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Artículos
relevantes de Endoscopia Gastrointestinal Española
Capsule endoscopy. Muñoz-Navas M.
World J Gastroenterol. 2009 Apr 7;15(13):1584-6
Gastroenterology Department, University Clinic of Navarra, Pio XII 36, Pamplona, Spain. [email protected]
Capsule endoscopy (CE) is a simple, safe, non-invasive, reliable technique, well accepted and tolerated by the patients, which allows complete exploration of the small intestine. The advent of CE in 2000 has dramatically changed the diagnosis and management of many diseases of the small intestine, such as obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, polyposis syndromes, etc. CE has become the gold standard for the diagnosis of most diseases of the small bowel. Lately this technique has also been used for esophageal and colonic diseases.
Local full-thickness excision as first line treatment for sessile rectal adenomas: long-term results.
Ramirez JM , Aguilella V , Gracia JA , Ortego J , Escudero P , Valencia J , Esco R , Martinez M. Ann Surg. 2009 Feb;249(2):225-8
Departments of Colorectal Surgery, University Hospital, Zaragoza, Spain. [email protected]
OBJECTIVE: Removing rectal adenomas not only relieves symptoms, but also eradicates the incidence of carcinoma. There are many techniques for local removal of rectal polyps. Transanal endoscopic microsurgery (TEM) is the most recent. The purpose of this study is to present our long-term results using TEM for rectal adenomas, paying special attention to the risk factors of harboring a malignancy. METHODS: Data from all patients undergoing TEM from December 1995 to December 2005 were collected prospectively. The selection criteria were benign sessile adenomas below the peritoneal reflection. In the study period, 173 patients were operated on for an apparently benign rectal adenoma. The mean distance of lower tumor was 7.6 cm (range, 1-18 cm), and the mean distance to upper edge was 11 cm (2-20 cm). Full-thickness local excision was performed in all procedures. Patients were followed for a minimum of 1 year. RESULTS: According to the histologic findings, 14% of the specimens were invasive carcinomas. No statistical differences were found when comparing the histologic findings by tumor size, distance to the anal verge, or location.In 10 (5.8%) cases, the dissection was considered uncompleted because of a normal mucosa margin smaller than 1 mm. The mean hospital stay was 4 days (2-30 days). The morbidity rate was 14.5%. There was 1 postoperative death (0.6%). There were 9 (5.4%) histologically proven recurrences. Four of the patients with recurrence had uncompleted microscopic circumferential resection (P = 0.001). At a mean follow-up of 35 months (range, 12-82 months), all carcinoma patients were alive with no evidence of disease. CONCLUSIONS: In conclusion, a significant number of adenomas that we assumed preoperatively to be benign were already carcinomas and we were unable to find any reliable predictor to identify them. TEM full-thickness excision provided a low rate of postoperative morbidity and potentially avoided a significant number of major abdominal operations and local recurrences.
Pericardial tumor diagnosed by EUS-guided FNA (with video)
Rafael Romero-Castro, Juan Jose Rios-Martin, Pastora Gallego-Garcia de Vinuesa, Antonio J. Castro-Fernandez, Francisco J. Marques-Asin, Carlos Caparros-Escudero, Francisco Pellicer-Bautista, Juan M. Herrerias-Gutierrez. Gastrointestinal Endosc. 2009 Mar;69(3):562-3. Epub 2009 Jan 18.
Right lateral position does not affect gastric transit times of video capsule endoscopy: a prospective study. Aparicio JR , Martínez J , Casellas JA.
Gastrointestinal Endoscopy. 2009 Jan;69(1):34-7. Epub 2008 Jul 11.
Current affiliations: Endoscopy Unit, Hospital General Universitario de Alicante, Alicante, Spain. [email protected]
BACKGROUND: Video capsule endoscopy (VCE) examination of the small bowel is not complete in approximately 20% of the procedures. This fact limits its diagnostic yield. One of the main factors that influences the small-bowel transit time (SBTT) is the gastric transit time (GTT), ie, the interval in which the capsule stays in the stomach. It has been described that placing the patient in a right lateral position (RLP) after swallowing the capsule could decrease the GTT. OBJECTIVE: To investigate whether the RLP, after the patient swallows the capsule, shortens the GTT and, secondarily, increases the rate of complete procedures. DESIGN: Randomized prospective study. SETTING: Third-level hospital. PATIENTS: Consecutive outpatients in whom VCE was indicated. Exclusion criteria were inpatients and previous gastric surgery. INTERVENTION: GTT for RLP 30 minutes after swallowing the capsule versus non-RLP (standing up position). MAIN OUTCOME MEASUREMENTS: The GTT, SBTT, and rate of complete procedures (examination of the entire small bowel). RESULTS: We did not observe significant differences in the GTT, the SBTT, and the complete procedures between groups. LIMITATION: Only outpatients were included. CONCLUSIONS: RLP after swallowing the capsule does not influence either GTT nor the rate of VCE complete procedures.
Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding / Hallazgos digestivos altos de la cápsula endoscópica en la hemorragia digestiva de origen oscuro. B. Velayos, A. Herreros de Tejada (1), L. Fernández, R. Aller, A. Almaraz (2), L. del Olmo, F. de la Calle,
T. Arranz and J. M. González. Rev. Esp. Enf. Dig. 2009. 101(1):11-19.
Service of Digestive Diseases. Hospital Clínico de Valladolid. Spain. (1) Center for Endoscopic Research and Therapeutics.
