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Results in Journal Revista Española de Enfermedades Digestivas: 6,202

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Lucía Seoane Blanco, Javier Soto Sánchez, Gema Sierra Dorado, Leire Parapar Álvarez, Manuel Crespo Sánchez, Luis Sánchez Domínguez, Juan De La Vega Fernández
Published: 21 July 2021
by 10.17235
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8067/2021

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Daniel Martín Escobedo Paredes, Angélica I Hernández-Guerrero, J Octavio Alonso-Lárraga, Mauro Eduardo Ramírez-Solís, César Jaurrieta Rico, Katia Picazo-Ferrera, Angélica Melina González-Saucedo, Raúl Uvaldo Aguilar-Moreno, Pablo Geraldo Soc-Choz
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Raúl Alberto Jiménez Castillo, Joel Omar Jáquez-Quintana, Ariadnee Irma Reyna-Aréchiga, Yessica Guadalupe López-Alejandro, Sayra Nallely Juárez-Hernández, Christian Devanny Del Ángel-Argueta, Daniel Eduardo Benavides-Salgado, Héctor Jesús Maldonado-Garza
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8251/2021

Kazuhiro Furukawa, Masanao Nakamura, Hiroki Kawashima, Mitsuhiro Fujishiro
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8232/2021

Diego Martínez-Acitores de la Mata, José Francisco Juanmartiñena, Helena León Brito, Ana Campillo Arregui
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8150/2021

Paloma Albacete Ródenas, María Luisa Ortiz Sánchez, Urszula Gajownik, Fernando Alberca De Las Parras, José Antonio Pons Miñano
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8241/2021

Albert González-Sagredo, Elena Iborra Ortega, Carolina Herranz Pinilla, Juli Busquets, Teresa López-Sobrino, Ramón Vila Coll
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8272/2021

Clara Amiama Roig, Joaquín Poza Cordón, Mario Álvarez Gallego, Laura Guerra Pastrian
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8187/2021

Abstract:
We present the ultrasound finding of intestinal endometriosis in a patient with stricturing Crohn's disease and clinical worsening. The images highlight a hypoechoic and hyperemic thickening of the pelvic ileum wall. Given the diagnostic challenge entailed by this entity in young women with inflammatory bowel disease, due to the association between both conditions and their similar symptoms, it seems relevant to us to include it in the differential diagnosis when performing intestinal ultrasound in this patient population.
Miquel Ángel Escribano-Pons, Juan José Segura-Sampedro, Cristina Pineño-Flores, José Carlos Rodriguez Pino, Francesc Xavier González-Argenté, Rafael Morales-Soriano
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8052/2021

Abstract:
Gastrointestinal melanoma metastases are not uncommon, with jejunum and ileum being the most common locations (58%), followed by gastric (26%), colonic (22%), duodenal (12%) and rectum metastases (5%).
Isabel Garrido, Armando Peixoto, Guilherme Macedo
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8178/2021

Abstract:
A 54-year-old male, with a past medical history of hypertension, dyslipidemia, obesity and diastolic heart failure, was admitted due to COVID-19 pneumonia. Respiratory failure gradually deteriorated and the patient was transferred to the Intensive Care Unit (ICU), where mechanical ventilation and venovenous extracorporeal membrane oxygenation (VV-ECMO) were started. On the second day in ICU, he had a septic shock due to ventilator-associated pneumonia. Five days later, the patient had new-onset melena and laboratory data showed a hemoglobin level of 7.8g/dL.
Asunción Ojeda Gómez, Almudena Íñigo Chaves, Lucía Madero Velázquez, Jorge Barragán Martínez, Maria Dolores Picó Sala, Andrea García Soria, Julia Sáez Fuster, Mariana Fe García Sepulcre
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8200/2021

Abstract:
We present a 81-year-old man with a history of colorectal and bladder cancer surgically removed, who was admitted to our hospital with a urinary infection. A routine renal ultrasound revealed a pelvic cyst and CT-scan confirmed a non-complicated cyst but observed a lesion in the left lung.
Alberto García Reyes, Manuel López-Cantarero García-Cervantes, Juan Antonio Bellido Luque, Inmaculada Sánchez-Matamoros Martín, Ángel Nogales Muñoz
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8156/2021

