José Guillermo de la Mora-Levy

Endoscopic management of the liver transplant patient

Endoscopy is useful for the evaluation of liver transplant (LT) patients during the pretransplantation and posttransplantation period (Table 1). Prior to transplantation, endoscopy is most commonly used for prevention and/or management of gastrointestinal bleeding from portal hypertension. Posttransplantation, endoscopy via endoscopic retrograde cholangiopancreatography (ERCP) is primarily used for managing biliary complications. This manuscript will review the role of endoscopy in the pretransplant and posttransplant period.

Argon plasma coagulation and hyperbaric oxygen therapy in chronic radiation proctopathy, effectiveness and impact on tissue toxicity

BACKGROUND chronic radiation proctopathy (CRP) is associated with recurrent rectal bleeding and transfusional requirements. Argon plasma coagulation (APC) and hyperbaric oxygen therapy (HOT) have been shown to be effective in the control of CRP. No prospective comparisons have been reported between these treatments. AIM the aim was to evaluate the effectiveness, safety and impact on tissue toxicity of APC compared to HOT in patients with CRP. MATERIAL AND METHODS a prospective study for evaluating treatment response was conducted. Patients with cervical cancer and CRP with rectal bleeding were recruited. They had not received previous treatment. Collected data included: demographics, previous radiation dosage, duration and severity of rectal bleeding. Hemoglobin, transfusional requirements, and tissue toxicity (SOMA LENT questionnaire) at baseline and at 1, 2, and 3 months follow up were recorded. RESULTS thirty-one patients were included, 14 in the APC group and 17 in the HOT group. No response was noted in 13 and 18% of patients in the APC and HOT group respectively (p = NS). At the 1 and 2 months follow-up, the APC group showed a significantly better response in terms of transfusional requirements (0.6 vs. 3.4 and 0.7 vs. 2.5) and tissue toxicity score (5.3 vs. 8.6 and 3.8 vs. 7.248). After 3 months, both groups showed further improvement in all parameters without significant differences between them. CONCLUSIONS APC and HOT were effective, safe and decreased the tissue toxicity scores in patients with CRP. However, response rate was higher and faster in the APC group.

Endoscopic management of esophago-mediastinal fistula secondary to mediastinal tuberculosis infection.

A 45-year-old male with chronic myeloid leukemia (bcr/abl positive) was treated with imatinib mesylate. After 2 months of treatment, the patient presented with fever, diaphoresis, cough, thoracic pain, and progressive dyspnea. Melena developed subsequently. An upper endoscopy was performed, showing an extrinsic compression in the middle third of the esophagus and a 10 mm-diameter, oval-shaped fistula with clear borders (A). The CT scan showed a cluster of nodules, subcarinal air bubbles, and massive pericardial effusion and was without alterations in the lung parenchyma (B). A covered, self-expandable, metal stent (Covered Wallflex 10 cm; Boston Scientific, Natick, Mass) was placed in the esophagus within 24 hours of these findings. The postprocedure esophagogram showed no leaks of contrast material (C). Adenosine deaminase levels of the pericardial fluid were 130 U/L (normal <40 U/L), so the diagnosis of tuberculosis was made. Appropriate antituberculous