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Introduction. Esophageal duplication is a congenital malformation that occurs due to an embryogenic error between the third and sixth gestational weeks. There are three morphological variants: cystic, tubular, and diverticular, and these have the common characteristics of having a developed muscular layer, an epithelial lining of the digestive tract, and being attached to the esophagus. The objective of this article was to present a clinical case of this disease with its successful endoscopic treatment. Clinical case. The clinical case of a 27-year-old patient is presented, with substernal pain, a sensation of heartburn and nausea, in whom an esophageal duplication was diagnosed and treated endoscopically. Results. Endoscopic management was performed, where a section of the septum was performed with endoscopic scissors, involving the mucosa, submucosa, and muscle fibers. The patient had adequate evolution and resolution of symptoms. Conclusions. Esophageal duplications are a rare disease, which must be taken into account in the differential diagnosis of esophageal diverticula and subepithelial lesions of the esophagus. The new endoscopic tools for the management of different pathologies allow procedures to be performed with multiple advantages over open or minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Introduction. Subepithelial lesions are masses that originate in the wall of a hollow viscus, respecting the integrity of the mucosa that covers them. They are differentiated from lesions that compromise the esophageal lumen due to extrinsic compression of the wall, of mediastinal or estraesophageal cervical origin. The objective of this article was to review the most frequent subepithelial lesions of the esophagus according to their histology, clinical manifestations, and recommended management. Methods. A review of the information available in the databases was carried out, establishing the characteristics, means for the study, and treatment of the most frequent subepithelial lesions of the esophagus. Results. Subepithelial lesions of the digestive tract, in general, require the support of endoscopy as the most precise diagnostic method to understand the characteristics of the lesion, in addition to allowing targeted biopsies to be taken, especially in lesions larger than 2 cm. Immunohistochemical techniques are necessary to achieve the diagnosis that establishes the most appropriate management of the different lesions. Conclusion. The management of the subepithelial lesions of the esophagus requires early study. Endoscopic techniques, such as endoscopic submucosal dissection and third space dissection, have allowed a new approach in the study and treatment of subepithelial lesions. [ABSTRACT FROM AUTHOR]

Introduction. Gastric duplications are rare congenital entities that are diagnosed primarily in early life, and rarely in adult patients. The objective of this article was to present the case of an adult with this pathology, successfully treated by surgery. Clinical case. A 26-year-old woman with chronic epigastralgia refractory to medical management, who during upper digestive endoscopy was identified with a cystic lesion suggestive of gastro-intestinal stromal tumor, confirmed by endoscopic ultrasound. Results. A laparoscopic surgical resection assisted by endoscopy was performed, with good postoperative evolution. The anatomopathological study reported the presence of a gastric duplication cyst. Conclusions. Despite the diagnostic adjuncts currently available, this pathology represents an important diagnostic challenge that, in many cases, can only be confirmed through pathology. In asymptomatic patients, the controversy continues between observing them or taking them to surgery due to the risk of malignancy. Currently, the management of gastric duplications in adults is considered eminently surgical. Laparoscopic resections and the use of intraoperative endoscopy ensure complete resection of the lesion, preserving the greatest amount of adjacent healthy tissue and preventing gastric stenosis or deformities that affect its proper functioning. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic ultrasound (EUS)-guided drainage and luminal-apposing metal stents (LAMS) are the options for managing symptomatic pancreatic pseudocysts. Aim: To evaluate the effectiveness and safety of LAMS for EUS-guided drainage of symptomatic pancreatic pseudocysts in two referral centers in Colombia. Materials and methods: A multicenter prospective cohort study between June 2019 and December 2021 included 13 patients diagnosed with symptomatic pancreatic pseudocysts who underwent EUS-guided drainage with LAMS. Technical success, clinical success, and successful stent removal were evaluated as outcomes. Safety outcomes included stent-related adverse events and general adverse events. Follow-up was carried out for eight weeks, collecting data on stent removal. Results: The average age was 53.4 years; 8/13 were men. The mean size of the pseudocyst was 9.56 ± 2.3 cm. Technical success was 100%, and clinical success was 92.3%. The stents were removed on average after 8 ± 2 weeks. The mean procedural time from puncture to stent deployment was 3.2 ± 2.4 minutes. In the imaging check-up, the collections had adequate drainage in all cases. There was a low frequency of complications; bleeding was documented in one case requiring surgery. Conclusions: LAMS is safe and effective in managing symptomatic pancreatic pseudocysts, reducing hospital stay and cost overruns. Clinical symptomatology prevails in the surgery decision. [ABSTRACT FROM AUTHOR]

