Retro-pneumoperitoneum and pneumomediastinum as a consequence of perforation of a duodenal diverticulum after upper digestive endoscopy

Resumen La enfermedad diverticular del duodeno es una entidad poco frecuente. Suele ser asintomática y descubrirse de manera incidental pero, cuando existe sintomatología, se relaciona con alguna complicación, encontrándose entre éstas la perforación iatrogénica por endoscopia digestiva alta. El diagnóstico precoz es fundamental para reducir la morbimortalidad, siendo la prueba de imagen de elección la TC abdominal, con visualización de gas extraluminal. Igualmente, el tratamiento debe ser precoz, y puede ser tanto conservador como endoscópico o quirúrgico, en función de la etiología y de la gravedad del paciente. Es importante que no se demore más allá de las 24 horas, debido a que el pronóstico dependerá directamente del intervalo de tiempo entre la perforación y el tratamiento.

GASTROESOPHAGEAL REFLUX DISEASE: A PRACTICAL APPROACH

ABSTRACT Gastroesophageal reflux disease (GERD) presents typical manifestations such as heartburn and/or regurgitation as well as atypical manifestations such as throat symptoms, laryngitis, hoarseness, chronic cough, asthma, and sleep alterations. There are two phenotypes of the disease: erosive GERD, when erosions are identified by upper digestive endoscopy, and non-erosive GERD, when the esophageal mucosa presents a normal endoscopic aspect. Relevant clinical findings are usually absent in the physical examination, but it should be highlighted that obesity is an important aggravating factor of reflux. The treatment is established based on clinical findings and, according to the clinical situation, on complementary exams such as upper digestive endoscopy. In dubious cases where a precise diagnosis is required, the indicated test is esophageal pHmetry or impedance-pHmetry. Clinical treatment is divided into behavioral/dietary measures and pharmacological measures. Most patients benefit from clinical treatment, but surgical treatment may be indicated in the presence of a larger hiatal hernia and complications of the disease.

Assessing Baveno VI Criteria Using Liver Stiffness Measured with a 2D-Shear Wave Elastography Technique

The present study evaluates the performance of Baveno VI criteria, using liver stiffness (LS) assessed with a 2D-SWE elastography technique, for predicting high-risk varices (HRV) in patients with compensated advanced chronic liver disease (cACLD). A secondary aim was to determine whether the use of spleen stiffness measurements (SSMs), as additional criteria, increases the performance of the 2D-SWE Baveno VI criteria. Data were collected from 208 subjects with cACLD, who underwent abdominal ultrasound, liver and spleen stiffness measurements, and upper digestive endoscopy. HRV were defined as grade 1 esophageal varices (EV) with red wale marks, grade 2/3 EV, and gastric varices. A total of 35.6% (74/208) of the included subjects had HRV. The optimal LS cut-off value for predicting HRV was 12 kPa (AUROC-0.80). Using both LS cut-off value < 12 kPa and a platelet cut-off value > 150 × 109 cells/L as criteria to exclude HRV, 52/208 (25%) subjects were selected, 88.5% (46/52) were without EV, 9.6% (5/52) had grade 1 EV, and 1.9% (1/52) had HRV. Thus 98% of the subjects were correctly classified as having or not having HRV and 25% of the surveillance endoscopies could have been avoided. Using SS < 13.2 kPa and a platelet cut-off value > 150 × 109 cells/L as additional criteria for the patients that were outside the initial ones, 32.7% of the surveillance endoscopies could have been avoided.