Universidad de Chicago. U.S.A. (2) Service of Preventive Medicine. Hospital Clínico de Valladolid. Spain
ABSTRACT
Objective: we analyzed our experience with the use of capsule
endoscopy in areas that can be explored with gastroscopy to
justify obscure bleeding, as well as the outcome after a new recommended
gastroscopy in order to determine if a second gastroscopy
before the capsule study can provide any benefit in the
management of this disease.
Methods: we retrospectively studied 82 patients who were explored
with capsule endoscopy for obscure gastrointestinal bleeding
who had undergone previously only one gastroscopy.
Findings in the zones which were accessible by gastroscopy
were normal, mild/known and severe/unknown. In the latter cases
we recommended a second gastroscopy, and their treatment
and outcome were subjected to further study.
Results: capsule endoscopy did not find any unknown
esophageal findings. In 63% of cases, no gastric or duodenal lesions
were shown; in 20%, lesions were mild or had been previously
diagnosed, and in 17%, a new gastroscopy was recommended
due to the discovery of an unknown condition which
could be the cause of the obscure bleeding. This new information
brought about a change in treatment for 78% of patients in this
group, all of whom improved from their illness. Capsule endoscopy
found significant intercurrent alterations in the small intestine
in only 14% of cases.
Conclusions: the performance of a second gastroscopy, previous
to capsule endoscopy, in the study of obscure gastrointestinal
bleeding can offer benefits in diagnostic terms and may introduce
therapeutic changes.
A detailed analysis of the upper tract frames in intestinal capsule
endoscopy studies is mandatory since it may provide relevant
information with clinical impact on the management of these patients.
Results of laparoscopic cholecystectomy in university hospital after 17 years of experience / Resultados de la colecistectomía laparoscópica en un hospital universitario tras 17 años de experiencia.
P. Priego, C. Ramiro (1), J. M. Molina (1), G. Rodríguez Velasco (1), E. Lobo (1), J. Galindo (1) and V. Fresneda (1). Rev Esp Enf Dig
2009. 101(1):20-30,
Department of General Surgery. Hospital General de Castellón. Spain. (1) Department of General Surgery.
Hospital Ramón y Cajal. Madrid, Spain.
ABSTRACT
Objective: the aim of the study is to determine the results obtained
with laparoscopic cholecystectomy at Ramón y Cajal Hospital
after 17 years of experience, comparing current results with
those at the beginning of the experience.
Material and methods: between 1991 and December
2007, 3,933 laparoscopic cholecystectomies were performed at
the “Ramón y Cajal Hospital”; 1,849 patients were operated on
between 1991 and 2000, and 2,084 between 2001 and 2007.
Patients studied included 69.8% of women and 30.2% of men,
with a mean age of 56.95 years (range 9-94 years). In all,
54.68% of patients had a concomitant disease before surgery (hypertension,
diabetes, ischemic heart disease, respiratory disease…).
Surgery was performed by a staff surgeon for 58.04% of
cases, and by a resident in the remaining 41.96%. Surgical indications
were cholelithiasis in 75.5%, pancreatitis in 13.3%, cholecystitis
in 6.3%, choledocholithiasis in 3.05%, and others in 1.2%
of cases.
Results: mean hospital stay was 3.06 days. Conversion to
open surgery was required for 8.3% of cases (331 patients). The
major surgical complication rate was 2.34%, with the most frequent
being hemoperitoneum (1%). Common bile duct injury occurred
in thirteen cases (0.3%), 51 patients (1.3%) were soon reoperated,
and 5 patients died (0.13%).
When the results of both decades (1991-2000 vs. 2001-2007)
were compared, we observed differences in the number of procedures
performed by residents (31.7 vs. 51.1%, p = 0.00001), number
of laparoscopic cholecystectomies for cholecystitis (4.9 vs.
7.53%, p = 0.001), conversion rate (5.46 vs. 11%, p = 0.000001),
and mean hospital stay (2.43 vs. 3.7 days, p = 0.001).
Conclusion: these results should be interpreted with caution
as this is a retrospective study with multiple uncontrolled variables
(high number of surgeons and continuous learning curve). The
lower conversion rate and mean hospital stay in the first decade of
the learning curve are amazing, although this could be related to
better patient selection and a lower number of cholecystites operated
using a laparoscopic approach in the initial series. In general,
these results are acceptable and concur with the rest of the literature.
Alerta en PubMed sobre artículos de Endoscopia Gastrointestinal
Este listado de artículos es el resultado de una alerta preconfigurada en PubMed y actualizada semanalmente, basada en la siguiente cadena de búsqueda:
("Endoscopy, Gastrointestinal"[Mesh] OR ("Endoscopy, Gastrointestinal/contraindications"[Mesh] OR "Endoscopy, Gastrointestinal/methods"[Mesh] OR "Endoscopy, Gastrointestinal/mortality"[Mesh] OR "Endoscopy, Gastrointestinal/standards"[Mesh] OR "Endoscopy, Gastrointestinal/statistics and numerical data"[Mesh] OR "Endoscopy, Gastrointestinal/trends"[Mesh] OR "Endoscopy, Gastrointestinal/utilization"[Mesh]))
By Alastair Forbes, BSc, MD, MCRP, J. J. Misiewicz,
BSc, FRCP, MD, FRCP, Carolyn C. Compton, MD, PhD,
Marc S. Levine, MD, Stephen E Rubesin, MD, Paul Thuluvath,
MD, MRCP, FRCP, FACG and M. Shafi Quraishy, MBBS,
FRCP(Lon), FRCP(Edin), FRCP&S(Glasg)
