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ABSTRACT: To evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with idiopathic acute pancreatitis (IAP), find factors predictive of a positive EUS finding in these patients and investigate whether these etiological findings are maintained during follow-up.
We performed EUS in patients with IAP between July 2004 and August 2007. We recorded epidemiological data, the number and severity of previous bouts of pancreatitis and gallbladder status.
A total of 44 patients were included in the study. EUS was normal in seven patients (16%). In the remaining 37 patients (84%) we found cholelithiasis (n = 3), microlithiasis (n = 20), chronic pancreatitis (n = 14), pancreas divisum (n = 3), pancreatic mass (n = 1), apudoma (n = 1), cystic tumor of the pancreas (n = 2) and choledocholithiasis (n = 2). Positive EUS findings were not influenced by sex, severity of pancreatitis or recurrent disease. Patients aged < 65 years (age > or < 65 years: 73.9% versus 95.2%; P = 0.097) and patients with gallbladder in situ (cholecystectomy versus non-cholecystectomy: 63.6% versus 90.9%; P = 0.054) showed a tendency to have positive EUS findings. Mean follow-up was 28.95 +/- 10.86 months (range 12-64 months; median 28 months). During follow-up the etiological diagnosis was changed in two patients, lowering the diagnostic yield to 79%.
EUS identified the cause of IAP in 79% of patients. Patients with gallbladder in situ and patients aged < 65 years showed a tendency to have positive EUS findings. The majority of the diagnoses provided by EUS are maintained during follow-up and seem to be reliable.
Scandinavian journal of gastroenterology 03/2010; 45(3):375-81. · 2.08 Impact Factor
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Endoscopy 01/2010; 42 Suppl 2:E5-6. · 5.21 Impact Factor
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Endoscopy 02/2009; 41 Suppl 2:E177-8. · 5.21 Impact Factor
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ABSTRACT: Up to 30% of patients with acute pancreatitis are diagnosed of idiopathic acute pancreatitis after an initial evaluation including a complete clinical history, physical examination, analysis with calcium and triglycerides determination, and at least one transabdominal ultrasonography. Unexplained pancreatitis represents a diagnostic challenge, although after different explorations a cause is found in the majority of these patients. During the last years endosonography has proved to be a low morbidity exploration very useful in the evaluation of patients with this entity. In this article we review the role of endosonography in the etiologic study of patients with idiopathic acute pancreatitis.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 03/2008; 100(2):90-7. · 1.55 Impact Factor
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ABSTRACT: our aim was to evaluate the accuracy of endosonography (EUS) in our experience, to stage rectal cancer.
we prospectively included all patients with rectal cancer staged in our unit from September 2002 until February 2006 in a database. We selected those patients who had a complete EUS examination and were surgically treated without neoadjuvant therapy. Once we had the results of the histopathological staging (pTN), which was considered the gold standard, we compared the results of the previous EUS staging (uTN) with those of the pTN. We calculated the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for each T stage, and for N staging considered as N positive or negative. We also calculated the global accuracy for T stage. We also calculated the agreement of uTN with pTN staging using the kappa index for N stage, and quadratic weighted kappa index for T stage.
we staged 120 patients with rectal cancer during the mentioned period. Of these, 36 patients met inclusion criteria and were evaluated, 21 women and 15 men. Mean age was 68,53+/-10,15 yo (range: 48-90). Global T stage accuracy was 83%. N stage accuracy was 72%. We obtained a S, E, PPV, NPV and A of 91, 100, 100, 96 and 97% for T1; 82, 88, 75, 91 and 86% for T2; 86, 91, 86, 91 and 89% for T3; and 14, 86, 20, 80 and 72% for N stage respectively. Kappa value for T stage was 0,87 indicating a "very good" agreement between uT and pT according to the kappa index criteria. Kappa value for N stage agreement was 0,005; "poor" according to the same criteria.
in our experience, the diagnostic accuracy of EUS for T and N staging of rectal cancer is 83% and 72% respectively, similar results as previously published. uT staging for rectal cancer shows a "very good" agreement with pT staging.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 04/2007; 99(3):132-7. · 1.55 Impact Factor
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Endoscopy 03/2007; 39 Suppl 1:E67-8. · 5.21 Impact Factor
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ABSTRACT: Somatostatin is one of the most extensively evaluated drugs in the prophylaxis of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP), but its utility remains controversial.
