Revista Española de Enfermedades Digestivas

What is the most cost-effective method for a difficult biliary cannulation in ERCP?

Post-ERCP pancreatitis: early precut or pancreatic duct stent?: a multicenter, randomized-controlled trial and cost-effectiveness analysis

Background: Pancreatitis is the most frequent complication due to ERCP. Pancreatic duct stent placement has been described as a preventive measure. There is also evidence pointing towards the preventive effect that early precut may provide. Aim: To determine and compare the cost-effectiveness of an early precut approach versus pancreatic duct stent placement for the prevention of post-ERCP pancreatitis. Methods: This was a multicenter, randomized-controlled pilot study with a cost-effectiveness analysis performed between early precut (group A) and pancreatic duct stent (group B) for the prevention of pancreatitis in high-risk patients. Patients with a difficult biliary cannulation and at least one other risk factor for post-ERCP pancreatitis were enrolled and randomized to one of the treatment arms. Both effectiveness and costs of the procedures and their complications were analyzed and compared. Results: From November 2011 to November 2013, 101 patients were enrolled; 50 subjects were assigned to group A and 51 to group B. There were no significant differences in terms of baseline characteristics of patients between groups. Two cases of mild pancreatitis were observed in each group. The overall costs were U$ 1,242.6 per patient in group A and U$ 1,606.5 per patient in group B. The cost in group B was 29.3% higher (p < 0.0001). Conclusion: Early precut showed a better cost-effectiveness profile when compared to pancreatic duct stent placement.

Introducción: la pancreatitis es la complicación más frecuente de la colangiopancreatografía retrógrada endoscópica (CPRE). La colocación de una prótesis pancreática es una medida preventiva. Hay evidencias, también, sobre el efecto protector que tendría la realización de un precorte temprano en los casos con canulación difícil. Objetivo: determinar y comparar el coste-efectividad entre la realización de precorte temprano y colocación de una prótesis pancreática en la prevención de pancreatitis post-CPRE. Métodos: estudio piloto, prospectivo, aleatorizado, multicéntrico y análisis de coste-efectividad entre precorte temprano (grupo A) y prótesis pancreática (grupo B) en la prevención de pancreatitis en pacientes de alto riesgo. Se incluyeron pacientes con canulación biliar dificultosa y otros factores de riesgo de pancreatitis. Se analizaron la efectividad y el coste de los procedimientos y sus complicaciones. Resultados: durante dos años se incluyeron 101 pacientes y se aleatorizaron 50 sujetos en el grupo de precorte y 51 sujetos en el grupo de prótesis. No hubo diferencias en las características demográficas de los participantes ni en las indicaciones del estudio. Se registraron dos pancreatitis leves en cada grupo. El coste fue de 1.242,6$ por paciente en el grupo A y 1.606,5$ por paciente en el grupo B. El coste del grupo B fue un 29,3% mayor (p < 0,0001). Conclusiones: el precorte temprano es más coste-eficaz que la prótesis pancreática en la prevención de pancreatitis post-CPRE.

Neurogenic appendicopathy: a report of 8 cases

Introduction: Neurogenic appendicopathy is not a very well-known disease. Objective: To analyze the experience in the management of neurogenic appendicopathy in a tertiary hospital, assessing its clinical presentation, histological staging, the treatment carried out and its clinical evolution. Method: The study population included patients with histopathological criteria for neurogenic appendicopathy who did not present with MEN 2B syndrome, neurofibromatosis typeI or Cowden syndrome. An analysis was carried out of tissue samples taken from a simple appendectomy after a diagnosis of neurogenic appendicopathy between 2000 and 2013, inclusive. The histopathological criteria were neurogenic hyperplasia with S-100 protein positivity and neuron-specific enolase in the immunohistochemical analysis. Results: Of the 4,969 samples from the appendectomies analyzed, 0.16% (n = 8) met histopathological criteria of neurogenic appendicopathy. The age at presentation was 27.8 ± 12 years. Four patients were male and four were female. All patients started with abdominal pain in the right iliac fossa (RIF), and were operated on due to a diagnosis of acute appendix, with a simple appendectomy being performed. In four cases, another associated disease accounted for the pain in the RIF. With regard to histopathological type, submucosal neurogenic hyperplasia was present in five patients and fibrous obliteration in three patients. No statistically significant differences were found between the histological types. After surgery, during a mean follow up of 73.2 ± 28 months (15-105), all the patients remained asymptomatic. Conclusion: Neurogenic appendicopathy is an uncommon entity that can evolve as abdominal pain which is similar to acute appendix. Simple appendectomy is curative.

