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The ingestion of more than one magnet can cause multiple complications. Current protocols recommend endoscopic extraction if possible. We report a patient who swallowed two magnets and the endoscopic extraction technique. An 11-yearold boy presented at the Emergency Room after ingesting two small magnets, being asymptomatic. In the abdominal x-ray two radiopaque bodies were identified at the gastric chamber, apparently together. A gastroscopy was done in the operating room under general anaesthesia. To enable the extraction, a neodymium magnet was placed externally at the abdominal wall. In the endoscopic image, the two magnets were fixed to the anterior gastric wall. Once located, the neodymium magnet was removed and the two magnets were retrieved with an endoscopic basket.

La ingesta accidental de más de un imán puede producir complicaciones graves. Los protocolos actuales recomiendan la extracción endoscópica de ser posible. El objetivo de este trabajo es presentar un caso clínico de una ingesta de dos imanes y la técnica endoscópica de extracción. Niño de 11 años que acudió a Urgencias tras la ingesta de dos imanes, asintomático. En la radiografía de abdomen, se identificaron dos cuerpos extraños radiopacos, aparentemente unidos, en la cámara gástrica. Se realizó una endoscopía bajo anestesia general en quirófano. Para facilitar la extracción, se colocó, encima de la pared abdominal, a nivel gástrico, un imán de neodimio. En la endoscopía, se observaron dos pequeños imanes localizados y fijados en la cara anterior del estómago. Una vez localizados, se retiró el imán externo y se procedió a su extracción con cesta.

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Background: The pull-through method to install endoscopic gastrostomies is not devoid of complications. Aim: To describe and show the results of a trans-abdominal method to perform endoscopic gastrostomies using the accessories available in any endoscopic facility. material and methods: The technique consists in installing an exchange tube using the pull kit, which acts as a tube installer. We attempted the procedure in 14 patients whose ages ranged from 15 days to 83 years in a regional hospital. results: In 13 patients, the tube was correctly installed using the trans-abdominal pathway and they could be fed two hours later. Three months later, 11 patients were alive and did not experience complications associated with the gastrostomy. Conclusions: This preliminary experience supports the use of the described technique to install gastrostomies.

Objetivo: Para evitar las complicaciones de la gastrostomía endoscópica (GE) hemos desarrollado un método transabdominal empleando accesorios disponibles en cualquier unidad de endoscopia y una técnica con la cual los endoscopistas están familiarizados. Describimos el método y mostramos sus resultados. material y método: Esta técnica consiste en instalar una sonda de recambio con la ayuda del kit Pull que actúa como instalador de la sonda. Hemos intentado este procedimiento en 14 pacientes con edades entre 15 días y ochenta y tres años. Esta experiencia se realizó en el Hospital de Iquique. resultados: En 13 pacientes se logró instalar la sonda por vía transabdominal y alimentar dos horas después. A los 3 meses, once permanecían vivos y no habían tenido complicaciones mayores relacionadas a su gastrostomía. Conclusión: Aunque se trata de una experiencia inicial, creemos que esta técnica de gastrostomía combinada presenta una alternativa a otras técnicas endoscópicas de acceso transabdominal.

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70 years old woman, without history of illness, came to the Digestive Endoscopic Center of the Gastroenterology department of Arzobispo Loayza hospital, with the diagnosis of Abdominal pain syndrome, in which Upper Endoscopy was practiced. Upper endoscopy concludes the diagnosis of a malignant lesion probably an Early gastric cancer type IIa+IIc, which was confirmed with pathology. Endoscopic treatment was done with Endoscopic submucosal dissection (ESD). The lesion was totally removed, in accordance with the pathologist. Endoscopic controls at 10 weeks showed retractable red scar and a negative biopsy for neoplasm. This case is reported for being the first one published in our literature in which therapeutic ESD with IT-Knife2, was done in Early Gastric cancer.

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CONTEXT: The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair. OBJECTIVE: To evaluate an endoscopic closure method for the gastric opening in natural orifice transenteric surgery DESIGN: Short-term survival animal study. METHODS: Ten White Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The animals received liquids in the same operative day. One shoot antibiotic was used. The leakage test was performed with a forceps and by air distention. RESULTS: No complication was detected in the postoperative course. One month later the endoscopy revealed a scar and some suture material was observed in all animals. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The adhesions were intense in an animal in which a cholecystectomy was performed before the repair. CONCLUSION: The endoscopic repair using T-tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure.

