Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure

A 65-year-old man was evaluated for a difficult-to-characterize pancreatic head mass in the setting of idiopathic chronic pancreatitis. He had no other relevant medical history and was not taking any anticoagulant or antiplatelet treatment. Endoscopic ultrasonography fine-needle aspiration (EUS-FNA) failed to reveal neoplasm cells. A linear array echoendoscope (Olympus GF-UCT140, Center Valley, PA) was advanced up to the duodenal bulb, from which the head of the pancreas was visualized. After ensuring a vessel-free access to the pancreatic parenchyma, the FNA was performed using a 22G needle (Slimline 22G Handle Needle; Boston Scientific, Marlborough, MA) with a total of 3 passes (Figure 1). Three weeks after this procedure, the patient was admitted for hematemesis preceded by vomiting. On admission, his general physical examination was unremarkable except for jaundice. His blood tests showed no anemia; his platelet count, prothrombin time, amylase, and liver enzymes were within normal range, but his total bilirubin level was elevated (7.4 mg/dL). Upper gastrointestinal endoscopy showed Mallory-Weiss tears, an evident extrinsic compression of the knee, and the second portion of the duodenum, which could not be passed by the endoscope. The investigation by computed tomography and magnetic resonance cholangiopancreatography led to the diagnosis of an 11-cm intramural duodenal hematoma (IDH), leading to both gastric outlet and main biliary duct obstruction (Figure 2). The case was successfully managed with nasogastric decompression and exclusive parenteral feeding. Symptoms improved within 15 days, and cholestasis progressively disappeared.info:eu-repo/semantics/publishedVersio

Vanek tumor -endo-laparoscopic approach

:Vanek’s tumor was first reported in 1949 as a benign gastrointestinal (GI) submucosal alteration, being more prevalent at the stomach (70%) and ileum (20%). This entity corresponds to 0.1% of all gastric polyps, and its diagnosis is mostly incidental when searching for an upper gastrointestinal bleeding cause. The authors present a case and iconography of a Vanek lesion

Comentário a “O papel da oxigenoterapia hiperbárica nas úlceras retais secundárias à terapêutica com árgon-plasma”

Dear Editor, We read with great interest the paper by Laranjo et al. [1] entitled “The Effect of Hyperbaric Oxygen Therapy on Rectal Ulcers after Argon Plasma Coagulation.” The authors reported the case of a patient with chronic radiation proctitis, who developed rectal ulcers after endoscopic treatment with argon plasma coagulation (APC) and was successfully treated with hyperbaric oxygen therapy (HBO). Although it is well established that HBO therapy is an effective alternative treatment for patients with radiation-induced rectal ulcers and severe chronic proctitis [2, 3], its application has not been described as a treatment option in APC-induced rectal ulcers. We acknowledge the authors’ awareness of HBO as an option for complications induced by conventional chronic proctitis treatments and we would like to share our experience on this particular matter. A 72-year-old female patient was admitted to our Emergency Department with rectal bleeding, acute anal pain, and iron deficiency anemia (hemoglobin 10.7 g/dL). She had a past medical history of endometrial carcinoma treated with radio- and brachytherapy 2 years before. Total colonoscopy revealed multiple bleeding rectal radiation-induced telangiectasias. Medical treatment with topical salicylates and sucralfate for 8 months was unsuccessful and APC therapy (45 W; 1.5 L/min gas flow) every 4 weeks was initiated. The patient was submitted to a total of 6 APC sessions, with an overall endoscopic improvement between the first and third sessions. However, amidst the fourth and sixth APC sessions, the patient developed multiple APC-induced ulcers and an ulcerated stenosis of the distal rectum.info:eu-repo/semantics/publishedVersio

Exploring the ways of “The great imitator”: a case report of Syphilitic Hepatitis

Introduction: Syphilis is a chronic infection caused by Treponema pallidum. Manifestations of this disease are vast, and syphilitic hepatitis is a rarely depicted form of secondary syphilis. Case Presentation: We report the case of a 63-year-old man with worsening jaundice, maculopapular rash and perianal discomfort. Proctological examination with anoscopy revealed a perianal gray/white area with millimetric pale granules along the anal canal. Liver function tests showed a mixed pattern. Venereal Disease Research Laboratory, T. pallidum hemagglutination assay and IgM fluorescent treponemal antibody absorbance were positive. The patient was successfully treated with a single dose of penicillin G. Discussion/Conclusion: Syphilitic hepatitis is scarcely reported in the literature. Secondary syphilis with mild hepatitis rarely leads to hepatic cytolysis and jaundice. Many signs of secondary syphilis including syphilitic hepatitis may be linked to immune responses initiated during early infection. Over the past decades, evidence has emerged on the importance of innate and adaptive cellular immune responses in the immunopathogenesis of syphilis. This report raises awareness to a clinical entity that should be considered in patients at risk for sexually transmitted diseases, who present with intestinal discomfort or liver dysfunction, as it is a treatable and fully reversible condition.info:eu-repo/semantics/publishedVersio

Towards a greener endoscopy: considerations on the strategies to improve sustainability