Introducción: la apendicopatía neurogénica es una patología poco conocida. Objetivo: analizar la experiencia en el manejo de la apendicopatía neurogénica en un hospital de tercer nivel, valorando su presentación clínica, su estadio histológico, el tratamiento realizado y su evolución clínica. Método: la población a estudio estuvo formada por pacientes con criterios histopatológicos de apendicopatía neurogénica que no presentaran síndrome de MEN IIb, neurofibromatosis tipo I ni enfermedad de Cowden. Se realizó un análisis de las piezas de apendicectomía simple con el diagnóstico de apendicopatía neurogénica entre los años 2000 y 2013 inclusive. Los criterios histopatológicos fueron hiperplasia neurogénica con positividad en la inmunohistoquímica para la proteína S-100 y enolasa neuronal específica. Resultados: de las 4.969 piezas de apendicectomía analizadas, el 0,16% (n = 8) tenía criterios histopatológicos de apendicopatía neurogénica. La edad de presentación fue de 27,8 ± 12 años. Cuatro pacientes fueron varones y otros cuatro fueron mujeres. Todos debutaron con dolor abdominal en fosa iliaca derecha (FID) y se intervinieron con el diagnóstico de apendicitis aguda, realizando una apendicectomía simple. En cuatro casos se asoció otra patología que justificaba el dolor en FID. Respecto al tipo histopatológico, la hiperplasia neurogénica submucosa tuvo lugar en cinco pacientes y la obliteración fibrosa en tres pacientes. No se objetivaron diferencias estadísticamente significativas entre los tipos histológicos. Tras la cirugía, durante un seguimiento medio de 73,2 ± 28 meses (15-105) todos los pacientes permanecen asintomáticos. Conclusión: la apendicopatía neurogénica es una entidad infrecuente que puede cursar con dolor abdominal similar a una apendicitis aguda. La apendicectomía simple es curativa.

The importance of a second opinion in the diagnosis of Barrett's esophagus: a "real life" study

Background: Barrett's esophagus is a precancerous lesion, and its identification with the early detection of dysplasia is of paramount importance to prevent adenocarcinoma onset. However, there is still debate on the correct pathological identification of Barrett's esophagus (and of associated dysplasia), and most studies have been conducted in an experimental setting. Aims: To assess previous uncertain diagnoses of Barrett's (with and without dysplasia) via a second opinion of an expert pathologist in a real life setting. Patients and methods: Histological sections of 32 suspected Barrett's patients from ten general Pathology units were centralized into one single unit in which an expert pathologist reviewed the slides blindly. Results: Overall, in 78% of cases there was diagnostic discordance; in particular, in 64% of cases the presence of low grade dysplasia was not confirmed. Of interest, 28% of cases with the original diagnosis were reclassified as non-Barrett's. Conclusions: The pathological diagnosis of Barrett's esophagus, especially with regard to the presence of dysplasia, is still misinterpreted, particularly in the setting of general pathology units. Thus, a second opinion from an experienced pathologist may help in the interpretation of the results and in starting appropriate follow-up programs.

