Juan Angel Gonzalez-Martin

Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey.

BACKGROUND EUS-guided cholangiopancreatography (ESCP) allows transmural access to biliopancreatic ducts when ERCP fails. Data regarding technical details, safety, and outcomes of ESCP are still unknown. OBJECTIVE To evaluate outcomes of ESCP in community and referral centers at the initial development phase of this procedure, to identify the ESCP stages with higher risk of failure, and to evaluate the influence on outcomes of factors related to the endoscopist. DESIGN Multicenter retrospective study. SETTING Public health system hospitals with experience in ESCP in Spain. PATIENTS A total of 125 patients underwent ESCP in 19 hospitals, with an experience of <20 procedures. INTERVENTION ESCP. MAIN OUTCOME MEASUREMENTS Technical success and complication rates in the initial phase of implantation of ESCP are described. The influence of technical characteristics and endoscopist features on outcomes was analyzed. RESULTS A total of 125 patients from 19 hospitals were included. Biliary ESCP was performed in 106 patients and pancreatic ESCP was performed in 19. Technical success was achieved in 84 patients (67.2%) followed by clinical success in 79 (63.2%). Complications occurred in 29 patients (23.2%). Unsuccessful manipulation of the guidewire was responsible for 68.2% of technical failures, and 58.6% of complications were related to problems with the transmural fistula. LIMITATIONS Retrospective study. CONCLUSION Outcomes of ESCP during its implantation stage reached a technical success rate of 67.2%, with a complication rate of 23.2%. Intraductal manipulation of the guidewire seems to be the most difficult stage of the procedure.

Gastric polyps: analysis of endoscopic and histological features in our center

BACKGROUND AND OBJECTIVE the prevalence of gastric polyps in esophagogastroduodenoscopies (EGDs) ranges between 0.33 and 6.35%. The relative frequency of histological subspecies varies widely among published series. The objective is to describe the endoscopic and histological characteristics of the polypoid lesions, and to study possible associations. MATERIAL AND METHODS we retrospectively revised the EGDs done in our center in 2009. Demographic, endoscopic and histological data were gathered. We proceeded to a descriptive analysis and studied possible associations. RESULTS gastric polypoid lesions were found in 269 of the 6,307 (4.2%) reviewed EGDs, 61% were found in women. Mean age was 64.93 years (SD: ±15.23). A single polyp was found in 186 patients (69.1%), over 10 lesions appeared in 31 (11.5%). An estimated size of ≤ 3 mm was found in 108 lesions (37.2%) and greater than 10 mm in 52 cases (17.9%). Most lesions were sessile (90.8%). The location of 34.8% was the gastric antrum, 39.3% were found in the gastric body and 25.9% were in the fundus. Chronic gastritis was confirmed in 53.5% of the patients and 46.5% had received protom pump inhibitors (PPIs). Histopathological diagnosis was: hyperplastic polyps 50.9%, fundic gland polyps 7.4%, adenomas 3%, adenocarcinomas 1.9% and normal mucosa 29.7%. We found no significant association between the histopathological type of lesions and the use of proton pump inhibitor. CONCLUSIONS we found polypoid lesions in 4.2% of the EGDs. The most frequent histopathological findings were hyperplastic polyps (50.9%), followed by fundic gland polyps (7.4%), adenomas (3%), and adenocarcinomas (1.9%).

Tratamiento de pancreatitis recidivante por páncreas divisum y ansa pancreática mediante técnica de Rendez-Vous guiada por ecoendoscopia

espanolEl tratamiento endoscopico de malformaciones ductales pancreaticas causantes de pancreatitis aguda de repeticion, como el pancreas divisum o el ansa pancreatica, se basa fundamentalmente en la esfinterotomia de la papila minor. En estos casos, no obstante, la complejidad tecnica de la colangiopancreatografia endoscopica retrograda (CPRE) convencional es mayor, pudiendo resultar fallida. Presentamos el caso de un pancreas divisum completo combinado con ansa pancreatica, sintomatico, en el que, tras fracasar el acceso endoscopico convencional a la papila minor, se logra la canulacion y esfinterotomia de esta mediante tecnica de Rendez-Vous guiada ecoendoscopicamente. EnglishEndoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP) is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique.Endoscopic treatment of pancreatic ductal malformations causing recurrent acute pancreatitis, such as pancreas divisum or ansa pancreatica, is mainly based on the sphincterotomy of the minor papilla. However, the technical complexity of conventional endoscopic retrograde cholangiopancreatography (ERCP) is increased in patients presenting anatomical variants like these and it may be unsuccessful. We report the case of a pancreas divisum combined with ansa pancreatica and describe the cannulation and sphincterotomy of the minor papilla using an ultrasound-assisted Rendez-Vous technique.

