Revista Espanola De Enfermedades Digestivas最新文献

A 73-year-old man with a 25-year history of liver cirrhosis has been treated for liver cancer for 13 years. His cancer is currently well-controlled, and his AFP is normal. The gastroscopy revealed a clearly-border whitish mucosa with a frost-like coating in the greater curvature of gastric body. Under magnification, the lesion revealed that the micro-structure(MS) of the mucosal surface are faintly discernible, with the marginal crypt epithelium(MCE) showing irregular and closely spaced villous projections. The color tone of the IIb region appears the same with the surrounding mucosa. The micro-vascular(MV) structure is invisible. The crystal violet staining reveals the presence of micro-structures. Considering early-stage lesions, we successfully performed ESD treatment. The final diagnosis was gastric adenocarcinoma with enteroblastic differentiation (tub2>por1). We did the mapping to better evaluate the lesion. The main lesion is located in the mucosal layer, with small foci-infiltrating into the submucosal layer to a depth of 196um. Pathology about specimen No.A7 showed biopsy position. The epithelial cells were cubic, the atypia was significant, and the cytoplasm was transparent and vacuole-like. Immunohistochemistry supported the diagnosis of GAED. The additional surgery was recommended to reduce the risk of lymph node metastasis. However, the patient and their family refused it because of the complexity of the patient's condition. 14months after endoscopic treatment, there has been no recurrence of the lesion, and the patient is living well without any digestive discomfort.

This pilot study evaluates the presence of potential unrecognized steatotic liver disease with moderate alcohol consumption (MetALD) in patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD) using the ALD/NAFLD index (ANI) score. A retrospective single-center study was conducted on 85 patients attending Digestive Diseases consultations in May and June 2024. MASLD was defined by hepatic steatosis with limited alcohol intake (<20 g/day for women and <30 g/day for men) and at least one cardiovascular risk factor. The ANI score identified 21.2% of patients as having a potential probability of MetALD, with higher alcohol consumption (10-30 g/day) and increased liver fibrosis observed in this group, though the latter did not reach statistical significance. Even though the ANI score is not validated to distinguish MetALD from MASLD, our findings highlight its potential utility in improving diagnostic accuracy by addressing underreported alcohol consumption.

Chemical burns of the rectum are so rare that there are few cases reported about this situation. In fact, chemical burns of the rectum can cause severe serious consequence, such as bleeding, perforation and necrosis, even developing to persistent rectal stricture. Here we present a case report of a 12-year-old child with rectal stenosis who imitates the use of corkage and inserts rust remover into the rectum unsupervised by family members. He underwent endoscopic balloon dilation followed by submucosal injection of bleomycin at the stenosis point.

Schistosoma japonicum, which has been endemic for a long time, associated colon abnormality has also been sporadically reported. The majority of patients with Schistosomiasis japonicum infected may mainly presented as acute manifestation or become chronic complication, known as schistosomiasis liver change, intestinal tract lesions and other system involved. Interestingly, both states could be observed in this patient. Acute infection presented as systemic hypersensitivity reaction, characterized by elevated eosinophils and intestinal symptom.

The differential diagnosis between Crohn's disease (CD) and intestinal tuberculosis (ITB) continues to pose a diagnostic challenge, as clinical presentation can be indistinguishable, as well as findings in imaging studies and endoscopy. It is essential to make a definitive diagnosis early on, screening for possible latent infectious diseases, especially in patients from endemic areas, as inmmunosuppressive treatment can result in a fatal outcome during the course of TBI.

An 83-year-old male with long-term dysphagia and weight loss was admitted due to an acute ST-elevation myocardial infarction. During hospitalization he developed hematemesis requiring several red blood cell transfusions. An upper endoscopy was attempted being interrupted due to esophageal high-volume stasis. Despite remaining fasting for several days and naso-esophageal tube drainage, three additional upper endoscopies still revealed non-removable solid food stasis in a markedly dilated esophagus and bleeding from severe underlying esophagitis. A thoracic CT confirmed an aberrant and massive esophageal dilation with 110x100mm and large food impaction leading to almost complete right lung atelectasis and respiratory failure. A narrow esophagogastric junction and no apparent associated obstructive lesions were also observed on CT scan. Based on clinical symptoms and radiologic findings a presumptive diagnosis of achalasia was considered although it could not be confirmed through esophageal manometry. Parenteral nutrition was started. Nevertheless, the patient died a few days later from aspiration pneumonia.

Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease (IBD) of the colon. Its presentation is varied, with the main symptoms being mucosanguineous diarrhea, abdominal pain, and weight loss. However, the diagnostic utility of these symptoms in pediatric populations is controversial. This study evaluates the clinicopathological association of different symptoms in UC through an analytical study of patients under 15 years of age who underwent upper and lower gastrointestinal endoscopy at a pediatric hospital between 2015 and 2022 for suspected IBD.

A 52-year-old male was diagnosed with primary liver cancer in June 2021 after experiencing abdominal pain and bloating. He had previously undergone resection for a Merkel cell tumor in March 2021, with no metastasis found. Three months later, imaging suggested a liver mass consistent with liver cancer. Lab tests showed elevated hepatitis B surface antigen (>130 IU/ml) and alpha-fetoprotein (24.54 IU/ml), and the imaging features resembled hepatocellular carcinoma (HCC).Finally,it was diagnosed as liver metastasis of Merkel cell carcinoma by pathology.

We present a 54-year-old man with a previous complicated choledocholithiasis 14 years ago, treated with sphincterotomy and biliary and pancreatic stents placement by endoscopic retrograde cholangiopancreatography (ERCP). The patient didn't attend the follow-up. On this occasion, seeks medical attention at this medical center for abdominal pain, jaundice, and fever. Laboratory tests report leukocytosis with neutrophilia, elevated C reactive protein, and hyperbilirubinemia with cholestasis. An ERCP was performed and showed inflammatory ampullary tissue with a previous pancreatic and biliary stent in situ, both were removed succesfully with cold snare. Cholangiogram revealed a dilated bile duct and filling defects compatible with large stones. Due to the soft consistency of the stones, some of them were removed by balloon catheter without complete extraction, therefore a double pig-tail plastic stent was placed (Figure 2) and new ERCP in 4 weeks. The patient received antibiotic therapy with piperacillin-tazobactam with a favorable evolution. During follow-up, a new ERCP was performed with extraction of stones and removal of the stent; there was no evidence of secondary biliary cirrhosis.

We present the Clinical Trial results of the first Spanish intragastric balloon manufactured: the Stella® balloon (SwanMedical, Barcelona). As a peculiarity, it has a double lumen in the introducer system. The first one is intended for the passage of a guidewire to insert the balloon quickly and safely, which also requires prior gastroscopy. The second lumen allows for regular filling. Therefore, Stella® accepts all current IGB indications, adding specific applicability for endoscopists in training and for some pharyngo-oesophageal anatomical alterations that could make the placement of another IGB model difficult or impossible. In conclusion, preliminary results suggest that Stella® could have efficacy and safety values comparable to those of the leading currently approved intragastric balloons. Final certification and market release of the device is expected by the end of 2024.