Abstract:
We present the case of a young patient who underwent laparoscopic cholecystectomy. This patient suffers a postoperative complication, a migration of the surgical clip to the common bile duct (<100 cases reported to date). Treatment in most cases is by ERCP. Our aim is to expose the infrequency of this complication and its management.
Rebeca Alfranca, Carmen López, Cristina Giralt, Marissa Ramírez, Fran Calvo
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7737/2020

Abstract:
The aim of this study is to analyse the process of detection and treatment of hepatitis C in individuals experiencing homelessness (IEH). An analytical cross-sectional study was conducted in a primary care centre. The centre screened and registered patients with a positive hepatitis C antibody test and referred them to the digestology service. 8.3% presented with a positive HCV antibody test, of which 6 were patients who had already received treatment. Of those who had not received treatment, one patient was successfully treated. 30.8% of the total could not be located or did not wish to participate. Community coordination and the use of rapid tests would improve detection.
Luis Gerardo Alcala-González, Alba Jimenez-Masip, Lucía Relea Pérez, Claudia Barber-Caselles, Elizabeth Barba-Orozco
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7598/2020

Abstract:
Prescription opioids usage is on the rise. There has been an increasing recognition that chronic opioid consumption can result in esophageal motility disorders and this association has been named opioid-induced esophageal dysfunction (OIED). Analyze the prevalence of chronic opioid consumption in patients referred for esophageal motility testing in a European center and to describe the clinical characteristics and the association of opioid consumption in esophageal motility disorders. METHODS Retrospective descriptive study in patients who had HRM performed in a single center. The clinical history in the electronic medical reports was reviewed. RESULTS The prevalence of opioid prescription in patients referred to our institution was 10.1% and 4.8% patients were on active chronic opioid use. We found a 32% prevalence of OIED. Comparing chronic active opioid user (CAOU) patients with OIED and CAOU patients without OIED, there was a higher prevalence of male sex (43.8% vs 8.8% p value=0.007). Converting the different opioids medication to morphine milligram equivalent daily dose (MMED), CAOU patients with OIED had a higher MMED than CAOU patients without OIED (125.2±31.3 vs 33.4±5.7 MME p=0.041). Dysphagia was the most common indication for performing an HRM in 60.0% in CAOU patients. Furthermore, dysphagia was more frequent in CAOU patients with OIED (87.5% vs 47.0% p= 0.019). CONCLUSIONS Patients on chronic opioids with OIED complained mostly dysphagia. We found an association of male sex and a higher dose of opioids in CAOU patients with esophageal motility disorders.
Noemi Marlene Bedon Lopez, Edwin Americo Quispe Sanchez
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7743/2020

Abstract:
We have read with great interest the article published by Ramia et al. on "Radical surgery in hepatic hydatidosis: analysis of results in an endemic area", where they prioritize the ultrasound evaluation according to the WHO classification, as a method for the surgical planning of the hepatic hydatid cyst (HHC). However, pharmacological treatment and the application of computed tomography with contrast (CCCT) during preoperative evaluations have not been properly described, despite the evidence found in the literature that considers them as success factors. For their part, Velasco and Cols. consider pre and post surgical pharmacological treatment to be recommended and, additionally, Zhang and Cols. recommend the use of CCCT for pre-surgical evaluations, due to a better morphological visualization allowing a positive impact on surgical results.
Esteban Fuentes-Valenzuela, Beatriz Burgueño Gómez, María Miguel Lucero Salaverry, Luis E. Abella
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8068/2021

Abstract:
A 51-year-old female presented with rectal bleeding and anal pain. A colonoscopy was performed revealing a large lesion in the middle and lower rectum. These findings were confirmed on the CT scan. Nevertheless, the histopathological analysis revealed a more uncommon synchronous squamous cell carcinoma. Thus, due to the histology, pelvic radiotherapy with concurrent chemotherapy was administered.
Fernando Ramírez Esteso, Esther Domínguez Ferreras, Francisco Domper Bardají, María Rodríguez González
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8093/2021