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CONTEXT: The endoscopic gastric perforation is a consequence of some endoscopic procedures and now a way to manage abdominal organs. This is the reason why endoscopists are studying a safe endoscopic repair. OBJECTIVE: To evaluate an endoscopic closure method for the gastric opening in natural orifice transenteric surgery DESIGN: Short-term survival animal study. METHODS: Ten White Landrace pigs underwent a gastric perforation of 1.8 cm in diameter under general anesthesia. The opening was repaired with stitch assembled in a T-tag anchor placed through the gastric wall with a needle. A plastic transparent chamber, adapted to the endoscope tip protected the abdominal organs from the needle puncture outside the stomach. Six T-tags were placed in most cases and the stitches were tied with a metallic tie-knot, forming three sutures. The animals received liquids in the same operative day. One shoot antibiotic was used. The leakage test was performed with a forceps and by air distention. RESULTS: No complication was detected in the postoperative course. One month later the endoscopy revealed a scar and some suture material was observed in all animals. The antral anterior gastric wall was clear with few adhesions in the laparotomy performed in the same time. The adhesions were intense in an animal in which a cholecystectomy was performed before the repair. CONCLUSION: The endoscopic repair using T-tag and a protector chamber is feasible, easy to perform and safe. Further studies are needed to show the real value of this kind of procedure.

CONTEXTO: A perfuração gástrica pode ser consequência de alguns procedimentos endoscópicos, atualmente, produzida intencionalmente para acesso a alguns órgãos com o advento da cirurgia transluminal endoscópica por orifícios naturais. Esta é a razão para que os endoscopistas estudem uma maneira segura de reparar estas lesões por via endoscópica. OBJETIVO: Avaliar um novo método de fechamento das perfurações gástricas utilizadas para acesso ao NOTES. MODELO DE ESTUDO: Pesquisa em modelos animais com curto tempo de sobrevida. MÉTODO: Dez porcos da raça White Landrace, foram submetidos a perfuração gástrica de 1,8 cm, monitorizados e sob anestesia geral. A abertura gástrica foi reparada com dispositivo especial constituído por agulha em forma de T montada com fio (T-tag), inserida, por via endoscópica, nas bordas do ferimento perfurando a parede gástrica e fixando-se a ela como uma âncora. Uma câmara plástica protetora, especialmente desenvolvida, foi adaptada à ponta do endoscópio para proteção dos órgãos subjacentes. Seis T-tags foram inseridos na maioria dos casos e os pontos foram amarrados e fixados com auxílio de outro dispositivo metálico de contenção do nó denominado “tie-knot”, formando três suturas. Um teste de vazamento do tipo manobra do borracheiro era realizado ao término do procedimento. Os animais recebiam líquido no pós-operatório imediato. Foi usada profilaxia antibiótica. RESULTADOS: Não houve complicações. Um mês depois, a endoscopia de controle revelou cicatriz e alguns restos de sutura. A laparotomia, feita no mesmo tempo, revelou poucas aderências na face anterior do antro. CONCLUSÃO: O reparo endoscópico com T-tags e câmara protetora parece ser efetiva, fácil e segura. Estudos maiores e com maior tempo são necessários para confirmar estes resultados e a utilidade deste procedimento.

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The principles of oesophago-gastro-duodenoscopy are described. One hundred and eighty-six abnormalities were detected in a consecutive series of 105 patients. The ratio of gastric: deuodenal: oesophageal lesions detected was 6:2:1. Diffuse mucosal inflammation (42 percent) was found to be the commonest type of lesion followed by ulceration (16 percent). Pyloric stenosis may be distinquished from pylorospasm. The diagnosis of neoplasia and gastrointestinal infections may also be readily confirmed. The advantages of this method of diagnosis of upper gastrointestinal disease are emphasized (AU)

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100 gastroscopic examinations were performed on 39 females and 61 males using the GFTA Olympus Gastrocamera with fibrescope. In 27 cases (27 percent) the Gastrocamera correctly diagnosed lesions which were misinterpreted at X-Ray. There were no complications from the procedure. Gastroscopy and gastrophotography are considered to be indispensable tools in the proper evaluation of gastric pathology (AU)

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