GE Portuguese Journal of Gastroenterology最新文献

{"title":"Bowel Obstruction after Liver Transplant: A Rare Cause","authors":"Tiago Ribeiro, Miguel Mascarenhas, Hélder Cardoso, Guilherme Macedo","doi":"10.1159/000533162","DOIUrl":"https://doi.org/10.1159/000533162","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136350024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic Abscess Caused by <i>Clostridium difficile</i>","authors":"Chee Yik Chang, Bryan Tan","doi":"10.1159/000533163","DOIUrl":"https://doi.org/10.1159/000533163","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underwater Endoscopic Mucosal Resection for a Terminal Ileum Adenoma","authors":"Atsushi Michigami, Satoshi Maeda, Shin Ichihara","doi":"10.1159/000531774","DOIUrl":"https://doi.org/10.1159/000531774","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136392575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Not Miss the Diagnosis: Not All Pink Findings Mean the Same in the Gastrointestinal Tract!","authors":"Jéssica Chaves, Diogo Libânio","doi":"10.1159/000531409","DOIUrl":"10.1159/000531409","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 Suppl 2","pages":"1-3"},"PeriodicalIF":1.0,"publicationDate":"2023-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Luminal and Extraluminal Applications of Endoscopic Stenting: A Bright Future for Gastroenterology.","authors":"Joel Ferreira-Silva, Diogo Libânio, Eduardo Rodrigues-Pinto","doi":"10.1159/000531271","DOIUrl":"10.1159/000531271","url":null,"abstract":"In recent years, considerable strides have been made in therapeutic endoscopy and specifically in stent technology to overcome strictures and fistulas. As such, several types of devices with advanced designs and materials are continuously being developed, and this evolution has helped expand the applications of therapeutic endoscopy to new horizons. The best example of this is the use of lumen-apposing metal stents (LAMS) in therapeutic endoscopic ultrasound (EUS), allowing for the endoscopic treatment of pancreaticobiliary and luminal disease previously reserved for surgical or percutaneous treatment. Thinking outside the box and using new devices to seal fistulas that cannot be managed with conventional endoscopic devices is also sometimes needed. While exciting, this continuing evolution and the growing number of therapeutic endoscopy applications may present a challenge for gastroenterologists to keep updated with the state of the art. This special issue ofGE – Portuguese Journal of Gastroenterology is dedicated to therapeutic endoscopy including 8 articles that provide further evidence of the safety, feasibility, and favorable outcomes of different applications of stents and similar devices in endoscopic therapeutic procedures, in particular the application of stents in therapeutic ultrasound endoscopy, luminal stenting, and treatment of leaks, perforations, and fistulas. The review articles also include several technical tips and tricks from experts that can clearly be helpful to the majority of endoscopists. Canakis and Baron [1] performed a review article focused on current indications and innovations in therapeutic EUS. The therapeutic role of EUS has evolved to become a complementary technique to endoscopic retrograde cholangiopancreatography (ERCP) to provide adequate drainage in patients with pancreatic and biliary","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 Suppl 1","pages":"1-3"},"PeriodicalIF":0.9,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10618961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Stenting: How I Do It.","authors":"Rui Silva","doi":"10.1159/000530704","DOIUrl":"10.1159/000530704","url":null,"abstract":"<p><p>Endoscopic esophageal stent placement is an effective palliative treatment for malignant strictures and has also been successfully used for benign indications, including esophageal refractory strictures and iatrogenic leaks and perforations. Despite several decades of evolution and the wide variety of esophageal stents available to choose from, an ideal stent that is both effective and without adverse events such as stent migration, tissue ingrowth, or pressure necrosis has yet to be developed. This paper is an overview of how this evolution happened, and it also addresses the characteristics of some of the currently available stents, like their material and construction, delivery device, radial and axial force pattern, covering and size which may help to understand and avoid the occurrence of adverse events. The insertion delivery systems and techniques of placement of an esophageal self-expandable metal stent are reviewed, as well as some tips and tricks regarding placement and management of adverse events.