Restoration of density of interstitial cells of Cajal in the jejunum of diabetic rats after quercetin supplementation

Background: Interstitial cells of Cajal (ICC) are required for normal motility in the gastrointestinal tract. Depletion of ICC has been associated with diabetic gastroenteropathy. Aim: To determine the effect of quercertin supplementation on anoctamin-1 (Ano1) immunoreactive ICC in the myenteric region (ICC-MY) and deep muscular plexus (ICC-DMP) in the jejunum of diabetic rats. Methods: Thirty-two 90-day-old male Wistar rats were distributed into the following groups: normoglycemic (C), normoglycemic supplemented with quercetin (CQ; 40 mg daily), diabetic (D), and diabetic supplemented with quercetin (DQ; 40 mg daily). Diabetes was induced by streptozotocin injection. After 120 days, preparations of the jejunal muscular and submucosal layers were immunostained for Ano1 to visualize ICC. Evaluation of the immunofluorescence intensity as well as density of ICC was performed. Results: The density of ICC-MY was 46% lower in group D compared to group C (p < 0.01); ICC-DMP were reduced by 37% (p > 0.05). After quercertin treatment, the densities of ICC-MY were significantly higher in the DQ group compared to group D (ICC-MY: 58%, p < 0.05). Supplementation with quercetin in normoglycemic animals (CQ) compared with group C did not significantly change the ICC density (p > 0.05). Conclusions: In STZ-treated diabetic rats, diabetes promoted a reduction in the density of jejunal ICC-MY with no significant effect on ICC-DMP. Supplementation with quercetin (DQ) appeared to protect ICC-MY from depletion in diabetes possibly due to its antioxidant action.

Restoration of density of interstitial cells of Cajal in the jejunum of diabetic rats after quercetin supplementation

The concerns of Spanish patients with inflammatory bowel disease as measured by the RFIPC questionnaire

Background and objectives: Concerns impact the quality of life for patients with inflammatory bowel disease (IBD). We attempted to identify the concerns of IBD patients in our practice, and to assess the applicability of the Rating Form of IBD Patients Concerns (RFIPC) questionnaire to Spanish patients. Patients and methods: One hundred and thirty-one patients seen in our practice filled out the Spanish version of RFIPC. The questionnaire's reliability, validity, and discriminating power were analyzed. Results: The total score was 46.93, with a standard deviation (SD) of 21.475. Primary concerns included: "having an ostomy bag", "effects of medication", "developing cancer", "energy level", and "uncertain nature of disease". Female patients scored higher on total RFIPC and on most items. Cronbach's alpha was 0.924. A good correlation was seen between two consecutive answers for 37 patients; the Spearman's coefficient was 0.842 (p < 0.001), and the intraclass correlation coefficient (ICC) was 0.775 (p < 0.001). Correlation was also found between RFIPC and both the IBDQ-32 emotional domain (0.413, p < 0.001) and anxiety scale (0.543, p < 0.001). Conclusions: The RFIPC questionnaire may be administered to Spanish patients.

Antecedentes y objetivos: las preocupaciones influyen en la calidad de vida de los pacientes con enfermedad inflamatoria intestinal (EII). Pretendemos identificar las preocupaciones de los pacientes con EII que atendemos en nuestra consulta y comprobar si el Rating Form of IBD Patients Concerns (RFIPC) es un cuestionario aplicable a los pacientes españoles. Pacientes y métodos: ciento treinta y un pacientes atendidos en la consulta contestaron la versión española del RFIPC. Se ha estudiado la fiabilidad, validez y capacidad discriminadora del cuestionario. Resultados: la puntuación total fue 46,93 con desviación estándar (DS) de 21,475. Las preocupaciones principales fueron: "que me coloquen una bolsa", "reacciones a medicamentos", "padecer cáncer", "vitalidad" y "situación incierta de la enfermedad". Los pacientes de sexo femenino puntuaron más alto en el RFIPC y en la mayoría de los ítems. El valor alfa de Cronbach fue 0,924. Se comprobó una buena correlación entre dos respuestas consecutivas de 37 pacientes, Spearman 0,842 (p < 0,001) y coeficiente de correlación intraclase (CCI) 0,775 (p < 0,001). También hubo correlación entre el RFIPC y el dominio emocional del Inflammatoy Bowel Disease Questionnarie (IBDQ) 32 0,413 (p < 0,001) y la escala de ansiedad 0,543 (p < 0,001). Conclusiones: el cuestionario RFIPC puede aplicarse a los pacientes españoles.

