Acta Gastroenterologica Latinoamericana最新文献

Currently, capsule endoscopy is the gold standard for evaluating small bowel diseases. Its most common use is to investigate intestinal bleeding of unknown origin, although its indications have been expanded to include the investigation of Crohn's disease, iron deficiency anemia, malabsorption syndromes, intestinal lesions related to the use of nonsteroidal anti-inflammatory drugs, small bowel tumors, and surveillance of polyposis syndromes. The main risk associated with its use is capsule retention. We present the case of a patient who was admitted to the emergency room due to acute abdominal pain and reported that four months earlier she had undergone a capsule endoscopy as part of an investigation into her anemia. Imaging studies revealed a metallic object in the colon and hydropneumoperitoneum. With a diagnosis of acute perforated abdomen, surgical intervention was decided upon, and a right hemicolectomy was performed. The pathological study reported the presence of an intraluminal endoscopic camera. The patient was discharged on the seventh day without complications. This case is presented to highlight the risks of capsular retention, which can lead to acute complications such as obstruction or perforation, emphasizing the importance of early diagnosis so that surgery is not necessary.

Oncologic gastrectomy is the only potentially curative treatment for gastric cancer, although it is associated with high postoperative morbidity and mortality. Early diagnosis of complications is essential to reduce mortality and guide timely therapeutic decisions. This paper presents a series of representative cases, grouped in a pictorial review of postoperative complications after oncologic gastrectomy, with emphasis on computed tomography findings. Early complications included bleeding at the entero-enteric anastomosis, anastomotic leakage, entero-quilloid fistula, acute pancreatitis, and omental infarction. Late complications included hiatal hernia complicated by intestinal obstruction, tumor recurrence at the anastomosis and peri-anastomotic ulcer. Multidetector computed tomography enabled us to accurately identiy fluid collections, contrast extravasation, dilated loops and inflammatory or ischemic changes, providing direct and indirect signs of complications. These findings were decisive in guiding treatment, whether conservative, interventional, or surgical. This case series highlights the usefulness of computed tomography in the early recognition of potentially serious complications, reinforcing its role as an essential diagnostic tool in the postoperative follow-up of oncologic gastrectomy.

Chylous peritonitis, which is caused by the accumulation of chyle in the abdominal cavity, is a rare cause of acute surgical abdomen. It has a milky appearance due to its high triglyceride content. It can originate from different mechanisms, including congenital malformations and injury or obstruction of the lymphatic ducts. Due to its low incidence, there is no clear diagnostic or therapeutic approach, adding further complexity to the condition. We present a clinical case of a 37-year-old female patient with a history of blunt cervical trauma that progressed to abdominal distension and peritoneal reaction. This led to surgical intervention and the finding of chyloperitoneum.

Acute pancreatitis is one of the leading causes of hospital admissions for gastrointestinal disease worldwide. Its incidence has increased in recent years, significantly impacting healthcare costs. It is an acute inflammatory process of the pancreas accompanied by abdominal pain, nausea, and vomiting. The most common causes are gallstones and alcohol abuse, though there are other, less frequent causes. A diagnosis of acute pancreatitis requires the fulfillment of at least two of three criteria: typical abdominal pain, amylase or lipase levels three times higher than the upper limit of normal, and/or compatible imaging findings. The disease can progress from mild forms with rapid resolution to severe cases that can lead to local and systemic complications and multiple organ failure. This condition significantly impacts morbidity and mortality. The latter occurs in 24% of mild cases and up to 50% of severe cases. Since there is no specific treatment for acute pancreatitis, its management is based on supportive measures and addressing the underlying cause to prevent further episodes.

Introduction: Gastric varices affect between 17% and 25% of patients with portal hypertension, and bleeding is a serious complication with high mortality. Although the standard treatment has been direct injection of cyanoacrylate by endoscopy, this can cause significant adverse effects in the patient and even damage to the endoscopic equipment. Therefore, this study describes the experience in managing gastric varices using endocoils, with or without cyanoacrylate, guided by endoscopic ultrasound.

Material and methods: A series of cases of patients with gastric varices treated with endocoil insertion, with or without cyanoacrylate injection, guided by endoscopic ultrasound, at two high-complexity institutions in Bogotá and Medellín, Colombia. The study period was from March 1, 2022, to July 31, 2024.

