Esther Saracíbar

Citocinas y otros parámetros inmunológicos como marcadores de alteración de órganos a distancia en la pancreatitis aguda

Fundamento y objetivo: Es conocido el papel que desempenan los mediadores inmunologicos proinflamatorios en la patogenia de algunas alteraciones de organos distantes en la pancreatitis aguda (PA). El objetivo de este estudio ha sido evaluar la relacion entre dichos mediadores y la afectacion hepatica, renal y pulmonar en pacientes con PA. Pacientes y metodo: En 34 pacientes con PA se valoraron el dia del ingreso, parametros bioquimicos de funcion hepatica, creatinina y presion parcial de oxigeno (PO2) arterial, y se establecieron puntos de corte. Se determinaron el receptor soluble tipo I del factor de necrosis tumoral (sTNFRI), el receptor antagonista de la interleucina (IL) 1 (IL-1Ra), la IL-6, el receptor soluble de la IL-6 (sIL-6R), la IL-18 y la molecula de adherencia intercelular-1 (ICAM-1) los dias 1, 2, 3 y 7, y se compararon entre los pacientes con los parametros en el momento del ingreso (bioquimicos y PO2) superiores o inferiores a un punto de corte establecido. Resultados: Se encontraron valores significativamente mas elevados y mantenidos de sTNFRI, IL-18 e ICAM-1, y de IL-6 solo el primer dia, en los pacientes con algun parametro de funcion hepatica superior al punto de corte. sTNFRI, IL-1Ra e ICAM-1 presentaban al inicio valores significativamente superiores en los pacientes en relacion con la creatinina, y de estos e IL-6 en los que presentaban PO2 inferior a 60 mmHg. Conclusiones: sTNFRI, IL-6, IL-18 e ICAM-1 se comportaron como marcadores tempranos de lesion hepatica; sTNFRI, IL-1Ra e ICAM-1, de disfuncion renal, y estos e IL-6, de afectacion pulmonar.

Enfermedad de crohn esofágica

Crohns disease is characterized by chronic inflammation of the digestive tract which may be localized at any level. Nonetheless, esophageal disease is infrequent. Two cases of esophageal involvement in this disease in 2 young women with a history of previous involvement at an intestinal level are presented. Esophageal involvement by Crohns disease should be suspected in any patient previously diagnosed with this disease who presents symptoms suggestive of esophagitis, using endoscopy with multiples biopsies of the affected areas and other of normal endoscopic appearance for diagnosis.

Severe cardiorespiratory complications derived from propofol sedation monitored by an endoscopist

INTRODUCTION deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. MATERIAL AND METHODS the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. RESULTS during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. CONCLUSION there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective.

Sa1593 Long-Term Oncologic Outcomes in Colon Cancer Patients With “Bridge to Surgery” Stenting. Comparative Study With TNM Matched Controls

Long-Term Oncologic Outcomes in Colon Cancer Patients With “Bridge to Surgery” Stenting. Comparative Study With TNM Matched Controls Francisco Igea, Sergio Maestro, Rocio Silvana Castillo, Antonio Perez Millan, Henar Nunez, Rosa Eva Madrigal, Esther Saracibar, Javier Barcenilla Complejo Hospitalario de Palencia, Palencia, Spain Background: Expandable metal stents are frecquently used as a bridge to surgery in colon cancer occlusions. Recently worse oncologic outcomes have been described comparing stented patients with control group matched by TNM staging (1). This could be a serious limitation for continuing stenting occluded colon cancers. At present moment,there are no randomized, prospective data. Aims: Compare oncologic outcomes of patients stented vs controls matched by age,sex,TNM stage and year of diagnosis. Methods: We reviewed all our colon cancer patients stented as bridge to surgery during the period nov 1999 nov 2007. A control group of colon cancer patients matched by sex , age, TNM staging and year of diagnosis was extracted from our database. All the patients were treated in our institution by the same surgeons and oncologysts. Global survival and presence of disease at 3 and five years were compared. Results: Population and TNM stagin carachteristics are reflected in Table 1. We found 41 stent patients and 73 non-stented matched controls. Stage IV was finally excluded in this study because serious difference in treatment approach between both groups. Three year survival in groups II & III was 65,7 % in stented group vs 75% in control group (ns.). Presence of disease was 13 % vs 7,8% in control group. Results at five years follow up in stage II & III are summarized in table 2 No significant difference was observed between both groups. Conclusions: 1) There are no significant diference in survival and disease free survival at 3 and five years in our experience 2)Prospective randomized studies are needed to elucidate this point(1)World J Surg. 2009 Jun;33(6)1281-6. Oncologic outcomes of selfexpanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. Kim JS,et al.