Martín Gómez Zuleta

Pólipos postinflamatorios y enfermedad inflamatoria intestinal. Reporte de caso y revisión de la literatura

1 Internist and Gastroenterology Fellow at the National University of Colombia and the National University Hospital of Colombia in Bogotá, Colombia 2 Professor in the Gastroenterology Unit of the National University and the National University Hospital of Colombia and Gastroenterologist at Clínica Fundadores in Bogotá Colombia waoteror@gmail.com 3 Professor in the Gastroenterology Unit of the National University and the National University Hospital of Colombia and Gastroenterologist at El Tunal Hospital and Kennedy Hospital in Bogotá, Colombia

Tres variedades de sarcoma de Kaposi con compromiso gastrointestinal

This article presents the cases of four adult patients with three varieties of Kaposi’s sarcoma: epidemic, associated with human immunodeficiency virus infections; iatrogenic, associated with chronic immune suppression (and in this case in a man with alcoholic cirrhosis); and classic, occurring in elderly patient without previously known immunosuppression. All four cases had gastrointestinal involvement. A brief review of the disease is included

Ecoendoscopia en la evaluación de las lesiones subepiteliales duodenales

Las lesiones o tumores subepiteliales (TSE) son raros. Se considera que en 1 de cada 300 endoscopias puede encontrarse un TSE, lo que corresponde al 0,36% de las endoscopias. De estos, solo el 10% se ubican en el duodeno, lo que proporciona una idea de lo infrecuente que es este hallazgo. Al realizar la endoscopia y detectar un TSE en el duodeno, inicialmente se describira su tamano, forma, color, movilidad, pulsacion y finalmente la consistencia, la cual puede evaluarse con la pinza de biopsia cerrada. Esto permitira detectar si es quistico, firme o si tiene el “signo de la almohada”, que es altamente sugestivo de lipoma. En caso contrario, esta indicada la realizacion de una ecoendoscopia, especialmente si el tumor es mayor de 1 cm.

Pancreatitis aguda y elevación de aminotransferasas: ¿en qué pensar? Reporte de caso y revisión de la literatura

Gallstones are associated with development of acute pancreatitis in 40% of cases, however the diagnostic sensitivities of abdominal ultrasound and CT scans for finding this etiology are limited. The case presented here exemplifies the predictive use of aminotransferase liver enzymes in patients with biliary cholecystectomy but abdominal ultrasound that is negative for cholelithiasis and choledocholithiasis. The case is a 55 year old patient whose clinical picture was consistent with acute biliary pancreatitis. The diagnosis was made and endoscopic treatment was recommended

Manejo del cálculo difícil en la vía biliar: Serie de casos

El 85% a 90% de los calculos de la via biliar son manejados de forma exitosa con la tecnica endoscopica es- tandar, que incluye esfinterotomia endoscopica combinada con canastilla y/o cateter con balon. Sin embargo, cuando los calculos son multiples, de gran tamano, de localizacion o forma inusual, o existen alteraciones anatomicas de la via biliar se hacen refractarios al manejo estandar, lo que obliga la realizacion de otras modalidades terapeuticas. Los calculos de gran tamano o impactados generalmente son manejados con tecnicas de fragmentacion como la litotripsia mecanica y en casos fallidos con litotripsia electrohidraulica (LEH) o litotripsia laser (LL) guiado por colangioscopia convencional o mas recientemente por un sistema de colangioscopia directa llamado Spyglass®. Tambien se puede usar el sistema de dilatacion endoscopica papilar con balon grande, que ha demostrado ser util en el manejo de calculos grandes y multiples. En casos con anatomia alterada con dificultad para acceder a la papila, el abordaje preferido para la tecnica de frag- mentacion es el percutaneo transhepatico. En pacientes ancianos y con pobre estado general la colocacion de una protesis biliar es la tecnica de eleccion definitiva mientras mejoran las condiciones del paciente para un tratamiento endoscopico posterior.Standard endoscopic techniques of sphincterotomy combined with Dormia basket and/or balloon catheteriza- tion can manage 85-90% of the gallstones found obstructing bile ducts. However, when there are several large calculi, when a stone is in an unusual location, or when there are anatomic abnormalities of the bile duct, they become refractory to standard management. Other therapeutic modalities become essential for management of these gallstones. Large or impacted calculi are generally handled with fragmentation techniques such as mechanical lithotripsy. When this fails, electrohydraulic lithotripsy (LEH) or laser lithotripsy (LL) guided by conventional cholangioscopy are usually resorted to. More recently, a system of direct cholangioscopy called Spyglass has been introduced. Endoscopic papillary dilation with a large balloon has also proven useful for management of large and multiple calculi. In cases with altered anatomy that makes access to the papilla diffi - cult, the preferred technique is a transhepatic approach combined with percutaneous fragmentation. In elderly patients whose overall condition is poor, the placement of a biliary stent is the definite choice of technique because it can improve the patients condition to make possible further endoscopic therapy.