Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru最新文献

Plexiform fibromyxoma (PF) is a rare mesenchymal neoplasm of the stomach usually arising in the gastric antrum, and its main differential diagnosis is gastrointestinal stromal tumor. Most common symptoms are hematemesis, anemia. Immunohistochemically, positivity for smooth muscle actin (SMA) and vimentin suggests the diagnosis of PF. We report the case of a 56-year-old female patient with a 30-day history of nausea at presentation 4 years ago. Gastroscopy at that time revealed a subepithelial lesion (SEL) in the gastric antrum, measuring approximately 20 mm in diameter, with leakage of serous fluid after biopsy. Histopathology showed only an inflammatory process. Follow-up gastroscopies were performed 24, 36, and 48 months later, with surveillance biopsy at each follow-up. The last gastroscopies showed changes in lesion appearance, reduction in size, and absence of fluid leakage. Histopathology showed bland spindle cell proliferation, with a vaguely plexiform/multinodular pattern, in a fibromyxoid stroma with an arborizing capillary network without mitoses. The tumor cells were positive for SMA and negative for DOG1, CD117, CD34, S100, desmin, EMA, CD10, calponin, and beta-catenin. The choice of treatment and follow-up depends on the SEL features, but because no cases of malignancy or metastatic disease have previously been reported, the patient chose a conservative approach.

Parenchymal liver diseases are commonly evaluated by laboratory and imaging studies. However, in some cases a liver biopsy is required. Endoscopic ultrasonography-guided liver biopsy (EUS-LB) has been reported as a procedure with high diagnostic yield (90-100%) with low adverse event profile, but there are not studies which report about the experience and technique in our country.

Objective: Determinate the effectiveness and the safety of endosonography-guided liver biopsy in liver parenchymal disease.

Materials and methods: A prospective study was conducted at a III-2 level of care Public Hospital in Lima, Peru. It included patients over 18 years of age with suspicion of parenchymal liver disease who underwent EUS-LB for study hepatic parenchymal disease since March of 2018 to October of 2022.

Results: The diagnostic yield of the biopsies was 77.02%, with a mean length of the sample of 13.98mm (standard deviation 7.34) and a median of 8 complete portal spaces (0-50). Only 31.25% of the procedures were performed with a fine needle biopsy (FNB), finding a significant difference between the type of needle and the diagnostic yield (p=0.01). The most common histopathological diagnosis was autoinmune hepatitis. There were 2.08% of post-procedure complications.

Conclusions: EUS-LB for the diagnosis of liver parenchymal disease had a diagnostic yield close to 80% in our region with a low profile of adverse events. However, more prospectives studies with a larger number of patients are required.

Endoscopy has evolved from a purely diagnostic technique to a therapeutic procedure. This is possible in many cases thanks to the use of fluoroscopy, which entails exposure to ionizing radiation for both patients and the personnel involved. Endoscopic retrograde cholangiopancreatography (ERCP), which necessarily requires fluoroscopy, is classified by the Food and Drug Administration as an examination with a potential risk of triggering radiation induced injuries. This article reviews the biological effects of radiation, the types of radiological equipment used in ERCP, as well as the magnitudes and dosimetric units, to finally address the radio protection elements in the endoscopy room. The objective is to provide the reader with the information to be able to perform these procedures with the greatest radiological safety for both patients and occupationally exposed personnel.

Objectives: To determine sociodemographic, anthropometric, biochemical-metabolic, clinical risk factors and comorbidities associated with advanced fibrosis due metabolic dysfunction associated steatotic liver disease in patients with diabetes mellitus type 2.

Material and methods: Case-control study. We reviewed 174 medical records of patients with metabolic dysfunction associated steatotic liver disease and type 2 diabetes mellitus treated at the Hospital Nacional Dos de Mayo from 2009 to 2018. The cases were patients with advanced fibrosis and controls without fibrosis. The presence of advanced fibrosis was defined by predictive clinical panels and/or liver biopsy result. To determine association, odds ratio, Pearson's chi-square and logistic regression analysis were calculated.