Bleeding risk in endoscopic retrograde cholangiopancreatography: impact of the use of antithrombotic drugs

Aims: To analyze the risk factors for hemorrhage during endoscopic retrograde cholangiopancreatography and the impact of antithrombotic drugs. Material and methods: Data sources: papers indexed in PubMed have been reviewed, as well as those found during the analysis of the bibliography of meta-analysis and reviews. Selection criteria: the references have been firstly evaluated by review of the abstract. After selecting the most significant articles (mainly randomized trials and well-designed case series) these have been deeply analyzed. Evaluation of the studies and synthesis: criteria by the Oxford Centre for Evidence-Based Medicine have been used for the analysis of the references and elaboration of evidence levels. Results: Seven hundred and sixty-five references were found, 753 in PubMed and the Cochrane Library. Twelve studies were selected during the analysis of other published articles (systematic reviews, meta-analysis and clinical practice guidelines). After analyzing the title or the abstract, 655 studies were excluded. Finally, 83 high quality trials or descriptive studies have been included in the analysis. Conclusions: Seven conclusions regarding the risk factors for bleeding and the impact of antithrombotic drugs have been defined.

Objetivos: analizar los factores de riesgo de hemorragia en la colangiopancreatografía retrógrada endoscópica así como el impacto sobre la misma del uso de los fármacos antitrombóticos. Material y métodos: fuentes de datos: valoración de los artículos indexados en PubMed así como de los detectados en el análisis de la bibliografía de metaanálisis y revisiones. Criterios de elegibilidad del estudio, participantes e intervenciones: se valoraron los artículos por los abstracts y, al detectar los más significativos (principalmente ensayos clínicos aleatorizados y series de casos bien diseñadas), se analizaron los estudios completos. Métodos de evaluación del estudio y síntesis: para el análisis de la bibliografía y la elaboración de los diferentes niveles de evidencia se han utilizado los criterios establecidos por el Centro de Medicina Basada en Evidencia de Oxford. Resultados: se han encontrado 765 referencias, de las cuales 753 fueron obtenidas de la búsqueda en PubMed y Cochrane Library. Doce trabajos fueron seleccionados a partir del análisis de otros estudios publicados (revisiones sistemáticas, metaanálisis y guías clínicas). Después de analizar el título o el resumen de los estudios, fueron eliminados 655 trabajos. Definitivamente, se han incluido en el análisis final 83 ensayos clínicos o estudios descriptivos de calidad. Conclusiones: se han definido siete conclusiones con referencia a los factores de riesgo de sangrado y al impacto de los fármacos antitrombóticos.

Liver metastasis secondary to primary mesenteric carcinoid

Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report

Sclerosing angiomatoid nodular transformation of the spleen: a case report

Combined endoscopic resolution of iatrogenic stricture in an ureterosigmoidostomy

Acute esophageal necrosis resolved in 72 hours

Portal hydatid with secondary cavernomatosis

Accumulation of mesalazine pills in the medium ileum in a patient with Crohn's disease

Long-standing indeterminate biliary stricture with iterative negative tissue sampling revealed as cholangiocarcinoma under SpyGlass^TM cholangioscopy

An immobile postsurgical nasojejunal tube: a case for King Arthur!