Abstract:
A 53-year-old male with a history of acute pancreatitis of biliary origin and subsequent laparoscopic cholecystectomy. Current hospitalization with a diagnosis of acute pancreatitis. Seventy-two hours after the onset of symptoms, he had fever, uncontrolled pain, and elevated inflammatory markers. Abdominal computed tomography (CT) revealed an aerial collection at the pancreatic gland suggestive of emphysematous pancreatitis. Proteus Vulgaris was isolated in pancreatic puncture and blood cultures. The patient developed septic shock, which requires admission to intensive care unit. Septic shock was controlled initially by percutaneous drainage. However, surgical debridement was also necessary in the following days. Emphysematous pancreatitis, which consists of the necrotic infection of the pancreatic gland, is a rare entity with significant morbidity and mortality. It presents some characteristic radiological findings, visualizing gas at the level of the pancreatic parenchyma associated with the presence of gas-forming bacteria. For differential diagnosis, the presence of entero-pancreatic fistulas (1), as well as the presence of gas secondary to endoscopic instrumentation, sphincterotomy, or previous trauma, must be excluded. The extraction of culture allows confirming the infection of the necrotic tissue. Gram-negative bacilli are the most frequently involved bacteria (2). This entity usually requires broad-spectrum antibiotic treatment, intensive care, and debridement of infected necrotic tissue. Although percutaneous debridement may choose initially, surgical resection is still necessary in refractory cases (3).
Joel Omar Jáquez-Quintana, Héctor Jesús Maldonado-Garza, Carolina Ivette Zubía-Nevárez
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8345/2021

Marta Izquierdo Romero, M. Ángeles Tejero Delgado, Jorge Rodríguez Prida, Rafael Tojo González
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8352/2021

Alma Keco-Huerga, Jesús García de la Borbolla-Serres, Manuel Castro-Fernández
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7882/2021

Abstract:
Hypomagnesemia is one of the uncommon adverse effects of drugs as widely used as proton pump inhibitors, which we must know in order to include it in our differential diagnoses in normal clinical practice. It has an essential suspicion diagnosis with easy treatment to avoid further complications. We report a case of symptomatic hypomagnesemia diagnosed in our hospital, with delay in diagnosis due to lack of initial suspicion and with immediate improvement after withdrawal of the drug.
Alexandre Oliveira Ferreira, Maria Pia Costa-Santos, Catarina Gomes, Luisa Glória, Marília Cravo, Mário Dinis-Ribeiro, Jorge Canena
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8104/2021

Carolina Cerrella Cano, Eduardo Junquera Alonso, Marina Terroba Alonso, Francisco Xavier Cano Calderero, Lucía Seoane Blanco, Edisa María Armesto González
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8129/2021

Abstract:
Central nervous system involvement is an uncommon side effect of fluoropyrimidine-based chemotherapy regimens. We report the case of a 79-yer-old male who presented with hyperammonemic encephalopathy shortly after treatment onset with capecitabine monotherapy for local progression of a a mucus-secreting pancreatic adenocarcinoma, with complete clinical resolution upon capecitabine discontinuation in association with supportive treatment.
Paloma Rodriguez-Vielba, Carlos Martín-Lorenzo, Emilio González Pablos
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.8013/2021

Abstract:
Pérez-Santiago L et al. on the conservative or surgical management of pneumatosis intestinalis (PI). Recently we had a case involving a 18-year-old woman diagnosed with anorexia nervosa who visited for general malaise.
Beatriz Arencibia Pérez, Julio José Delgado Sánchez, Joaquín Marchena Gómez
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7873/2021

Abstract:
In relation to the article "A case of a mixed adenoneuroendocrine tumor of colon" 1, we want to contribute a new case of this exceptional and biphasic clinical entity which are the MANECs (Mixed adenoneuroendocrine carcinoma), tumors represented by the mix of pathological components highly aggressive that affect the gastrointestinal and pancreatobiliary tract characterized by the dual presence of glandular and neuroendocrine epithelial elements, where each component represents at least 30% of the tumor.
José López-Fernández, Gabriel García Plaza, Sara María García Quesada, Juan Ramón Hernández Hernández
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7932/2021

