Pilar Esteban

Effect of double-balloon enteroscopy on pancreas: An experimental porcine model

AIM To evaluate the effect of double-balloon enteroscopy (DBE) on pancreas histology and levels of pancreatic enzymes. METHODS Conventional upper gastrointestinal endoscopy was performed on five control pigs. Oral DBE was performed with an EN-450T5 enteroscope on 20 pigs. Two experimental groups (10 pigs each) were defined according to DBE duration: 90 min for Group 1 and 140 min for group 2. During oral insertion, the balloons were not inflated in the descending part of the duodenum to avoid the minor duodenal papilla. Serum amylase, lipase and C-reactive protein (CRP) levels were monitored before the procedure and repeated every 30 min until the exploration was finished, as well as 24 h and 7 d after. After the procedure and for a total of 7 d, the pigs were observed twice a day for signs of decreased activity, irritability, vomiting or anorexia. Gross and microscopic examination of the pancreas was performed on day 7. RESULTS All animals tolerated DBE without clinical manifestations of acute pancreatitis. Experimental groups had higher levels of enzymes than the control group at 24 h. Throughout the exploration, the amylase levels increased significantly above the baseline 24 h after DBE, although the increase was not statistically significant and did not reach 20% of the baseline. An increase in lipase and CRP was observed at 24 h after the procedure, although by day 7, all enzymatic levels had returned to baseline. No differences between groups 1 and 2 were found for any enzyme and sampling site during and after the procedure. Similarly, no correlation between insertion depth and enzyme levels was observed. Direct in situ and post-removal inspection of the pancreas did not show any evidence of fluid collection, abscesses or hemorrhage. Histological examination of the pancreas from groups 1 and 2 revealed the existence of focal areas (0.14-0.26 mm2) of ischemic necrosis in 47.4% of the animals. In the pigs with damaged pancreas, the left lobe (tail) was always affected. However, this only happened in 83.3% of the samples from the right lobe (head) and in 33.3% of the samples from the body of the pancreas. Significant differences were found between the left lobe (tail) and the body for the percentage of affected pancreas. Both the size of the lesions and the percentage of affected pancreas were higher in the left pancreatic lobe (tail). The presence of the lesions was not related to the exploration length. CONCLUSION The increase in pancreatic enzymes after DBE could be related to focal points of pancreatic ischemic necrosis due to mechanical stress.

Carbon dioxide insufflation safety in double-balloon enteroscopy: an experimental animal study.

The aim of the present study was to assess the safety and efficacy of CO2 during double‐balloon enteroscopy (DBE) in an experimental animal model study. In this study, insufflation with room air and with CO2 was compared.

Abordaje endoscópico en cirugía bariátrica. Papel de la enteroscopia de doble balón

Presentamos el caso de una paciente mujer de 34 anos de edad, intervenida hace 8 anos mediante bypass gastrico con exclusion antropilorica, sin complicaciones inmediatas en el postoperatorio, que se remite a nuestra unidad para estudio de anemia ferropenica severa con requerimientos transfusionales y gastroscopia y colonoscopia normales. La EDB mostro mucosa normal de intestino delgado hasta la anastomosis, continuando de forma retrograda hasta piloro sin detectar lesiones, pudiendo sobrepasarse este (Fig. 1) hasta el munon gastrico, donde se aprecio una lesion ulcerosa origen de la hemorragia digestiva, se pudo objetivar con mayor precision haciendo retroversion en la misma cavidad (Fig. 2). Se objetivo la papila de aspecto normal in situ.

Transesophageal access to the cardiac cavities and descending thoracic aorta via echoendoscopy. An experimental study

OBJECTIVE The applications of endoscopic ultrasonography have diversified over recent years. The possibility of reaching cardiac territory has been successfully explored in experimental models, opening up a new field of possibilities for diagnostic and therapeutic interventions that were unthinkable until very recently. The aims set out in this study are to evaluate cardiac anatomy, its approach, the safety of the experimental procedure and the resulting morphological and histological changes after the procedure. MATERIAL AND METHODS The study has been performed on two adult pigs. They have undergone different surgical approaches to the cardiac cavities and descending thoracic aorta with excellent results. RESULTS Different cardiac structures have been identified and operated upon (right auricle, left auricle, left ventricle, cardiac valves), as well as major vessels. The use of contrast, both intracavitary and from a peripheral vein, enabled us to verify the anatomical spaces studied. During the procedures we monitored for arrhythmias, hemodynamic behavior, possibility of infection by obtaining sample hemocultures before and after procedures, and response to punctures. CONCLUSIONS The present study has enabled us to evaluate access to the heart from the esophageal lumen using endoscopic ultrasonography, with results that are very similar to those described in the current bibliography. However, we offer two novelties: puncture of the right auricle through the interauricular partition and puncture of the descending thoracic aorta, both performed with ease and apparent safety.

