RESUMO
La esofagitis eosinofílica (EoE) es una enfermedad causada por una respuesta inmune frente a antígenos alimentarios en contacto con la mucosa esofágica; por su parte, la enfermedad de Von Willebrand (EVW) es el trastorno hemorrágico hereditario más común en los seres humanos. La característica central de todos los tipos de EVW, es la presencia de cantidades reducidas o de formas anormales del factor de Von Willebrand (FVW) en el torrente sanguíneo. Debido a que no se han reportado casos previos de EVW tipo 2A asociada a EoE, se describe este caso clínico con el objetivo principal de dar a conocer el hallazgo casual de estas dos patologías, la seguridad de la evaluación por endoscopia de vías digestivas altas y el pronóstico de posibles complicaciones
Eosinophilic esophagitis (EoE) is a disease caused by an immune response against food antigens in contact with the esophageal mucosa; alternatively, Von Willebrand disease (VWD) is the most common inherited bleeding disorder in humans. The central characteristic of all types of VWD is the presence of reduced amounts or abnormal forms of VWF in the bloodstream. Since no previous cases of VWD type 2A associated to EoE have been reported, this clinical case is described with the main objective to present the coincidental finding of these two pathologies, the safety of the evaluation by upper gastrointestinal endoscopy, and the prognosis of possible complications
Assuntos
Humanos , Masculino , Adulto Jovem , Doenças de von Willebrand/complicações , Esofagite Eosinofílica/complicações , Esofagite Eosinofílica/diagnóstico , Biópsia/efeitos adversos , Endoscopia do Sistema Digestório/efeitos adversos , Esôfago/patologia , Esofagite Eosinofílica/patologia , Hemorragia Gastrointestinal/prevenção & controleRESUMO
SpyGlass DS is a peroral cholangioscopy system, associated with improved image quality and configuration. Currently, there is diversity in its use and little information on its implementation, including clinical outcomes and adverse events. To describe the experience of using SpyGlass DS in several gastroenterology reference centres in Colombia, mentioning efficacy and possible adverse events. This is an observational study (case series). The main indication was choledocholithiasis (n:204), followed by biliary stricture (n:40) and pancreatolithiasis (n:16). 49.2% were male, mean age 58.6 years, clinically with predominance of abdominal pain (80.5%) and jaundice (86.1%). All cases had previous imaging (CT scan, MRI or ultrasound), 98.07% previous endoscopic retrograde cholangiopancreatography (n:255) and 75% biliary plastic stent. Laser was used in 78/220 patients and electrohydraulic lithotripsy in 142/220 patients, with single-session resolution rates of 96.15% and 95.07%, respectively. Seven cases required a second lithotripsy session and 3 patients required surgical management, one for pancreatolithiasis with basal pancreas divisum and 2 for hepatolithiasis. 40/260 patients presented with biliary stricture, 32/40 with malignant findings (cholangiocarcinoma) and 8/40 with benign pathology (primary sclerosing cholangitis, non-specific inflammatory changes) after histopathological studies. As complications, 6 cases of bacteraemia (2.5%) were recorded, being more frequent in cases of stenosis. The mean postoperative stay was 2.04 days. We concluded that the use of SpyGlass DS is feasible in our setting, being effective for diagnosis and treatment of biliary lesions, and with low risk of adverse events.
Assuntos
Neoplasias dos Ductos Biliares , Colestase , Gastroenterologia , Litíase , Hepatopatias , Pancreatopatias , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/métodos , Colômbia , Constrição Patológica/etiologia , Litíase/etiologia , Hepatopatias/etiologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal , Colestase/etiologia , Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/patologiaRESUMO
Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.
This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Endoscopia do Sistema Digestório , Duodenopatias/diagnóstico , Estudos Transversais , Estudos Retrospectivos , Endoscopia do Sistema Digestório/efeitos adversos , Duodenite/diagnóstico , Esofagite/diagnóstico , Gastrite/diagnóstico , Neoplasias Gastrointestinais/diagnósticoRESUMO
BACKGROUND: Choledocholithiasis is one of the main complications of cholelithiasis with a prevalence in the Mexican population of 14%. The management through the guide proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 can support the surgeon for the timely resolution of the pathology. OBJECTIVE: To determine that the guide proposed by ASGE for the management of choledocholithiasis in patients with "high risk" reduces the complications of this pathology. METHODS: A comparative, retrospective case-control study was conducted from January 1, 2015 to December 31, 2017. We included patients who were stratified at high risk of choledocholithiasis according to the ASGE guidelines. They were divided into 2 groups: the case group (diagnosis by ASGE guidelines) was submitted directly to endoscopic retrograde cholangiopancreatography (ERCP), the second group (no ASGE) followed the protocol of performing computed tomography, magnetic cholangioresonance, and finally ERCP. RESULTS: Of 61 patients with choledocholithiasis, the following groups were compared: the appearance of cholangitis, the complications after ERCP, time of ERCP, days of hospital stay and mortality. Obtaining significant difference in: "complications post ERCP" group ASGE 3/35 (9%), group no ASGE 8/26 (30.7%) with OR of 0.2 (0.05 - 0.9 IC 95%) and a p = 0.03; "Cholangitis" group ASGE 2/35 (5.7%), group no ASGE 8/26 (30-7%) with ORP 0.13 (0.03-0.71 IC 95%) and p = 0.009. CONCLUSION: In our setting, the use of the ASGE guideline reduces the presence of cholangitis and post-ERCP complications.