Climate crisis is dramatically changing life on earth. Environmental sustainability and waste management are rapidly gaining centrality in quality improvement strategies of healthcare, especially in procedure- dominant fields such as gastroenterology and digestive endoscopy. Therefore, healthcare interventions and endoscopic procedures must be evaluated through the ‘triple bottom line’ of financial, social, and environmental impact. The purpose of the paper is to provide information on the carbon footprint of gas- troenterology and digestive endoscopy and outline a set of measures that the sector can take to reduce the emission of greenhouse gases while improving patient outcomes. Scientific societies, hospital execu- tives, single endoscopic units can structure health policies and investment to build a “green endoscopy”. The AIGO study group reinforces the role of gastrointestinal endoscopy professionals as advocates of sus- tainability in digestive endoscopy. The “green endoscopy” can shape a more sustainable health service and lead to an equitable, climate-smart, and healthier future.info:eu-repo/semantics/publishedVersio

Today, in the endoscopist hands

Endoscopic submucosal dissection (ESD) was first described as a non-surgical promise for early gastric epithelial lesions

Short Inflammatory Bowel Disease Questionnaire: translation and validation to the Portuguese language

Background The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is a widely used instrument to assess Health-related Quality of Life (HRQoL) among inflammatory bowel disease (IBD) patients. Our aim was to translate and adapt the SIBDQ so that it could be adequately used in Portugal. Methods This is a prospective design cohort study undertaken at a tertiary hospital. This study took place simultaneously with the first part of the SexIDI study, a study aiming to assess the impact of IBD on patients’ sexual QoL. The original SIBDQ was translated by two independent translators and adapted by an IBD expert panel following the opinions of a convenient sample of 5 IBD patients. Afterwards, IBD patients from the outpatient clinic were consecutively invited to fill the Portuguese version of the questionnaire (SIBDQ-PT) at three different timepoints (0, 2, 4 weeks). Ninety-two patients completed the SIBDQ-PT at baseline, whereas 33 did so after 2 and 4 weeks (approximately). Statistical analysis was performed using SPSS version 25, and the following aspects were analysed: reliability (through internal consistency, test–retest and intraclass correlation), validity (through exploratory factor analysis [EFA], and Pearson correlation coefficient for linear correlations), score distribution, and responsiveness analysis (through t-student tests). Results Overall, SIBDQ-PT was shown to have a high internal consistency (Cronbach's α = 0.80) and a high test–retest reliability (0.80 [CI 0.74–0.86] and 0.69 [CI 0.50–0.82]). EFA detected four dimensions—bowel, social, emotional and systemic. As expected, an overall SIBDQ-PT score was positively correlated with sexual satisfaction (r = 0.27; p < 0.05) and negatively correlated with depression (r = − 0.63; p < 0.01). Moreover, SIBDQ-PT was found to have an adequate score distribution, and to be responsive, as there was a significant subscore change for patients who reported an “overall worsening in general well-being” (0.93 ± 0.13 decrease; p < 0.01). Conclusions The Portuguese version of the SIBDQ hereby presented is a reliable, valid and responsive instrument that can be used to measure HRQoL among Portuguese IBD patients.info:eu-repo/semantics/publishedVersio

Minimally invasive treatment of gastric GIST by endo-laparoscopy

The gastrointestinal stromal tumor,s (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Surgery is the primary therapeutic approach. Objective: To present the results of patients undergoing combined endo-laparoscopic (ELC) approach as a minimally invasive treatment for gastric GIST

How many biomarker measurements are needed to predict prognosis in Crohn's disease patients under infliximab?—A prospective study

BackgroundTimely stratification of Crohn's disease (CD) is essential for patients' management. The use of noninvasive accurate biomarkers is key to monitor treatment and to pursue mucosal healing, the ultimate treatment endpoint in CD. ObjectiveWe aimed to evaluate the performance of readily available biomarkers and develop risk matrices to predict CD progression. MethodsData from 289 CD patients receiving infliximab (IFX) maintenance therapy for 2 years was collected; those patients were included in DIRECT, a prospective multicenter observational study. Disease progression was evaluated using two composite outcomes incorporating clinical and drug-related factors, the first including IFX dose and/or frequency adjustments. Univariate and multivariable logistic regressions were used to calculate the odds ratios (OR) and to develop risk matrices. ResultsThe isolated presence of anemia at least once during follow-up was a significant predictor of disease progression (OR 2.436 and 3.396 [p 10.0 mg/L) and fecal calprotectin (FC; >500.0 mu g/g) in at least one visit were also significant predictors, while milder elevations (3.1-10.0 mg/L and 250.1-500.0 mu g/g) were only relevant when detected in at least two visits (consecutive or not). The combination of biomarkers in risk matrices had good ability to predict progression; patients simultaneously presenting anemia, highly elevated CRP and FC at least once had 42%-63% probability of achieving the composite outcomes. ConclusionThe combined evaluation of hemoglobin, CRP, and FC in at least one time point and their incorporation into risk matrices seems to be the optimal strategy for CD management, as data from additional visits did not meaningfully influence the predictions and may delay decision-making.Portuguese Group of Studies in Inflammatory Bowel Disease (GEDII)info:eu-repo/semantics/publishedVersio