Mucormycosis: an unusual cause of gastric perforation and severe bleeding in immunocompetent patients

Mucormycosis is a rare and often fatal opportunistic infection that especially occurs in immunocompromised patients. Primary gastrointestinal infection is uncommon and accounts for only approximately 7% of all cases of mucormycosis but it is associated with an 85% mortality rate due to perforation and massive bleeding. Very few cases of gastrointestinal mucormycosis in an immunocompetent host have been reported. We describe a case of gastric necrosis and massive bleeding due to fulminant invasive mucormycosis.

Central pancreatectomy for the treatment of a benign pancreatic lesion: case report and literature review

We present the case of a 45 year old female patient with an incidental diagnosis of a cystic pancreatic lesion corresponding to a serous cystadenoma of 14 mm. During a 5-year follow-up (CT and MRT) the lesion tripled in size and a surgical intervention was decided upon. The lesion was thought to have a benign pathology and, in an attempt to preserve the spleen and a major portion of pancreatic tissue, a central pancreatectomy with a diversion of the remaining distal pancreas was carried out. The authors reviewed national and international publications.

Presentamos el caso de una mujer de 45 años diagnosticada incidentalmente de lesión quística pancreática compatible con cistoadenoma seroso de 14 mm. Tras cinco años de seguimiento (TAC y RM) la lesión triplicó su tamaño y se indicó la intervención. Teniendo en cuenta la probable benignidad de la lesión, y en un intento de preservar tanto el bazo como la mayor cantidad posible de parénquima pancreático, se realizó una pancreatectomía central con derivación del remanente distal. Se revisa la literatura nacional e internacional publicada.

Primary non-functioning neuroendocrine tumor of the extrahepatic bile duct

In contrast to the primary biliary carcinoma or cholangiocarcinoma, other tumors derived from the bile duct are difficult to diagnose preoperatively, mainly because of its low incidence and difficult diagnostic process. However, since cholangiocarcinomas account for about 80% of all primary biliary tumors, it is important to think about other options despite their low frequency when a patient presents with abnormal characteristics. We present a case of a primary neuroendocrine tumor of the bile duct, and a review of the literature on this rare disease.

En contraste con el adenocarcinoma primario biliar o colangiocarcinoma, otros tumores derivados de la vía biliar son difíciles de diagnosticar preoperatoriamente, debido principalmente a su baja incidencia y el difícil proceso diagnóstico que requieren. Sin embargo, dado que los colangiocarcinomas suponen alrededor del 80% de todas las neoplasias biliares primarias, cuando se trata de un paciente con un tumor biliar con características anormales, es importante pensar en otras opciones, a pesar de su baja frecuencia. En este trabajo presentamos un caso clínico de un tumor neuroendocrino primario de la vía biliar, y una revisión de la literatura acerca de esta rara enfermedad.

Colonic endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD): a short case series

The endoscopic treatment of early gastrointestinal neoplasms usually involves the resection of the superficial layers, mucosa and submucosa, of the wall. However, in some circumstances, a full-thickness resection may be necessary. Endoscopic full-thickness resection (EFTR) may be an adequate approach in challenging lesions such as adenomas or early cancers with severe submucosal fibrosis or small sub-epithelial lesions in the lower GI tract. Furthermore, this novel technique has the potential to spare surgical therapy in a subset of cases. In this paper, we describe our results with the full-thickness resection device (FTRD) in three different situations.

Revista Española de Enfermedades Digestivas

What is the most cost-effective method for a difficult biliary cannulation in ERCP?