Abstract:
A 41-year-old female patient under study for abdominal pain located in the epigastrium and mesogastrium with no other associated symptoms. There was no record of previous episodes of pancreatitis and she denied abdominal trauma. Laboratory tests were normal. A CT scan was performed showing an aneurysm of the superior mesenteric vein, varicose veins in the gastrohepatic ligament and left splenorenal shunt.
Daniel Alvarenga Fernandes, José De Arimatéia Batista Araújo Filho, Amélia Ribeiro de Jesus
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7964/2021

Abstract:
We report a case of a COVID-19 patient presenting fever, headache and dyspnea evolving with severe acute abdominal pain; contrasted computed tomography (CT) scan diagnosed splenic infarction. We emphasize the importance of seeking the identification of complications of SARS-CoV-2 infection, notably thromboembolic events, with the potential to reduce the morbidity and mortality of the disease. Studies on radiological aspects involving the spleen and splenic infarctions associated with COVID-19 are scarce.
Juan Manuel Martin Guerrero, Carlos Ortiz Moyano, Mercedes Serrano Romero
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7869/2021

Abstract:
A 66 year-old male referred to our hospital two years ago for jaundice an a clinical, radiological and endosonographic suspicion of advanced pancreatic cancer though not confirmed by EUS- FNA cytology who was treated successfully with an uncovered biliary self-expandable metal stent (uSEMS). However, an IgG4 disease was diagnosed during follow-up. The patient developed recurrent episodes of cholangitis so removal of the uSEMS was mandatory and use of a mechanical lithotripter was implemented. We consider the use of this device easier than other techniques due to the traction force that can be achieved.
Albert Martin-Cardona, Ferran Vall-Llovera Calmet, Clarisa Gonzalez Minguez, Carme Loras
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7875/2021

Abstract:
We present the first case reported of Cytomegalovirus (CMV) infection in adrenal gland (AG) diagnosed by Endoscopic Ultrasound. Moreover, it is a rare case of unilateral CMV infection of AG in a non-HIV infected patient mimicking a neoplasic hypercaptation in PET. Case Report: A 71-year-old woman with stage IV follicular lymphoma in complete remission since 2006. In March 2019, chemotherapy treatment was initiated due to a relapse with pulmonary involvement. At three months, the patient presented bad general condition and fever. A positron emission tomography (PET) showed abnormal metabolic activity in the left adrenal gland (AG) suggestive of lymphoma recurrence. Tuberculosis and human immunodeficiency virus (HIV) infection were ruled out. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) was performed. A hypoechoic, heterogeneous nodular lesion, with well-defined margins, about 27x16mm of maximum diameters was reported. Cytopathology confirmed isolated epithelial cells without cytological atypia, focus of adrenal adenoma, and cytomegalic inclusions with positive immunohistochemical expression for cytomegalovirus (CMV). A clinical improvement was observed after treatment with ganciclovir. Discussion: The most frequent causes of solid unilateral lesions in AG in patients without HIV infection are benign lesions such as adenomas, primary malignancy tumors and metastases of lung neoplasia. AG infections secondary to CMV typically occur HIV-infected patients and with bilateral involvement. The presence of an adenoma in left AG could have caused a false-positive in initial PET, but after ganciclovir treatment, no abnormal metabolic activity was detected in control PET. To our knowledge, this is the first case reported in the literature of unilateral CMV infection of AG in a non-HIV infected that have been diagnosed by EUS-FNA. Given that PET scan hypercaptation is not always diagnostic of malignancy, it is mandatory to obtain pathological samples, of which EUS-FNA has proven the best technique.
Javier A.-Cienfuegos, Víctor Valentí, Fernando Rotellar Sastre
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7851/2021

Abstract:
Alterations in liver function test have been described in 17-50% of patients COVID-19. The pathogenic mechanism remains obscure. With the occasion of a recent manuscript on the journal, we discuss the possible mechanisms.
Eduardo Valdivielso Cortázar, Andrea Guerro Noya, Pedro Alonso Aguirre
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7811/2021