ANTECEDENTES: La coledocolitiasis es una de las principales complicaciones de la colelitiasis, con una prevalencia en la población mexicana del 14%. El manejo a través de la guía propuesta por la American Society for Gastrointestinal Endoscopy (ASGE) en 2010 puede apoyar al cirujano para la resolución oportuna de la patología. OBJETIVO: Determinar que el uso de la guía de la ASGE para el manejo de coledocolitiasis en pacientes con «alto riesgo¼ reduce las complicaciones de esta patología. MÉTODO: Estudio comparativo, retrospectivo, de casos y controles, del 1 de enero de 2015 al 31 de diciembre de 2017. Se incluyeron pacientes que se estratificaron en alto riesgo de coledocolitiasis de acuerdo con la guía ASGE y se dividieron en dos grupos: el grupo de casos (diagnóstico por guía ASGE) fue sometido directamente a colangiopancreatografía retrógrada endoscópica (CPRE), y el otro grupo (no ASGE) siguió el protocolo de realizar tomografía computarizada, colangiorresonancia magnética y finalmente CPRE. RESULTADOS: De 61 pacientes con coledocolitiasis, se comparó entre los grupos la aparición de colangitis, las complicaciones posteriores a la CPRE, el tiempo de realización de la CPRE, los días de estancia hospitalaria y la mortalidad. Se obtuvo diferencia significativa en complicaciones tras la CPRE (grupo ASGE 3/35 [9%], grupo no ASGE 8/26 [30.7%]; odds ratio [OR]: 0.2; intervalo de confianza del 95% [IC 95%]: 0.05-0.9; p = 0.03) y en colangitis (grupo ASGE 2/35 [5.7%], grupo no ASGE 8/26 [30-7%]; OR: 0.13; IC 95%: 0.03-0.71; p = 0.009). CONCLUSIÓN: En nuestro medio, el empleo de la guía ASGE reduce la presencia de colangitis y las complicaciones tras la CPRE.
Assuntos
Colangite/prevenção & controle , Coledocolitíase/diagnóstico por imagem , Endoscopia do Sistema Digestório/normas , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colangiopancreatografia Retrógrada Endoscópica/normas , Colangite/etiologia , Coledocolitíase/complicações , Coledocolitíase/mortalidade , Estudos Transversais , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/mortalidade , Endoscopia Gastrointestinal/normas , Feminino , Humanos , Tempo de Internação , Imageamento por Ressonância Magnética , Masculino , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia. METHODS: Naïve or previously treated patients were included between February 2016 and April 2018.âA small-caliber (5.9âmm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed. RESULTS: 45 patients were included, aged 45.5 years (interquartile range [IQR] 22â-â69); 53â% (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37â-â77) and median myotomy length was 13.5âcm (IQR 6â-â20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 (Pâ<â0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5âmmHg (Pâ<â0.001), and timed barium esophagram (TBE) 100â% severely delayed vs. 86â% normal (Pâ<â0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52â-â77]). Reflux was confirmed at 3 months clinically in 17â% of patients, endoscopically in 20â%, and on pH monitoring in 53â%. At 6 months and 12 months, 40â% and 33â% of patients remained positive on pH monitoring and were medically managed. CONCLUSIONS: Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.