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 Suppl 1","pages":"35-44"},"PeriodicalIF":0.9,"publicationDate":"2023-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10614487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71428996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepaticoduodenostomy (Right Intrahepatic Biliary Duct) Using a Lumen-Apposing Metal Stent.","authors":"Carolina Chálim Rebelo,&nbsp;Nuno Nunes,&nbsp;Margarida Flor de Lima,&nbsp;Diogo Bernardo Moura,&nbsp;José Renato Pereira,&nbsp;Maria Antónia Duarte","doi":"10.1159/000522578","DOIUrl":"https://doi.org/10.1159/000522578","url":null,"abstract":"Biliary decompression in cases of hilar obstruction is challenging, and the intrahepatic approach is often necessary [1]. We describe a case of endoscopic ultrasoundguided biliary drainage (EUS-BD) for unresectable hilar malignant obstruction, using lumen-apposing metal stent (LAMS). A 85-year-old woman was admitted due to abdominal pain, jaundice, and choluria. From the personal history, it is worth noting a rectovaginal septum gastrointestinal stromal tumor (GIST), treated surgically in 2002 and with imatinib for 2 years. She was also being followed for pulmonary nodules, suspected of malignancy. Abdominal computed tomography showed a 76 × 57 × 61 mm mass on the left hepatic lobe, with irregular borders, and central necrosis, suggestive of metastasis. This mass compressed the biliary tree at the hilar plaque and led to intrahepatic biliary dilatation (Fig. 1). She had portal vein invasion, pulmonary and peritoneal metastasis. Biochemical workup showed a cytocholestase pattern and total bilirubin of 26 mg/dL. The patient refused liver biopsy. After multidisciplinary discussion it was decided for an endoscopic palliative treatment. Transpapillary access through endoscopic retrograde cholangiopancreatography (ERCP) was attempted but failed due to impossibility of biliary cannulation. The procedure was performed under deep sedation. A linear echoendoscope (GF-UCT260; Olympus Medical Systems, Tokyo, Japan) was used. There was a significant intrahepatic biliary dilation (12.8 mm), and the right intrahepatic biliary duct was close enough to the duodenal bulb (5 mm), without intervening vessels (as confirmed by color doppler). As so, we performed an hepaticoduodenostomy using a 6 × 8 mm LAMS (HotAxiosTM, Boston Scientific®, Marlborough, MA, USA): under ultrasound control, the right intrahepatic biliary duct was punctured","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"243-245"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/54/pjg-0030-0243.PMC10305248.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Ectopic Adrenocorticotropic Hormone Secretion from Pancreatic Neuroendocrine Tumour Presenting with Cushing Syndrome.","authors":"Soon Liang Lee,&nbsp;Chiun Yann Ng,&nbsp;Jasminder Sidhu,&nbsp;Asmawiza Awang","doi":"10.1159/000521518","DOIUrl":"https://doi.org/10.1159/000521518","url":null,"abstract":"<p><p>Ectopic adrenocorticotropic hormone secretion (EAS) from the pancreatic neuroendocrine tumour (PNET) is rare, aggressive, and challenging to treat. We hereby present a rare case of EAS from PNET presenting with Cushing syndrome diagnosed with endoscopic ultrasound-guided fine-needle aspiration cytology. This case highlights the advanced presentation of EAS from PNET with poor clinical correlation of hypercortisolism and the grade of PNET.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"239-242"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/df/pjg-0030-0239.PMC10305245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not Everything That Ulcerates Is Crohn's Disease.","authors":"Edgar Afecto,&nbsp;Catarina Gomes,&nbsp;Ana Ribeiro,&nbsp;Ana Ponte,&nbsp;João Paulo Correia,&nbsp;Manuela Estevinho","doi":"10.1159/000524062","DOIUrl":"https://doi.org/10.1159/000524062","url":null,"abstract":"A 41-year-old male with a history of Crohn’s disease (CD) with penetrating phenotype (A2L2B3p, Montreal Classification), who was diagnosed aged 17 years and had started treatment with infliximab monotherapy at 30 