Abstract:
A case of a massive gastrointestinal bleeding secondary to a between esophagus and aberrant right subclavian artery (arteria lusoria) is presented, treated first with haemostatic clips and later with a Sengstaken-Blakemore tube and endovascular stent. A brief literary review is done.
Cristian Ramos Vera
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7812/2021

Abstract:
In number 1 of volume 113 of this journal, one important article was published that evaluated statistically significant association (p 100) and the histological diagnosis of gangrenous acute cholecystitis in patients with who underwent cholecystectomy (OR = 3,1).
Julio Pérez De La Serna Y Bueno, Antonio Ruiz De León San Juan, Concepción Sevilla Mantilla, Constanza Ciriza De Los Ríos, Ana Atarain Valles, Marta Aparicio Cabezudo, Laura García Pravia, David Olivares Quintanar, Enrique Rey Díaz-Rubio
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7767/2020

Abstract:
Background The impact of the COVID-19 pandemic has led to the interruption of most manometry or impedance-pH monitoring studies. The risk to restarting activities is unknown. Objective Assess the risk of SARS-Cov-2 virus contagion, both to patients and healthcare workers in relation to esophageal and anorectal functional tests during the pandemic without protective measures. Method A questionnaire was designed to find out whether patients and healthcare workers had COVID-19, confirmed either by a test or only compatible symptoms, after functional studies were performed from January until March 2020. Results 263 (92.9%) patients answered the survey. In the two weeks after functional test, four (1.52%) patients had confirmed COVID-19 (adjusted rate 8.34 cases per 1,000 (95% CI -0.06-16.74), OR 0.84 (95% CI: 0.83-0.85), p<0.001), no one after anorectal manometry. Other five had only compatible symptoms, total 9 (3.42%) (adjusted rate 27.50 cases / 1,000 (95% CI: 7.27-47.74), OR 2.84 (95% CI: 2.81-2.87). In the total study period 18.25% had COVID-19 confirmed or with compatible symptoms. The average of days between the procedure and the first day of symptoms was progressively shortened: January 56 days, February 33 days, March 10.5 days. Two out of 10 healthcare workers (20%) were confirmed with COVID-19. Conclusions The risk of COVID-19 contagion when performing functional tests is low and more related to the evolution of the pandemic than to the procedures themselves. The small number of healthcare workers included in the study does not allow a definitive conclusion to be drawn on their risk of contagion.
Jie Wu, Zhiheng Huang, Min Ji, Zhinong Jiang, Yuhuan Wang, Zifei Tang, Ying Huang
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7682/2020

Abstract:
Intestinal lymphangiectasia is an unusual cause of protein-losing enteropathy due to either congenital malformation or the obstruction of the intestinal lymphatics. However, few reports have investigated the use of video capsule endoscopy in children with intestinal lymphangiectasia. This study was performed to evaluate the diagnostic value of video capsule endoscopy for paediatric intestinal lymphangiectasia. In this retrospective study, we included all patients who underwent video capsule endoscopy between January 2014 and July 2020. Clinical information and video capsule endoscopy data were analysed. Twelve children, 7 males and 5 females, with an age of disease onset of 4.5 (range: 3.2-9.3) years, and a disease duration of 12.0 (range: 1.3-30.0) months were enrolled. The most common symptoms were hypoproteinaemia (10, 83.3%), diarrhoea (7, 58.3%), oedema (6, 50.0%), and abdominal pain (3, 25.0%). Eight patients had low lymphocyte counts, whereas 10 had reduced serum albumin levels (23.2±5.8 g/L). Video capsule endoscopy revealed an overall white snowy appearance due to the presence of whitish, swollen villi in all patients. Regarding the macroscopic lesions of lymphangiectasia, 7 cases involved the entire small bowel from the duodenum to the ileocecal valve, while 5 cases involved part of the small bowel. All patients were treated with medium-chain triglyceride diets, and albumin infusions were administered for 10 patients; sirolimus treatment was administered to 3 patients. At the last follow-up, 5 patients still had hypoalbuminemia, and one patient had died of intestinal lymphoma. Video capsule endoscopy is useful for the diagnosis of intestinal lymphangiectasia and should be applied as a valuable and less invasive examination to confirm or establish a diagnosis.
María Pipa-Muñiz, Andrés Castaño-García, Susana Sanmartino, Alicia Mesa, Carmen Álvarez-Navascués, María Luisa González-Diéguez, Valle Cadahía-Rodrigo, Mario Ernesto Piscoya-Díaz, Serafín Marcos Costilla-García, Manuel Rodríguez, et al.
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7696/2020