Assuntos
Endoscópios , Endoscopia do Sistema Digestório , Acalasia Esofágica , Refluxo Gastroesofágico , Miotomia , Cirurgia Endoscópica por Orifício Natural , Complicações Pós-Operatórias/diagnóstico , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/instrumentação , Endoscopia do Sistema Digestório/métodos , Desenho de Equipamento , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/epidemiologia , Acalasia Esofágica/cirurgia , Monitoramento do pH Esofágico/métodos , Monitoramento do pH Esofágico/estatística & dados numéricos , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Humanos , Masculino , México , Pessoa de Meia-Idade , Miotomia/efeitos adversos , Miotomia/instrumentação , Miotomia/métodos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/instrumentação , Cirurgia Endoscópica por Orifício Natural/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos RetrospectivosRESUMO
Antecedentes: la videocolonoscopia es un procedimiento imprescindible para el diagnóstico y tratamiento de afecciones colorrectales que forma parte de los recursos del cirujano. Posee un índice de complicaciones que pueden ser graves y requieren un adecuado manejo. Objetivo: analizar la experiencia de complicaciones de once años de un equipo quirúrgico realizando videocolonoscopia, con revisión de la bibliografía actual. Material y métodos: análisis retrospectivo consecutivo sobre una base de datos prospectiva. Entre enero de 2005 y diciembre de 2016 se realizaron endoscopias digestivas altas y bajas, diagnósticas y terapéuticas. Se analizan puntualmente las complicaciones de las videocolonoscopias y su manejo por parte del equipo quirúrgico. Resultados: de 3218 videocolonoscopias, 8 pacientes registraron complicaciones (0,2%). Todas fueron perforaciones colónicas resueltas mediante cirugía, con rafia primaria y operación tipo Hartmann. No hubo mortalidad en la serie. Conclusiones: si bien los procedimientos endoscópicos tienen efectos adversos, pueden ser llevados a cabo con estándares de calidad por cirujanos. Es importante que el equipo actuante esté capacitado para la resolución de complicaciones.
Background: colonoscopy is essential for the diagnosis and treatment of colorectal conditions, and is part of the surgeon's resources. Complications associated with the procedure could be severe, and require an appropriate management. Objective: to analyze complications associated with colonoscopies done by a surgical team. Material and method: retrospective analysis on a prospective database. Diagnostic and therapeutic colonoscopies done by a surgical team between January 2005 and December 2016 were included. Complications and management strategies were analyzed. Results: of 3218 colonoscopies, 8 patients presented complications (0.2%). All were colon perforations solved by surgery, with primary closure and a kind of Hartmann's procedure. There was no mortality In this series. Conclusions: although endoscopic procedures may have adverse effects, they can be done under standards of quality by surgeons. It is important that the intervening team be qualified for the solution of complications.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Morbidade , Colonoscopia/efeitos adversos , Endoscopia por Cápsula/efeitos adversos , Estudos Retrospectivos , Estudos Longitudinais , Endoscopia do Sistema Digestório/efeitos adversos , HemorragiaRESUMO
ABSTRACT We present two cases of esophageal papillomatosis, a very rare reported disease leading to dysphagia and did not improve after endoscopic treatment. Both patients refused surgery and they were followed-up for 3 years, but no significant clinical or endoscopic changes were seen.
RESUMO Apresentamos dois casos de papilomatose esofágica, lesão raramente relatada, que pode levar à disfagia, e que não teve melhora após tratamento endoscópico. Ambos os pacientes recusaram cirurgia e foram acompanhados por até 3 anos, sem alterações clínicas ou endoscópicas importantes.
Assuntos
Humanos , Feminino , Idoso , Papiloma/diagnóstico , Neoplasias Esofágicas/diagnóstico , Transtornos de Deglutição/diagnóstico , Endoscopia do Sistema Digestório , Papiloma/complicações , Neoplasias Esofágicas/complicações , Transtornos de Deglutição/etiologia , Endoscopia do Sistema Digestório/efeitos adversosRESUMO
We present two cases of esophageal papillomatosis, a very rare reported disease leading to dysphagia and did not improve after endoscopic treatment. Both patients refused surgery and they were followed-up for 3 years, but no significant clinical or endoscopic changes were seen.
Assuntos
Transtornos de Deglutição/diagnóstico , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/diagnóstico , Papiloma/diagnóstico , Idoso , Transtornos de Deglutição/etiologia , Endoscopia do Sistema Digestório/efeitos adversos , Neoplasias Esofágicas/complicações , Feminino , Humanos , Papiloma/complicaçõesRESUMO
Introdução e objetivos: a Endoscopia Digestiva Alta (EDA) representa o método de endoscopia mais usado, e geralmente é realizada sob sedação consciente. Dentre os efeitos adversos (EA) deste exame, os eventos cardiorrespiratórios são os que implicam maior importância, representando cerca de 60% do total, estando relacionados a fatores predisponentes dos pacientes, tais como obesidade, idade e doenças pulmonares prévias. Assim, considerando-se a relevância dos fatores de risco (FR) relacionados ao paciente e seus possíveis efeitos na morbimortalidade geral do procedimento, objetiva-se com o presente trabalho epidemiológico traçar o perfil do paciente que se submete à EDA no Brasil. Métodos: o estudo é transversal com amostragem aleatória de 974 pacientes submetidos à EDA eletiva. O questionário foi aplicado entre janeiro de 2013 e junho de 2013. Resultados: a média de idade foi de 40,88 anos, sendo 11,50% acima dos 60 anos. A média do IMC foi de 26,21kg/m², com 53,18% dos entrevistados apresentando sobrepeso ou obesidade. As morbidades encontradas incluíram hipertensão arterial sistêmica (N=152); outras doenças cardíacas (N=35); doenças respiratórias (N=599); diabetes mellitus (N=43); doença tireoidiana (N=68). Os principais medicamentos utilizados foram os benzodiazepínicos (4,93%) ou outros neuropsiquiátricos, somando 11,59%. O uso de álcool foi relatado por 37,39% e 5,54% eram tabagistas. Apenas 19,40% dos pacientes não apresentavam alguma enfermidade coexistente ou FR. Conclusão: considerando-se a endoscopia e a sedação envolvida, a atenção às variações demográficas e epidemiológicas populacionais assume especial importância, visto que estão diretamente relacionadas ao aumento da probabilidade de ocorrência de EA cardiorrespiratórios durante e após o procedimento. As conclusões deste trabalho devem ser entendidas à luz de seu local de realização, que é uma unidade ambulatorial.