Post-ERCP pancreatitis: early precut or pancreatic duct stent?: a multicenter, randomized-controlled trial and cost-effectiveness analysis

Neurogenic appendicopathy: a report of 8 cases

The importance of a second opinion in the diagnosis of Barrett's esophagus: a "real life" study

Restoration of density of interstitial cells of Cajal in the jejunum of diabetic rats after quercetin supplementation

Restoration of density of interstitial cells of Cajal in the jejunum of diabetic rats after quercetin supplementation

The concerns of Spanish patients with inflammatory bowel disease as measured by the RFIPC questionnaire

Bleeding risk in endoscopic retrograde cholangiopancreatography: impact of the use of antithrombotic drugs

Liver metastasis secondary to primary mesenteric carcinoid

Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report

Sclerosing angiomatoid nodular transformation of the spleen: a case report

Combined endoscopic resolution of iatrogenic stricture in an ureterosigmoidostomy

Acute esophageal necrosis resolved in 72 hours

Portal hydatid with secondary cavernomatosis

Accumulation of mesalazine pills in the medium ileum in a patient with Crohn's disease

Long-standing indeterminate biliary stricture with iterative negative tissue sampling revealed as cholangiocarcinoma under SpyGlass^TM cholangioscopy

An immobile postsurgical nasojejunal tube: a case for King Arthur!

Mucormycosis: an unusual cause of gastric perforation and severe bleeding in immunocompetent patients

Central pancreatectomy for the treatment of a benign pancreatic lesion: case report and literature review

Primary non-functioning neuroendocrine tumor of the extrahepatic bile duct

Colonic endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD): a short case series

Xanthogranulomatous pancreatitis: a lesion that mimics pancreatic cancer

Endoscopic removal of a hashish packet

Liver metastasis from colorectal cancer 12 years after liver transplantation

Primary chancre in the rectum: an underdiagnosed cause of rectal ulcer

Ball valve syndrome caused by a giant gastric Vanek's tumor

Unusual presentation of obstructive jaundice

Revista Española de Enfermedades Digestivas

What is the most cost-effective method for a difficult biliary cannulation in ERCP?

Post-ERCP pancreatitis: early precut or pancreatic duct stent?: a multicenter, randomized-controlled trial and cost-effectiveness analysis

Neurogenic appendicopathy: a report of 8 cases

The importance of a second opinion in the diagnosis of Barrett's esophagus: a "real life" study

Restoration of density of interstitial cells of Cajal in the jejunum of diabetic rats after quercetin supplementation

Restoration of density of interstitial cells of Cajal in the jejunum of diabetic rats after quercetin supplementation

The concerns of Spanish patients with inflammatory bowel disease as measured by the RFIPC questionnaire

Bleeding risk in endoscopic retrograde cholangiopancreatography: impact of the use of antithrombotic drugs

Liver metastasis secondary to primary mesenteric carcinoid

Hemolymphangioma as a cause of overt obscure gastrointestinal bleeding: a case report

Sclerosing angiomatoid nodular transformation of the spleen: a case report

Combined endoscopic resolution of iatrogenic stricture in an ureterosigmoidostomy

Acute esophageal necrosis resolved in 72 hours

Portal hydatid with secondary cavernomatosis

Accumulation of mesalazine pills in the medium ileum in a patient with Crohn's disease

Long-standing indeterminate biliary stricture with iterative negative tissue sampling revealed as cholangiocarcinoma under SpyGlassTM cholangioscopy

An immobile postsurgical nasojejunal tube: a case for King Arthur!

Mucormycosis: an unusual cause of gastric perforation and severe bleeding in immunocompetent patients

Central pancreatectomy for the treatment of a benign pancreatic lesion: case report and literature review

Primary non-functioning neuroendocrine tumor of the extrahepatic bile duct

Colonic endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD): a short case series

Xanthogranulomatous pancreatitis: a lesion that mimics pancreatic cancer

Endoscopic removal of a hashish packet

Liver metastasis from colorectal cancer 12 years after liver transplantation

Primary chancre in the rectum: an underdiagnosed cause of rectal ulcer

Ball valve syndrome caused by a giant gastric Vanek's tumor

Unusual presentation of obstructive jaundice

Long-standing indeterminate biliary stricture with iterative negative tissue sampling revealed as cholangiocarcinoma under SpyGlass^TM cholangioscopy