years old, had been on clinical, imagiological, and endoscopic remission for the previous 2 years. On follow-up ileocolonoscopy with the purpose of considering stopping biological treatment (per the patient’s wishes), only 2 superficial ulcers in the sigmoid colon and 3 small erosions in the terminal ileum (shown in Fig. 1) were detected. Histological examination of the ileum erosions demonstrated an infiltrate of atypical lymphoepithelial cells, CD20 positive and CD5, CD23, CD10, and cyclinD1 negative, compatible with a marginal zone B-cell lymphoma of the mucosal-associated lymphoid tissue (MALT; shown in Fig. 2). Immunoglobulin deposition was not identified in this tissue. Cervico-thoraco-abdominopelvic computed tomography and magnetic resonance bowel enterography were unremarkable. The histological specimens were analyzed by two different pathologists with expertise in hematopathology. Serum lactate dehydrogenase, β2-microglobulin, and immunoglobulin levels were normal. Hepatitis C virus antibodies and DNA of Campylobacter jejuni on ileum tissue were negative. Staging was complete as a MALTlymphoma Galian stage A and Lugano stage I. A 6-month course of antibiotic therapy with combined metronidazole and ampicillin was proposed after consultation with Hematology. As the patient was in clinical remission and the endoscopic activity was residual, biologic therapy was suspended due to an unfavorable risk/benefit. Unfortunately, CD recurred clinically and endoscopically so vedolizumab was started after endoscopic and histologic documentation of MALT remission (1 year after diagnosis, 6 months after antibiotics). Due to a primary non-response, the patient was swapped to ustekinumab and is currently in clinical remission, with a further endoscopic evaluation at 6–9 months.","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"246-248"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/47/pjg-0030-0246.PMC10305256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Learning Curve in Endoscopic Submucosal Dissection of Rectal Neoplasms with Severe Fibrosis: Experience of a Western Center.","authors":"Catarina Félix,&nbsp;Pedro Barreiro,&nbsp;Rui Mendo,&nbsp;André Mascarenhas,&nbsp;Cristina Chagas","doi":"10.1159/000522579","DOIUrl":"https://doi.org/10.1159/000522579","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic submucosal dissection (ESD) of lesions with severe submucosal fibrosis has been associated with worse outcomes, such as lower curative resection rate and higher incidence of adverse events. This study aims to investigate its true impact on rectal ESD performed in the West and to assess predictive factors of severe fibrosis.</p><p><strong>Methods: </strong>We conducted a retrospective study including all rectal ESDs performed at our tertiary center from January 2013 to January 2021. Lesions were grouped as nonsevere fibrosis or severe fibrosis. ESD outcomes, predictors of severe fibrosis, and the learning curve were evaluated.</p><p><strong>Results: </strong>ESD was performed in 195 lesions, 45 with severe fibrosis. Three resections were interrupted (one due to severe fibrosis). The presence of severe fibrosis was related to a significantly lower resection speed (16.93 mm²/min vs. 24.66 mm²/min, <i>p</i> = 0.007), en bloc (86.4% vs. 96.6%, <i>p</i> = 0.019), R0 (61.4% vs. 79.7%, <i>p</i> = 0.013), and curative (54.5% vs. 78.4%, <i>p</i> = 0.003) resection rates and a higher rate of hybrid ESD required to complete resection (13.6% vs. 2.0%, <i>p</i> = 0.005). No significant difference was noted regarding adverse events rate (18.2% vs. 8.1%, <i>p</i> = 0.09). Male sex, ulcerative colitis, pelvic radiotherapy, a lesion on the anastomotic site, previous manipulation, and deep submucosal invasion were independent predictors for severe fibrosis. En bloc resection rate improved during time (60.0% vs. 94.1%, <i>p</i> = 0.018).</p><p><strong>Conclusions: </strong>Severe submucosal fibrosis is an important factor related to noncurative resections and challenging rectal ESD. Factors predicting its severity are extremely important and could allow more experienced endoscopists to be assigned to more difficult cases, allowing safer procedures.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"30 3","pages":"221-229"},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a2/db/pjg-0030-0221.PMC10305249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}