Background: the Upper Gastrointestinal Endoscopy (UGE) represents the most common endoscopic modality and it is usually made with conscious sedation. Among the adverse events of this procedure, the cardiovascular events are the most relevant, comprising around 60% of overall events. It is known that some adverse events are related to patient's risk factors, such as obesity, age and pulmonary disease. Thus, considering the importance of risk factors and their impact in the morbimortality related to the procedure, the aim of this study is to know the epidemiological profile of the patients that need an endoscopy in Brazil. Methods: it is a sectional study with an aleatory sample of 974 patients that was submitted to an elective UGE in the period of January of 2013 and June of 2013. A questionnaire was applied to each individual. Results: the average age of the study was 40.88 years old, with 11.50% being over 60 years old. The body mass index (BMI) average was 26.21 kg/m² among which 53.18% of the interviewed could be classified as overweight or obese. The morbidities founded were high blood pressure (N=152); other cardiac diseases (N=35); respiratory diseases (N=599); diabetes mellitus (N=43); thyroid diseases (N=68). The most used drugs were benzodiazepines (4.93%) or other psychiatric drugs, comprising 11.59%. The use of alcohol was mentioned by 37.39% and 5.54% were smokers. Only 19.40% amongst the patients did not mention any comorbidity or risk factor to the procedure. Conclusion: considering the endoscopy and the sedation involved in the procedure, knowing the demographic and epidemiological differences between populations are of special importance, since they are related to the cardiorespiratory adverse events that can occur during and after an UGE. The conclusions of this study should be interpreted taking into account that it was made in an ambulatory unity.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Perfil de Saúde , Estudos Epidemiológicos , Fatores de Risco , Sedação Consciente , Sedação Consciente/efeitos adversos , Endoscopia do Sistema Digestório , Endoscopia do Sistema Digestório/efeitos adversos , Estudos Transversais , Inquéritos e Questionários , Assistência AmbulatorialRESUMO
INTRODUCTION: In Bouveret's syndrome, a biliary stone obstructs the duodenum. Surgical treatment is plagued by high morbidity and mortality. Therefore, endoscopic treatment has become a first-line approach. Areas covered: A literature search of Medline and Google Scholar databases was performed using the terms endoscopic treatment, non-operative treatment, Bouveret's syndrome, and gallstone ileus. Sixty-one cases of successful endoscopic treatment were found over the period 1978-2016 and are summarized herein. Therapeutic modalities used in 52 patients with complete success included mechanical lithotripsy (40% of cases), electrohydraulic lithotripsy (21% of cases), extraction of the intact stone and laser lithotripsy (15% of cases each), extracorporeal shockwave lithotripsy and duodenal stenting (4% of cases each). In the remaining 9 patients, stone fragments migrated distally and required surgical removal. Cholecystectomy was performed in five (8.2%) of 61 patients and gallbladder cancer was detected in three (4.9%) patients. Expert commentary: Meticulous preparation, including that of instruments, personnel, patient anesthesia, and X-ray availability, is key to success in this unusual situation. Partial success (stone fragmentation and mobilization to another location) may render surgery easier as these patients present with dense adherences in the right upper quadrant. Cholecystectomy is reserved for highly selected patients (e.g. relapsing ileus, gallbladder cancer).