Results: Fifteen adult patients with gastric varices were included; 60% women, with a mean age of 63.3 years and a BMI of 29.1. 93% of the patients had chronic liver disease, mainly due to metabolic hepatic steatotosis or alcohol. IGV1 varices were observed in 10/15 patients and GOV2 varices in 5/15 patients, with an average variceal size of 15.1 mm. Between one and two endocoils were used per patient, and in six cases complementary cyanoacrylate was applied. The clinical success rate was 100% and the technical success rate was 93%. No serious complications were reported.

Conclusion: Treatment with EUS - guided endocoils, with or without cyanoacrylate injection under EUS guidance, is an innovative and effective technique, considered the treatment of choice for acute gastrointestinal bleeding and secondary prophylaxis in patients with GV. This case series showed high clinical and technical success rates, along with a low incidence of complications, suggesting that it is a safe procedure.

Introduction: Underwater endoscopic mucosal resection is an alternative technique to conventional endoscopic mucosal resection, with potential advantages in efficacy and safety. In Latin America, there are few reports on its application.

Objective: To evaluate the effectiveness, feasibility, and safety of underwater endoscopic mucosal resection for non-pedunculated colorectal lesions in a Latin American series.

Materials and methods: A prospective, observational study conducted between December 2023 and December 2024. Consecutive patients with non-pedunculated colorectal lesions ≥ 10 mm without endoscopic signs of deep submucosal invasion were included. Demographic data, lesion characteristics, technical success, resection type, histological findings, complications, and six-month recurrence were recorded.

Results: Sixty patients with 67 lesions were included. The mean lesions size was 16.7 mm. The most common location was the right colon (56.7%), and the predominant morphology was granular LST (59.7%). Technical success was 100%, and en bloc resection was achieved in 91% of cases (96.5% for lesions ≤ 20 mm). Histology showed: tubular adenomas (47.7%), tubular adenomas with high-grade dysplasia (16.4%), serrated adenomas without dysplasia (4.4%), serrated adenomas with low-grade dysplasia (16.4%), and intramucosal adenocarcinomas (5.9%). Intraprocedural bleeding occurred in 11.9% and delayed bleeding in 2.9%, with no perforations. A significant association was found between lesion size and resection type (p < 0.001). Piecemeal resection was more frequent in lesions > 20 mm (RR 12.88; 95% CI: 2.75 - 60.43). At six months, control colonoscopy was performed in 85.1% of cases, with no evidence of recurrence.

Conclusions: Underwater endoscopic mucosal resection proved to be effective, safe, and feasible, with high en bloc resection rates, and low rate of complications and absence of short-term recurrence.

Introduction and objectives: Eosinophilic esophagitis is a chronic inflammatory esophageal disease mediated by a type-2 immune response, mainly triggered by food allergens. Its incidence and prevalence have significantly increased in recent decades, making it a frequent cause of dysphagia and esophageal obstruction. The aim of this narrative review is to summarize current evidence of the diagnosis and treatment of EoE, with emphasis on clinical applications in Latin America.

Material and methods: A narrative review of literature published in PubMed and complementary databases up to May 2025 was conducted. Original studies, systematic reviews, clinical practice guidelines, and international consensus statements relevant to the diagnosis and management of EoE were included.

Results: Diagnosis requires integration of clinical practice with endoscopic and histological findings, supported by standardized diagnostic scores such as EREFS and EoEHSS. In terms of treatment, proton pump inhibitors, swallowed topical corticosteroids, and elimination diets represent first-line options. The introduction of biologic agents, particularly dupilumab, has expanded therapeutic strategies for patients with refractory disease. Endoscopic dilation is safe and effective in fibrostenotic cases. Long-term monitoring should combine clinical, endoscopic, and histological assessments, as symptoms by themselves do not reliably reflect inflammatory activity.

Conclusion: EoE is a chronic condition that requires early diagnosis and comprehensive management. Despite therapeutic advances, challenges remain concerning the availability of specific drugs, reliable noninvasive biomarkers, and cost-effective monitoring strategies, which constitute priority areas for future research.