Results: An association was found with age > 60 years, a body mass index >= 25 kg/m2, abdominal circumference in men >= 94 cm and abdominal circumference >= 88 cm in women, time of diabetes disease >10 years; chronic microvascular complications; HDL in women < 50 mg/dL, HDL in men < 40 mg/dL and albumin < 3.5 g/dL. About comorbidities were associations with chronic kidney disease and hypertension. After logistic regression analysis, age > 60 years, high body mass index, abdominal circumference in women, low HDL in women, chronic microvascular complications and hypertension remained independent risk factors.

Conclusions: The risk factors for advanced fibrosis were age over 60 years, high body mass index, abdominal circumference ≥ 88 cm in women, chronic microvascular complications, low HDL level in women and hypertension as the main comorbidity.

The wireless capsule to measure gastroesophageal reflux, also known as pH monitoring capsule, is a technique used in ambulatory reflux monitoring. This capsule is introduced through a guide into the esophagus and is placed using a suction system and anchored to the esophageal mucosa. From there, it communicates with an external device using radio signals to record the activity of gastric acid in the esophagus over a specified period of time. Unlike the conventional technique, which involves inserting a tube through the nose into the esophagus, the wireless capsule may be a more comfortable and tolerable alternative for patients, potentially improving adherence to the procedure. In some cases, patients may present chest pain after placement of the pH monitoring capsule, however there is little evidence about the etiology and management. We present the case of a woman with a clinical picture of gastroesophageal reflux, with pH monitoring capsule placement, which resulted in severe chest pain that required endoscopic capsule removal.

Intestinal amyloidosis is a rare and underdiagnosed systemic disease, which is characterized by the extracellular deposition of proteins that are grouped into amyloid fibers. This entity is rare and is usually a form of presentation in the context of systemic amyloidosis, the diagnosis of which is based on the presence of amyloid in histology. The clinic is usually non-specific; chronic diarrhea, weight loss, abdominal pain and bloating; Gastrointestinal bleeding is a very rare manifestation. The case of a 61-year-old woman with symptoms of weight loss, abdominal distension, nausea, vomiting and long hair is presented. Tomographically, a wall thickening of jejunal loops with contrast uptake was evidenced, a finding that was corroborated by a double-balloon anterograde stereoscopy in which multiple were evidenced. The pathology shows distorted and ulcerated villous architecture with positive histochemistry for Congo Red and LAMBDA (+++) immunohistochemistry. In addition, bone marrow aspirate and bone biopsy compatible with infiltration of Lambda chain monoclonal multiple myeloma were performed. During the hospital stay, the patient developed complications such as chronic malnutrition, recurrent infection and several episodes of intestinal subocclusion; characterized by intestinal pneumatosis; due to multiple episodes of these complications, the patient died. Within clinical practice in gastroenterology, intestinal amyloidosis as part of the differential diagnosis of upper gastrointestinal bleeding is infrequent, so a history of diagnosis of multiple myeloma or other monoclonal gammopathy associated with light chains is crucial for early diagnosis and adequate treatment.

The presence of esophageal foreign body (EFB) is a common emergency in gastroenterology. The protocol for management and endoscopic intervention can be variable among institutions.

Objective: to define the clinical characteristics of EFB in adults, its radiological and endoscopic diagnosis, and complications based on a sample of patients in a gastroenterology center.

Materials and methods: case series of patients admitted from the emergency department and referred to the gastroenterology department with a presumptive diagnosis of EFB. Clinical variables were collected, as well as characteristics, comorbidities, time of evolution and diagnostic opportunity, confirmatory studies, and complications.

Results: 84 subjects, 70% men, mean age 45 (range: 17-87; SD 12.5) years. Urgent upper endoscopy was performed in 98.8% of the patients, with an average in-hospital stay of 2.5 days. 93% had no associated underlying pathology, in 6/84 (7.14%) patients structural or functional esophageal pathology was documented. 59/84 (70.2%) patients consulted in the first 24 hours, in 57.6% the presence of foreign body was confirmed endoscopically. In 67/84 (79.76%) patients radiography was performed prior to endoscopy, of which 62/67 (92.5%) had an abnormal result. Seventy percent of confirmed EFB were fish bones. The most frequent site of localization was in the cricopharyngeal region in 90% of the cases. In 66/84 (78.6%) subjects there was absence of complications, followed by deep laceration in 10/84 (11.9%) cases. In 3/84 (3.6%) cases complications requiring surgery were identified.

Conclusions: Endoscopic intervention in the first 24 hours is an opportune moment to identify complications and provide the indicated treatment.