Assuntos
Colecistectomia , Obstrução Duodenal/terapia , Endoscopia do Sistema Digestório , Cálculos Biliares/terapia , Litotripsia , Stents , Idoso , Idoso de 80 Anos ou mais , Colecistectomia/efeitos adversos , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/métodos , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Humanos , Litotripsia/efeitos adversos , Litotripsia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Síndrome , Resultado do TratamentoRESUMO
BACKGROUND: Duodenal hematoma (DH) is a rare complication of esophagogastroduodenoscopy (EGD) with duodenal biopsy and uncommon, but better described following blunt abdominal trauma (BAT). We aimed to describe DH incidence and investigate risk factors for DH development post-EGD and compare its features to those post-BAT. METHODS: Multiple electronic databases were searched for the diagnosis of DH from 2000 to 2012. Inclusion criteria were patients 0 to 21 years of age who developed a DH following EGD with biopsy or BAT. Exclusion criteria were DH secondary to any other mechanism, EGD performed at another medical center, and insufficient information in the electronic medical record to determine treatments or outcomes. RESULTS: A total of 14 post-EGD and 15 post-BAT patients with DH were included in the study. There were 26,905 EGDs with duodenal biopsies performed during the study period, for an incidence of 1:1922 procedures. Thirteen of 14 (93%) post-EGD DH events occurred between 2007 and 2012 (Pâ<â0.001). The proportion of procedures performed under general anesthesia versus moderate sedation, and performed in the supine position versus left lateral decubitus were close to but did not reach statistical significance. DH-related complications and time to hematoma resolution was similar between groups. CONCLUSIONS: In a 13-year study period, 14 patients developed DH after EGD, for an incidence of 1:1922. Method of sedation and supine positioning of the patient during endoscopy warrant further investigation as potential risks. The clinical course and time to recovery with conservative management are similar between patients with EGD and BAT-induced DH.
Assuntos
Duodenopatias/epidemiologia , Endoscopia do Sistema Digestório/efeitos adversos , Hemorragia Gastrointestinal/epidemiologia , Hematoma/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Adolescente , Biópsia/efeitos adversos , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Duodenopatias/diagnóstico , Duodenopatias/etiologia , Duodenopatias/patologia , Duodeno/lesões , Duodeno/patologia , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/patologia , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/patologia , Hospitais Pediátricos , Humanos , Incidência , Lactente , Mucosa Intestinal/lesões , Mucosa Intestinal/patologia , Masculino , Philadelphia/epidemiologia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/patologia , Estudos Retrospectivos , Fatores de Risco , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/fisiopatologiaRESUMO
Iatrogenic perforation during endoscopy is associated to significant morbidity and mortality, and presents a high incidence due to the increasing number of endoscopic procedures and the frequency of complex therapeutic procedures. Evidence available to decide which is the best strategy to manage patients with iatroenic perforation is scarce, mainly due to rare occurrence of this complication. The European Society of Gastroenterology (ESGE) published their Position Statement on Diagnosis and management of iatrogenic endoscopic perforations including recommendations for developing a strategy for the prevention and management of iatrogenic perforations in the gastrointestinal tract. Among the multiple recommendations, the following have shown a reduction in the morbi-mortality rate: implementing a written protocol on the management of these complications; including information on their location, and initial endoscopic management; carrying out a CT if signs or symptoms are present; attempting endoscopic closure, depending on the type of perforation, its size and endoscopic expertise; change to CO2 insufflation; derivation of luminal contents and decompression of pneumoperitoneum or pneumothorax; and finally, considering additional management based on successful closure of the perforation and on the patients clinical condition, as well as early surgical resolution if no endoscopic closure is performed or if the procedure fails in patients with poor clinical condition.
La perforación iatrogénica durante los procedimientos endoscópicos se asocia a significativa morbilidad y mortalidad y presenta una incidencia creciente por el alto número exploraciones endoscópicas y la realización cada vez más frecuente de procedimientos terapéuticos complejos. La evidencia disponible para decidir cuál es la mejor estrategia para manejar a los pacientes con una perforación iatrogénica es escasa, principalmente debido a lo inhabitual de esta complicación. La Sociedad Europea de Endoscopia Gastrointestinal (ESGE) publicó su Declaración de Posición de Diagnóstico y Manejo de Perforaciones Endoscópicas Iatrogénicas en la que formula diversas recomendaciones para desarrollar una estrategia de prevención y manejo de perforaciones iatrogénicas del tubo digestivo. Dentro de las principales recomendaciones, las siguientes han demostrado una reducción en la morbimortalidad: implementar un protocolo escrito sobre el manejo de estas complicaciones; incluir en el informe datos sobre su tamaño, localización y manejo endoscópico inicial; la realización de una tomografía computada ante síntomas o signos sugerentes; intentar el cierre endoscópico, dependiendo del tipo de perforación, su tamaño y la experiencia endoscópica disponible; el cambio a insuflación con CO2; la derivación del contenido luminal y la descompresión del neumoperitoneo o neumotórax a tensión; y finalmente, basar el manejo adicional en el éxito estimado del cierre y en la condición clínica del paciente, considerando la resolución quirúrgica precoz en caso de no realizar un cierre endoscópico o falla de éste y/o en pacientes con deterioro clínico.