Small bowel adenocarcinoma diagnosed by double balloon enteroscopy in a patient with nonpolyposis colorectal cancer

A 56-year-old woman with positive genetic testing of hereditary nonpolyposis colorectal cancer (HNPCC), many familiarhistory of different neoplasia (Fig. 1), and a personal history of hysterectomy due to an endometrial cancer was referred toour Unit because of anemia with a positive fecal occult blood test. Both, gastroscopy and colonoscopy were performed withthe only result of less than 10 hyperplastic colonic polyps without signs of recent bleeding. An abdominal CT was also per-formed and was completely normal. According to these results, it was indicated a capsule endoscopy that showed a stenoticpolypoid lesion near of the Treitz angle. The capsule stayed retained and its battery went off at this point. With the objectiv eof making a histological diagnosis and removing the capsule endoscopy, a double balloon endoscopy was performed, andA 56-year-old woman with positive genetic testing of hereditary nonpolyposis colorectal cancer (HNPCC), many familiarhistory of different neoplasia (Fig. 1), and a personal history of hysterectomy due to an endometrial cancer was referred toour Unit because of anemia with a positive fecal occult blood test. Both, gastroscopy and colonoscopy were performed withthe only result of less than 10 hyperplastic colonic polyps without signs of recent bleeding. An abdominal CT was also per-formed and was completely normal. According to these results, it was indicated a capsule endoscopy that showed a stenoticpolypoid lesion near of the Treitz angle. The capsule stayed retained and its battery went off at this point. With the objectiv eof making a histological diagnosis and removing the capsule endoscopy, a double balloon endoscopy was performed, and

Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model

Double balloon enteroscopy (DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.

PILOTAJE SOBRE EL CRIBADO DE CÁNCER COLORRECTAL DE LA REGIÓN DE MURCIA. RESULTADOS ENDOSCÓPICOS Y ANÁLISIS DE CARGA ASISTENCIAL

Introduccion y objetivo La Region de Murcia realizo en el bienio 2006–2007 un estudio piloto para evaluar eficacia, coste y aplicabilidad de un programa de Cribado de Cancer Colorrectal que fuera extensible en el futuro al resto de la Region. Metodo El estudio se aplico a la totalidad de la poblacion de entre 50 y 69 anos (riesgo medio) del area sanitaria dependiente del Hospital Morales Meseguer (29726 personas) a las que se invito a la realizacion de un test de SOHi cuantitativo y posterior colonoscopia como prueba de confirmacion diagnostica. Se definieron diferentes parametros de control de calidad para la colonoscopia: porcentaje de intubaciones a ciego, tiempos de endoscopia, polipos recuperados, cumplimiento en sedoanalgesia y grado de satisfaccion. Resultados Se realizo el test de SOHi el 42,3% de la poblacion diana. Fueron positivos el 9,47%. La tasa de aceptacion de la colonoscopia fue del 93,3%. Se realizaron 1369 colonoscopias con los siguientes resultados en (%): Lesiones 80,9, adenomas 61,1, Adenomas de alto riesgo 38,4, Pacientes de alto riesgo por adenomas: 22,7, Carcinoma in situ o intramucoso 8,1, Carcinoma infiltrante 4,67. Valor predictivo positivo del test de SOHi fue: Adenoma alto riesgo: 46,5%; Adenoma bajo riesgo: 21,5%; Carcinoma: 3,6%. 159 (11,5%) pacientes precisaron sucesivas colonoscopias (224 pruebas) por los siguientes motivos: dolor 35 (2,52%), mala preparacion limpieza 13 (0,94%), anticoagulacion-antiagregacion 12 (0,87%), complicaciones 8 (0,58%), control endoscopico de carcinoma invasivo 18 (1,31%), polipos multiples 16 (1,16%), lesiones complejas 58 (4,23%). 59 del total precisaron 72 colonoscopia bajo sedacion profunda para su resolucion. Se predijeron 15 (1,09%) complicaciones (12 hemorragias, 1 perforacion y 3 serositis); 8 de ellas requirieron ingreso hospitalario para tratamiento. 90 pacientes fueron derivados a una Consulta de Alto Riesgo por presencia de lesiones multiples (> 10). 58 pacientes estan en seguimiento por polipos adenomatosos multiples en sus distintas calificaciones y han sido detectadas 5 PAF atenuadas. Conclusiones El metodo ha demostrado su eficacia para la deteccion y tratamiento de lesiones si bien al coste por colonoscopia hay que sumar las cargas de trabajo derivado de la necesidad de tratamiento de los problemas hallados en dichos pacientes. La aplicabilidad del programa dependera de la capacidad de las unidades para dimensionar adecuadamente su actividad.