The aim of this study was to evaluate the role of somatostatin as prophylaxis of ERCP-induced acute pancreatitis. A group of consecutive patients that underwent ERCP in our endoscopy unit was prospectively studied for 8 months. Patients in this group were administered an endovenous bolus of 250 micrograms of somatostatin immediately before introducing the catheter in the papilla of Vater (somatostatin group). This group was compared with another group composed of consecutive patients who had undergone ERCP in the 8 previous months, without somatostatin administration (placebo group). Both groups contained the same number of patients. The following variables were recorded; sex, age, contrast injection in the duct of Wirsung, endoscopist, therapeutic maneuvers, and the development of post-ERCP pancreatitis.
During the 16 months of patient inclusion, we performed 320 ERCP in our unit, of which 248 were included in the study: 142 in the somatostatin group and 142 in the placebo group. Of these patients, 152 (53.5%) were men and 132 (46.5%) were women. The mean age was 70.05 +/- 13.83 years (range: 27-93 years). Acute pancreatitis occurred in 10 patients in the somatostatin group and in 5 in the placebo group; this difference was not statistically significant (p > 0.05). No significant differences were found between the two groups in the remaining variables studied.
Somatostatin does not seem to be useful in preventing post-ERCP acute pancreatitis.
Gastroenterología y Hepatología 05/2006; 29(4):231-6. · 0.73 Impact Factor
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ABSTRACT: We wanted to know if patients read and understand the informed consent (IC) document used for endoscopic procedures, and to evaluate the readability of IC.
During two months we gave patients studied in our endoscopy unit an anonymous questionnaire with different items concerning reading degree, knowledge of the technique, complications, sedation used, and information received. We evaluated IC readability using the Flesch index.
309 patients were included (mean age: 53 years, 55% males, 86% outpatients, 50% with basic education); 85% of patients read the IC, 96% considered they understood the exploration technique, 22% were not aware of severe complications, and 82% knew which kind of sedation would be used; 88% of patients received additional information from their doctors. Outpatients read the IC in a greater percentage versus inpatients (p < 0.05); patients with only basic education tended to ignore the possibility of complications (p < 0.05). Doctors gave more information to rural patients (p = 0.08), offered better information about complications to urban patients (p = 0.09), and offered more information on other diagnostic procedures to patients older than 50 years (p < 0.05). With the Flesch index we found that gastroscopy and colonoscopy ICs had a "standard" level of readability, while ERCP ICs were more complex.
The majority of our patients read and understands the IC. Doctors adapt information to patient characteristics. Our IC documents have an acceptable level of readability, but given that 50% of our patients have only a basic educational status, we should attempt to provide an easier IC document.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 02/2006; 98(2):101-11. · 1.55 Impact Factor
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ABSTRACT: Infection by the varicella-zoster virus (VZV) is an important cause of morbidity and mortality in patients who have received a bone marrow transplantation (BMT), both autologue and alogenic. Infection is generally produced in the first post-transplant year and, in its disseminated form, it can show itself through abdominal pain that translates the visceral affectation, pain that can precede the appearance of the characteristic cutaneous lesions by days, making diagnosis difficult. The clinical case described belongs to a patient who, 10 months after a bone marrow transplant, showed an infection by varicella-zoster virus, manifested through abdominal pain due to hepatic affectation, with an interval of 2 days between the start of pain and the appearance of cutaneous lesions. The diagnosis and treatment of these patients is discussed.
Anales del sistema sanitario de Navarra 25(3):335-8. · 0.32 Impact Factor
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Anales del sistema sanitario de Navarra 23(1):141-5. · 0.32 Impact Factor
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Anales del sistema sanitario de Navarra 25(1):71-4. · 0.32 Impact Factor
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ABSTRACT: We present the case of an 85 year old male who was admitted to hospital with abdominal pain and jaundice. Different explorations were performed for this reason, with a mass observed in his 2nd duodenal portion. Histological study showed that it was a duodenal gangliocytic paraganglioma. The clinical characteristics of this infrequent tumour are described and we review the diagnosis and treatment.
Anales del sistema sanitario de Navarra 28(1):109-13. · 0.32 Impact Factor