Assuntos
Humanos , Endoscopia do Sistema Digestório/efeitos adversos , Perfuração Intestinal/etiologia , Colonoscopia/efeitos adversos , Guias como AssuntoRESUMO
BACKGROUND: significant advances in medical therapy for Crohn's disease (CD) occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series. METHODS: this was a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD) referral center, treated between January 2008 and June 2012 with laparoscopic approach (LA) or conventional approach (CA). VARIABLES ANALYZED: age at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LA or CA), and complication rates and characteristics were compared. Statistical analysis was performed with Mann-Whitney test (quantitative variables) and chi-square test (qualitative variables), with p < 0.05 considered significant. RESULTS: a total of 46 patients (25 men) were included (16 submitted to LA), with mean age of 38.1 (± 12.7) years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CA group (p = 0.029). The most common procedure performed was ileocolic resection on both groups (56.7% of the CA and 75% of the LA patients - p = 0.566). Overall, total complications (surgical and medical, including minor and major issues) occurred in 60% (18/30) of the CA group and 12.5% (2/16) of the LA group (p = 0.002). Wound infection was the most frequent complication (10/30 on CA and 1/16 on the LA groups). There were 3 deaths in the CA group. Specific analysis of each complication did not demonstrate any difference between the groups regarding abdominal sepsis, urinary tract infections, pneumonia, readmission, reoperations and deaths (p = 0.074). CONCLUSIONS: there was a higher complication rate in patients operated with CA as compared to LA. This was probably due to patient selection for the laparoscopic approach, with severe cases, mostly due to fistulizing abdominal CD, being operated mainly by open surgery. LA tends to be the recommended approach in most cases of non-complicated CD. (AU)
INTRODUÇÃO: avanços significativos no tratamento medicamentoso da doença de Crohn (DC) ocorreram nos últimos 12 anos, principalmente após a introdução da terapia anti-TNF. A cirurgia laparoscópica colorretal representa um dos maiores progressos no tratamento cirúrgico minimamente invasivo da DC, bem como no manejo de outras afecções. Existe uma tendência a menores taxas de complicações com as ressecções intestinais laparoscópicas quando comparadas a cirurgia convencional. O objetivo deste estudo foi analisar e comparar as taxas de complicações após ressecções intestinais na DC entre as duas vias de acesso em uma série de casos brasileira. MÉTODO: estudo retrospectivo longitudinal, incluindo pacientes com DC submetidos a ressecções intestinais em um centro de referência brasileiro em doença inflamatória intestinal (DII), tratados entre janeiro de 2008 e junho de 2012, com cirurgia laparoscópica (CL) ou cirurgia convencional (CC). As variáveis analisadas foram: idade no momento da cirurgia, gênero, classificação de Montreal, tabagismo, medicações concomitantes, tipo de cirurgia, via de acesso, presença e tipo de complicação em até 30 dias do procedimento. Readmissão, reoperações e mortalidade também foram avaliadas. Os pacientes foram alocados em dois grupos de acordo com a via de acesso (CL ou CC), sendo as taxas de complicações comparadas entre si. Análise estatística foi realizada pelos testes de Mann-Whitney (variáveis quantitativas) e chi-quadrado (qualitativas), com p<0.05 considerado significativo. RESULTADOS: No total, 46 pacientes (25 homens) foram incluídos (16 operados por CL), com média de idade de 38,1 (± 12,7) anos. Os grupos foram considerados homogêneos em relação à idade, gênero, localização da doença, DC perianal e medicações concomitantes. Houve predomínio da forma fistulizante no grupo de cirurgias abertas (p = 0.029). O procedimento mais realizado foi a ileocolectomia direita em ambos os grupos (56,7% na CC e 75% na CL - p = 0.566). No total, complicações pós-operatórias (cirúrgicas e clínicas) ocorreram em 60% (18/30) dos casos após CC e 12,5% (2/16) após a CL (p = 0.002). Infecção da ferida operatória foi a complicação mais frequente (10/30 na CC e 1/16 na CL). Ocorreram 3 óbitos no grupo da CC. Em análise individualizada das complicações, não houve diferença entre os grupos em relação a sepse abdominal, infecções urinárias, pneumonia, reinternações, reoperações e óbitos (p=0.074). CONCLUSÕES: houve maior taxa de complicações nos pacientes operados por CC comparado a CL. A seleção de casos para cirurgia laparoscópica provavelmente contribuiu para este resultado, havendo uma tendência a utilização da cirurgia convencional nos casos mais graves, geralmente com DC abdominal fistulizante. A CL parece ser a via de acesso recomendada na maioria dos casos de DC não-complicada. (AU)