Abstract:
The effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) depends on the selection of suitable patients. The ''Six-and-twelve score" distinguishes three groups of ideal patients with different overall survival based on the sum of number and size of tumors. This may impact clinical practice and trials design. The aim of the study is to assess the reproducibility and the prognostic value of the model in western patients treated with Drug-Eluting Beads (DEB)-TACE. observational, retrospective, unicentric study developed in consecutive compensated patients treated with DEB-TACE from October/2008 to October/2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation. 225 HCC consecutive patients were included, BCLC-0/A n=131 (single nodules > 5, n=29), BCLC-B n=94. The median overall survival (OS) was 27 months (95% CI 23.8-30.2). OS was different between BCLC-0/A vs B: 30 vs 24 months (p= 0.03), Child-Pugh A5 vs A6-B7: 30 vs 27 months (p= 0.003). ''Six-and-twelve score" groups discriminated OS: group 1, n=123, 32 months (95% CI 27.5-63.5); group 2, n=101, 24 months (95% CI 19.6-28.4) and group 3, n=1, 27 months (p=0.024). When comparing the three scores, the ''Six-and-twelve score" showed the best discrimination power: C-index 0.603, Akaike's information criterion (AIC) 1.642, likelihood ratio test (LRT) 16.21. The ''Six-and-twelve score" is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score >12) and no differences were observed with BCLC, therefore its applicability is limited.
Pilar Del Pino Bellido, María Fernanda Guerra Veloz, Reyes Aparcero López
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7974/2021

Abstract:
We present the case of a 71-year-old man, with medical history of hypertension, dyslipidemia and acute myocardial infarction in 2007, taking low dose of aspirin and bemiparing 3500 every 24h. He was admitted in the Urology Service with recurrent hematuria 14 days after radical prostatectomy, which ceased after continuous bladder irrigation.
Miguel Mascarenhas Saraiva, Tiago Ribeiro, Patrícia Andrade, Hélder Cardoso, Guilherme Macedo
Revista Española de Enfermedades Digestivas; https://doi.org/10.17235/reed.2021.7633/2020

Abstract:
Capsule enteroscopy (CE) and 99mTc Red blood cell (RBC) scintigraphy are frequently used tests in the investigation of obscure gastrointestinal bleeding (OGIB). There is a scarcity of data comparing both diagnostic modalities. This study aims to assess the performance of CE and scintigraphy for the diagnosis of OGIB. Patients who underwent CE and scintigraphy for OGIB were selected and analyzed retrospectively. The hemorrhagic potential of CE findings was rated using Saurin's classification. The concordance between both diagnostic techniques for bleeding detection and localization was analyzed. Eighty-five patients (62% female), with a median age of 63 years, were included. Capsule enteroscopy identified 37 patients (43%) with high hemorrhagic potential (P2) lesions. Most scintigraphy exams were positive for gastrointestinal bleeding (82%). No concordance was found between the detection of lesions with hemorrhagic potential in CE and scintigraphy (kappa <0). The distribution of P0, P1, and P2 findings was similar in patients with positive or negative scintigraphy (p=0.526). There was no agreement regarding the location of P2 findings in CE and the bleeding detected in the scintigraphy (kappa <0). Patients with P2 lesions had significantly lower median levels of hemoglobin (p=0.002) at presentation. No significant difference was found in hemoglobin values between patients with positive or negative scintigraphy (p=0.058). Significant diagnostic discrepancy was observed between CE and scintigraphy. The findings of CE correlated better with hemoglobin values at presentation than the scintigraphy results. Therefore, scintigraphy didn't appear to be useful in the diagnostic workup of OGIB. .
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