mg/day due to severe clinical, biochemical, and endoscopic recurrence. The patient achieved a rapid clinical response with normalization of inflammatory biomarkers. Two weeks after UPA initiation, he developed pruritic vesicular lesions on the palms and fingers, which were diagnosed as de novo dyshidrotic eczema by an expert dermatologist. The cutaneous manifestation was mild to moderate and resolved rapidly with topical corticosteroids, without the need to discontinue UPA. Crohn's disease remained in clinical and biochemical remission after 9 months of follow-up. Possible immunological mechanisms underlying this paradoxical reaction are discussed, including selective JAK1 inhibition-related immune imbalance, with disruption of the Th1/Th2 axis, altered IL-4 and IL-13 signaling, and a potential predominance of Th1/Th17 responses. Although UPA has been exceptionally used as a therapeutic option for refractory dyshidrotic eczema, and this condition has been reported as an infrequent adverse event in pivotal ulcerative colitis trials, this case likely represents the first report of upadacitinib-induced dyshidrotic eczema in Crohn's disease.

Blown-out myotomy (BOM) is an uncommon complication following surgical or endoscopic myotomy, associated with food retention and recurrent symptoms. We report a 58-year-old man with type III achalasia who developed dysphagia and regurgitation after peroral endoscopic myotomy (POEM). Endoscopy and imaging revealed a pseudodiverticulum at the previously treated site, consistent with BOM. The patient was successfully treated with an anterior myotomy, achieving complete and sustained symptom resolution. This case highlights the importance of considering BOM in patients with recurrent symptoms after myotomy and supports endoscopic management as a safe and effective option.

Mostly, Schistosoma japonicum preferred living in mesenteric veins and oviposit rather than the highly acidic environment in the stomach. Herein, we described a rare case of synchronous multiple early gastric cancer with Schistosoma japonicum eggs.

To our knowledge, formally established and systematically evaluated second-victim support programmes are not widely implemented or reported in Spanish endoscopy units. Collegiality and goodwill may exist, but identifiable and measurable programmes remain uncommon. Recognising and sharing existing initiatives would be an essential first step, not as "soft psychology," but as patient safety, talent retention, and serious medicine. What we carry that is visible has weight. But what we do not say weighs far more.

In recent decades, the treatment of inflammatory bowel disease (IBD) has changed markedly. Several biological therapies and small molecules have been approved, leading to improved outcomes and quality of life of these patients. However, access to these new therapies is heterogeneous across different countries. In this scenario, the use of thiopurines, through personalized treatment, remain a valid option.

We report the case of a 56-year-old male with a long-standing history of stricturing CD involving distal ileum. He had previously been treated with multiple biologics agents (infliximab, adalimumab, ustekinumab) due to persistent stenotic disease requiring repeated endoscopic ileal dilations. He presented to the emergency department with a two-week history of generalized abdominal pain, nausea and vomiting. Physical examination revealed diffuse abdominal tenderness and distension without signs of peritonism. Laboratory tests were unremarkable. Abdominal radiography demonstrated dilated small bowel loops and CT scan suggested an incomplete ileal obstruction secondary to an intraluminal foreign body.

Although various upper digestive endoscopy visibility scores are available, no comparative studies have directly evaluated them to determine the most effective tool. A prospective study was conducted to evaluate the inter- and intra-rater agreement of four upper digestive endoscopy visibility scores. A dataset of 32 videos was randomly selected from a collection of complete endoscopy procedures. Eight videos were assessed twice to estimate the intra-rater reliability. Eleven evaluators, four of whom had over five years of experience, independently rated the videos using four different scoring systems: Elvas, Kuo, Bhandari, and Chen.

EMP in the head of the pancreas is difficult to diagnose, many of them postmortem, EUS-FNB in experienced hands in conjunction with immunohistochemistry and flow cytometry is a valuable tool.

The duodenal diverticulum is a relatively frequent entity whose diagnosis has been increased over time with the development of new diagnostic and exploratory techniques. Periampullary diverticula (PAD) were classified as type 1, 2, or 3 according to the position of the major papilla from the endoscopic view: type 1, the major papilla was located inside of the diverticula; type 2, the major papilla was located at the edge of the diverticula; type 3, the major papilla was located outside of the diverticula. Complications of duodenal diverticula include ulceration, bleeding, perforation and inflammation with intestinal obstruction. Perforation of duodenal diverticula due to both local ischemia or mechanical obstruction, is exceedingly rare, however, this entity has a high associated mortality. Duodenal perforations can either be free or contained. The optimal management of which has not been well established. We describe the case of a 61-year-old male with a diagnosis of acute pancreatitis due to abdominal pain, elevation of pancreatic enzymes and computed tomography (CT) findings of inflammatory peri and pancreatic changes. However, he presented a severe elevation of acute phase reactants and poor control of the pain. Given lack of improvement, the abdominal CT was repeated and revealed a probable perforation of the duodenal diverticulum with local inflammatory changes which would explain the elevation of pancreatic enzymes but the lack of response to treatment. With the new diagnosis of duodenal diverticulum and spontaneous perforation, evaluation was performed with General Surgery indicating conservative management. Absolute diet, parenteral nutrition and empirical antibiotic therapy with ciprofloxacin and metronidazole were started with improvement, allowing the progressive reintroduction of the diet, being well tolerated. Analytically and radiologically improvement was finally also observed.