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Doença de Crohn/cirurgia , Endoscopia do Sistema Digestório/efeitos adversos , Perfil de Saúde , Estudos Retrospectivos , LaparoscopiaRESUMO
BACKGROUND: Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0-4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complications, and postoperative pain of LESS compared with those of laparoscopic cholecystectomy (LC). METHODS: A prospective randomized controlled study was conducted between January and June 2011 at two university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients were randomly assigned to undergo laparoscopic or LESS cholecystectomy. Skin and aponeurosis wound sizes were recorded. A 10-point visual analog scale (VAS) was used to assess pain at postoperative hours 3 and 24. Healing and wound complications were assessed at follow-up. RESULTS: A total of 57 patients, 53 women and 4 men with a mean age of 48.7 years, were randomly assigned to undergo LESS (n = 28) or LC (n = 29). The mean length of the umbilical skin incision was 4.0 cm (range = 2.1-5.8) in LESS and 2.7 cm (1.5-5.1) in LC (p < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0-5.5) in LESS and 2.3 cm (1.2-3.5) in LC (p < .0001). The mean operative time was 60.3 min (32-128) for LESS and 51.3 min (25-120) for LC (p = 0.11). Gallbladder perforation at detachment occurred in 15.69 % of the LESS cases and in 5.88 % of the LC cases (p = 0.028). The mean VAS score for pain at hour 3 was 2.0 points (0-7) for the LESS group and 4.0 (0-10) for the LC group (p = 0.07), and at postoperative hour 24 it was 0.3 points (0-6) for LESS and 2.3 (0-10) for LC (p = 0.03). There were no significant differences in wound complications. Incisional hernias were not found in either group. CONCLUSIONS: The LESS single-port (SP) operations demand a bigger incision than LC surgery. However, there were no differences in healing, wound infections, and hernia development. We found a tendency of less postoperative pain associated with LESS/SP than with LC.
Assuntos
Colecistectomia Laparoscópica/métodos , Endoscopia do Sistema Digestório/métodos , Doenças da Vesícula Biliar/cirurgia , Dor Pós-Operatória/etiologia , Umbigo/cirurgia , Adolescente , Adulto , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Endoscopia do Sistema Digestório/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Adulto JovemRESUMO
Upper gastrointestinal endoscopy has been increasingly used in children for various diagnostic and therapeutic purposes. But this has not always been a morbidity free procedure especially in small kids. Three patients who presented with history of endoscopic intervention followed by abdominal pain and radiographic evidence of free air under diaphragm were managed conservatively over a period of two years.
Assuntos
Duodeno/lesões , Endoscopia do Sistema Digestório/efeitos adversos , Perfuração Intestinal/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Perfuração Intestinal/diagnóstico , MasculinoRESUMO
UNLABELLED: BACKGROUND/GOAL: Self-expandable metallic stents can be used to reestablish luminal continuity in patients with malignancy of the esophagus, gastric outlet, or colon who are at high risk for surgical intervention. Data regarding their complication profiles remain incomplete. Our aim was to evaluate the feasibility and complications of endoscopic stenting in esophageal, gastroduodenal, and colonic malignancies. STUDY: Between January 2003 and December 2005, 153 patients underwent 182 endoscopic procedures for insertion of 199 metallic stents in a single referral center. Complications were assessed retrospectively. RESULTS: The mean follow-up was 170 days. The mortality was 73.9% (113 patients), 105 cases between 1 and 60 weeks after the procedure (median survival, 17 wk), but none directly related to the stent placement. One single stent was required in 115 (75%) patients, and 37 (24.2%) cases required an overlapping stent. The procedure was unsuccessful in only 1 case of colonic obstruction. Thirty-eight (26.6%) patients developed 52 complications, of which 16 (9.4%) procedure-related complications (perforation, 5; migration, 5; obstruction, 3; misplacement, 2; and hemorrhage, 1) and 36 (21.3%) late complications (obstruction, 20; migration, 9; fistula, 6; and perforation, 1). Eight (5.6%) patients experienced more than 1 complication. Five (3.5%) cases required surgery (colon: 2 perforations, 1 fistula, and 1 obstruction; esophagus: 1 perforation). No significant difference on the complication rates was found for any site in which a metallic stent was inserted. CONCLUSIONS: Endoscopic stenting for palliation of digestive cancer, despite a reasonable complication rate, is feasible in most patients. Most dysfunctions are not life-threatening and can be managed endoscopically.