Chronic atrophic gastritis: an update on diagnosis

Background and aim. Atrophic gastritis is a precancerous gastric lesion, therefore its early detection is a priority in preventing gastric cancer. The aim of the present paper is to develop a narrative synthesis of the present knowledge on diagnostic methods of chronic atrophic gastritis. Methods. A literature search was carried out on main databases: PubMed, Hinari, SpringerLink and Scopus (Elsevier) for the period 2000-2020. The searched keywords were: chronic atrophic gastritis, intestinal metaplasia and dysplasia + diagnosis. Inclusion criteria were focused on the articles about the invasive and non-invasive diagnosis of chronic atrophic gastritis and of precancerous gastric lesions, intestinal metaplasia and dysplasia; exclusion criteria were articles published before 2000 and those that did not include the proposed theme. Results. The search returned 575 papers addressing the topic of precancerous lesions. From these, 60 articles were qualified representative for the materials published on the topic of this synthesis article, being those that met the inclusion criteria. The data emphasize the need to use upper digestive endoscopy with biopsies for the diagnosis of chronic atrophic gastritis. However serological diagnosis is available as alternative mainly recommended in follow up. Conclusions. There are two main methodological approaches for the evaluation of chronic atrophic gastritis as a precancerous gastric lesions: invasive examination, which requires histological analysis of biopsy samples taken during upper digestive endoscopy, being the "gold standard" for diagnosis, and non-invasive serological examination using markers of gastric function.

Endoscopic Removal of Foreign Body in Upper Gastrointestinal Tract in Dogs: Success Rate and Complications

Background: Dogs and cats with acute signs of choking, retching, cough, vomiting, regurgitation, hypersalivation, dysphagia and odynophagia should have the presence of a gastrointestinal foreign body (FB) as part of their differential diagnosis, where it is a frequent condition in the care of small animals. Most objects lodged in the esophagus, stomach, and proximal duodenum can be removed by upper digestive endoscopy, a curative, little invasive procedure. The objective of our study was to evaluate the physical aspects and location of esophageal and gastric FBs observed in 88 dogs and the age and breed of the affected animals and to determine the success rate and eventual complications associated with the procedure as well.Materials, Methods & Results: Eighty-eight cases of dogs, males and females of varying ages and breeds, submitted to upper digestive endoscopy were selected because of suspicion of esophageal or gastric FBs. The endoscopic procedure aimed at confirming the diagnosis, whether or not followed by endoscopic removal of these objects. Prior to endoscopy, the animals had laboratory tests (blood count and serum biochemistry) and subsequently to the anesthetic protocols of choice for each case. Data including breed, age, type of constituent material and anatomical location of the FB, endoscopic procedure success rate and complications were recorded and descriptively evaluated. Of the 88 dogs evaluated, 60% (n = 53) were male and 40% (n = 35) female. According to the breed of the animals, 55% (n = 49) were small-breed dogs, 29% (n = 25) large-breed dogs, and 8% (n = 7) medium-breed dogs, and 8% were of mixed breed dogs, which could assume various sizes. Shih Tzus accounted for 18% (n = 16) of the animals, Lhasa apsos 8% (n = 7) and mixed breed 8% (n = 7), where these were the most frequently affected breeds. Regarding age, animals 1 to 5 years old represented 66% (n = 58) of the patients, and those 6 to 10 years old accounted for 20% (n = 18), while 11% of the dogs were over 10 years old (n = 10). Two animals (3%) had no information about their ages. Pieces of cloth were the most frequently found FBs, representing 20%(n = 20), followed by animal bones (19%) and fruit pits (10%). As for location, 78% (n = 69) of the FBs were located in the stomach and 22% (n = 19) in the esophagus. The success rate of endoscopic FB removal in this study was 83% (n = 73). In 76% (n = 67) of the animals, there were no complications due to the presence of FB in the upper gastrointestinal tract. The most frequent complications were esophageal ulcerations (n = 7) and the inability to move the FB (n = 5) and adherences. (n = 4).Discussion: The results showed that small-breed dogs, especially Shih Tzus and Yorkshires, represented a larger number of cases, probably due to their popularity in Brazil, where the study was conducted. Males were more prevalent than females, and the most affected age was between 1 and 5 years, with emphasis on younger animals. There were more gastric FB cases compared to esophageal FB cases, which was related to the interval between the ingestion of the object and veterinary care. Although not the most prevalent FB, the high rate of mango pits can be explained by the vast number of mango trees in the Federal District. There were few complications compared to the success of cases, indicating that endoscopy is the procedure of choice for the diagnosis and removal of FBs from the gastrointestinal tract.