What Is the Value of the Learning Curve in Endoscopic Balloon Dilatation of the Major Papilla

Introduction Endoscopic papillary large balloon dilatation (EPLBD) is an alternative for the treatment of common bile duct (CBD) stones. Existing evidence of factors associated with its outcomes is contradictory. Objective To identify predictors (including the experience of an endoscopist) of success and adverse events in EPLBD. Methods We reviewed the first 200 EPLBD with endoscopic sphincterotomy (EST) performed at our center. Demographic, clinical, and anatomic variables were studied, as well as the performance characteristics, correlating them with individual and group experience. Results Global success was obtained in 87% of cases, and adverse events occurred in 16% of cases. Success was associated with stone size, CBD diameter, and the need to perform mechanical lithotripsy (ML). Despite that adverse events were not univariately associated with any factor, severe adverse events were more likely to occur in stones > 13.5 mm. Multivariate analysis which disclosed success was higher when ML was not required and stones were < 13.5 mm. It also showed that no factor was associated with adverse events or their severity. No differences were found on success or adverse events that could be directly related to experience. Conclusions Success of EPLBD-EST is higher in stones < 13.5 mm and when ML is not required. Experience does not appear to play a major role.

Tumor rectal de crecimiento lateral tipo no granular resecado mediante disección endoscópica submucosa pura: un tratamiento inusual para una lesión atípica

Consulta de Alto Riesgo de Cancer Colorrectal. Unidad de Endoscopia. Department of Gastroenterology. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain. Endoscopy Division. National Cancer Center Hospital. Tokyo, Japan. Department of Gastroenterology. Fujita Health University University School of Medicine. Aichi, Japan. Department of Gastroenterology. Hospital Virgen de la Arrixaca. Murcia, Spain. Department of Pathology. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain. Departmento of General and Digestive Surgery. Hospital Universitario Ramon y Cajal. Madrid. Universidad de Alcala, IRYCIS. Madrid, Spain PICTURES IN DIGESTIVE PATHOLOGY

Respuesta de autores: Réplica: ¿Existe asociación entre los inhibidores de la bomba de protones y los pólipos glandulares fúndicos?

En respuesta a la carta enviada por Fernández y Viola a su revista acerca del artículo “Pólipos gástricos: Análisis de características endoscópicas e histológicas en nuestro medio” (1) en la que se cuestionaba la ausencia de asociación entre pólipos de glándulas fúndicas (PGF) y consumo de inhibidores de la bomba de protones (IBP) que se extrae de nuestros datos, querríamos hacer constar las siguientes puntualizaciones: a) nuestro estudio, aunque amplio (más de 6.000 gastroscopias revisadas) fue retrospectivo y con un número de PGF discreto (7,4% de los pólipos encontrados), aunque similar a otras series europeas, como señalan en su carta Fernández y Viola. b) Pueden existir, como ya exponemos en nuestro artículo, posibles sesgos derivados del tipo de estudio realizado (descriptivo, retrospectivo), del bajo número total de pacientes con PGF incluidos, y no ser la relación causal con IBP objetivo principal del trabajo, estando de acuerdo con los anteriores autores en que la ausencia de una asociación significativa en nuestra serie no es un dato concluyente para descartar su existencia. c) La relación causal entre la toma de IBP y la aparición de PGF es un tema polémico en la literatura, existiendo datos tanto a favor (2,3) como en contra (4). Hay que tener en cuenta, sin embargo, que las series publicadas no son homogéneas en cuanto a la duración del tratamiento con IBP, ni las características de la población estudiada (área geográfica, edad, etc.). Esto podría explicar en parte los diferentes resultados obtenidos por los autores, sin que estas divergencias se deban necesariamente a fallos en la metodología de los estudios. d) Asumimos que el trabajo de Zelter y cols. (5), aunque con menor número de endoscopias que el nuestro, al ser prospectivo y diseñado específicamente para buscar la relación entre PGF e IBP, sus resultados tienen, en este sentido, una relevancia notable. e) No obstante, también en su estudio, se consideró como objetivo secundario la relación de PGF e infección por Helicobacter pylori debiendo en este sentido sus hallazgos ser tomados con precaución; el no concretar número y localización de biopsias gástricas, ser este el único método diagnóstico de la infección efectuado y no confirmar si los pacientes llevaban al menos 15 días sin consumo de IBP en el momento de la realización de la endoscopia, hacen que la exclusión de la infección no cumpla los estándares requeridos (6,7). f) Agradecemos los comentarios de Fernández y Viola y creemos que estudios prospectivos bien diseñados acabarán de concretar la relación de los PGF tanto con el consumo crónico (¿más de 1 año?) de IBP y también de la controvertida relación con Helicobacter.