Assuntos
Neoplasias Colorretais/cirurgia , Neoplasias Duodenais/cirurgia , Neoplasias Esofágicas/cirurgia , Stents/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Neoplasias Duodenais/mortalidade , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/métodos , Neoplasias Esofágicas/mortalidade , Feminino , Seguimentos , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos , Estudos RetrospectivosRESUMO
El neumomediastino espontáneo es un trastorno infrecuente que, por lo general, ocurre en personas jóvenes sin un factor o una enfermedad evidente precipitante. El término espontáneo se refiere a la ausencia de trauma u otros procesos patológicos identificables que expliquen el origen del neumomediastino. Se presenta el caso de un paciente masculino de 29 años de edad, ingresado en el Hospital Escuela, quien luego de presentar crisis convulsivas secundarias a síndrome de abstinencia inicia con dolor torácico,disnea y crepitación subcutánea; la radiografía de tórax reveló enfisema subcutáneo y aire libre en la cavidad torácica, se realizó varios exámenes entre ellos una TAC de tórax que confirmó el hallazgo. Se concluyó que presentó neumomediastino espontáneo. La evolución fue satisfactoria.
Assuntos
Humanos , Masculino , Adulto , Enfisema Mediastínico/diagnóstico , Enfisema Subcutâneo/diagnóstico , Endoscopia do Sistema Digestório/efeitos adversos , Tomografia/métodosRESUMO
El neumomediastino espontáneo es un trastorno infrecuente que, por lo general, ocurre en personas jóvenes sin un factor o una enfermedad evidente precipitante. El término espontáneo se refiere a la ausencia de trauma u otros procesos patológicos identificables que expliquen el origen del neumomediastino. Se presenta el caso de un paciente masculino de 29 años de edad, ingresado en el Hospital Escuela, quien luego de presentar crisis convulsivas secundarias a síndrome de abstinencia inicia con dolor torácico,disnea y crepitación subcutánea; la radiografía de tórax reveló enfisema subcutáneo y aire libre en la cavidad torácica, se realizó varios exámenes entre ellos una TAC de tórax que confirmó el hallazgo. Se concluyó que presentó neumomediastino espontáneo. La evolución fue satisfactoria.
Assuntos
Humanos , Masculino , Adulto , Enfisema Mediastínico/diagnóstico , Enfisema Subcutâneo/diagnóstico , Tomografia/métodos , Endoscopia do Sistema Digestório/efeitos adversosRESUMO
O estudo teve como objetivo descrever o padrão de uso de antiinflamatórios não-esteróides (AINE) por pacientes encaminhados para endoscopia digestiva alta no Hospital das Clínicas/UFMG, Belo Horizonte/MG. Trata-se de um estudo transversal de uma amostra de 533 pacientes com idade igual ou superior a 17 anos, com endoscopia previamente marcada. Os dados foram coletados por meio de questionário padronizado. As variáveis estudadas foram relativas aos antiinflamatórios não-esteróidese ao seu modo de uso. Cerca de 34% dos entrevistados relatou uso de AINE no período de um mês anterior à endoscopia. Os AINE mais utilizados foram o ácido acetilsalicílico e o diclofenaco e o uso caracterizou-se, principalmente, pela forma esporádica e por período inferior a sete dias. Entre os AINE que foram utilizados por período prolongado, foram mais frequentes o uso em dose diária elevada e o uso de mais de uma especialidade. Evidenciou-se um cenário de utilização inadequada destes medicamentos entre os pacientes estudados, caracterizado pelo uso de especialidades desaconselhadas, uso de AINE em indicações inadequadas, uso de associações medicamentos as questionáveis e uso desnecessário de especialidades dispendiosas em detrimento daquelas seguras e mais acessíveis. Os resultados apontam para a necessidade de estudos adicionais, a fim de maior aprofundamento no conhecimento dessa questão no Brasil.
The objective of this study was to describe the pattern of use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients referred for upper endoscopy at the Teaching Hospital of the Federal University of Minas Gerais, Belo Horizonte, Brazil. This cross-sectional survey included 533 patients, aged 17 or older, whose endoscopies had been previously scheduled. A standardized questionnaire was used to collect the data, which related to the nonsteroidal anti-inflammatory drugs taken and the way in which they were used. Almost 34% of the interviewed subjects reported having taken NSAIDs during the month prior to the endoscopy. The NSAIDs used most were acetylsalicylic acid and diclofenac and their pattern of use was characterized, in the main, by sporadic use over a period of less than seven days. Among the NSAIDs taken for long periods of time (> 30 dias), a commonly observed pattern was high daily doses and more than one kind of drug. The general picture that emerged was of inappropriate use of these medicines among the studied patients, typically the use of non-recommended types of drug, inappropriate use of NSAIDs for certain conditions, use of questionable drug combinations and the unnecessary use of expensive drugs despite the availability of safer and cheaper alternatives. The results point to the need to carry out more research, to improve our understanding of this question in Brazil.