Introduction: Patients with malignant biliary distal obstruction who cannot be treated with endoscopic retrograde cholangiopancreatography (ERCP) or who had a failed ERCP, can find alternative treatment in endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy. EUS-CDS performs with high rates of technical and clinical success and with low rates of morbimortality. Moreover, this method could have the potential to improve the patient's quality of life, compared with percutaneous or surgical means. Objective: This study aims to describe the initial experience with endoscopic ultrasound-guided biliary drainage in patients with malignant biliary distal obstruction in a reference center. Methods: Retrospective case review of six patients with malignant biliary obstruction and prior ERCP-placed and failed. Endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy was performed as an alternative method. Technical and clinical success rates, adverse event rates, dysfunction rates, and patient survival time were described. Results: 6 cases were analyzed with a higher proportion of female patients, with a mean age of 71,8 ± 19,8 years. The symptoms were related to pancreas adenocarcinoma, periampullary tumor, and distal cholangiocarcinoma. The procedure was technically successful in 100% of cases and clinically successful in 83% of cases. Serious adverse events were nor reported. After 30 days, a survival rate of 66,7 % was observed. Conclusion: Choledochoduodenostomy is a viable, safe, and effective method in patients with malignant biliary obstruction who had a failed ERCP, and it has high rates of technical and clinical success. [ABSTRACT FROM AUTHOR]

Biliary lithiasis is a common condition in pregnant women, and complications related to gallstones during pregnancy can lead to adverse outcomes in both the mother and the fetus. Choledocholithiasis during pregnancy requires an adequate diagnostic approach to minimize the risks of medical interventions. The following are two cases of pregnant women with choledocholithiasis diagnosed using magnetic resonance cholangiography. Treatment included a combination of endoscopic ultrasound and retrograde endoscopic cholangiopancreatography (ERCP) without fluoroscopy, achieving the resolution of choledocholithiasis, without exposing the fetus to ionizing radiation, confirming the permeabilization of the common bile duct, and observing an adequate postoperative evolution of both the mother and the fetus. [ABSTRACT FROM AUTHOR]

Endosonography is a diagnostic method that has revolutionized the way to approach patients with tumors in the gastrointestinal tract and other extra-digestive organs and structures. Currently, it is a method of choice to assess subepithelial lesions of the gastrointestinal tract and to classify gastrointestinal tumors in the esophagus, stomach, rectum, and pancreas. Therefore, this literature review presents evidence on the classical indications of endosonography, as well as current applications to approach gastrointestinal tumors. [ABSTRACT FROM AUTHOR]

Endosonography, born more than 30 years ago, is one diagnostic modality for benign and malignant pathologies of the gastrointestinal tract. In recent years, transgastric (left) or transduodenal (right) fine needle biopsies of the adrenal glands guided by endosonography has been demonstrated to be safer and more efficacious than percutaneous approaches guided by CT or ultrasound. Differential diagnoses of adrenal insufficiency with evidence of masses in adrenal glands must consider paracoccidioidomycosis despite the fact that it is exclusively present in Latin America where its etiological agent is found. We present a case of paracoccidioidomycosis with adrenal insufficiency and bilateral adrenal thickening whose diagnosis was achieved by transgastric biopsy of the left adrenal gland guided by endosonography. [ABSTRACT FROM AUTHOR]

Anorectal endosonography can diagnose many diseases of the anal canal and rectum. In Colombia, the procedure is performed in only a few medical centers because of the scarcity of trained personnel. Four years ago, a group of teachers from the gastroenterological surgery clinical at the University of Caldas received training in endoluminal ultrasonography in Chile and Spain and have been practicing these procedures ever since. This is a descriptive study of a prospective cohort using data from patients who underwent endoluminal ultrasonography between October 2014 and September 2015. Data were obtained from 136 patients, of whom 72.05% were women. 20.6% of the patients came from departments other than Caldas. Fecal incontinence was the reason for the procedure for 44 patients (32.35%, 86% of whom were women). Other indications were rectal malignancies (23.5%), perianal fistulas (12.5%), anal pain (11.03%), endometriosis (7.35%), and perianal abscesses (6.62%). The most common final diagnoses were defective sphincters in 40 patients (29.41%), rectal malignancy in 13.24% of the patients, perianal fistulas in 11.76% of the patients, perianal abscesses in 8.82% of the patients, and benign rectal neoplasms in 6.62% of the patients . The results are consistent with those found in the international literature where the most common final diagnoses reported for the reason for fecal incontinence are sphincter defects and obstetric disorders. Anorectal endosonography is of great importance when used alone or to support other diagnostic tools. It is recommended that this procedure be done in a referral center such as ours which performs a large volume of these procedures and which follows international guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Optimal linear endobronchial ultrasound (EBUS) outcomes require sedation to ensure that the patient remains calm, immobile, and does not cough, and so that the bronchoscopist can work comfortably. The choice of anesthesia techniques, on a spectrum ranging from general anesthesia to sedation, is not standardized. The aims of this study were to determine doses, safety and satisfaction for intravenous sedation with propofol and remifentanil, and identify potential predictors of coughing during the procedure, and determine patient and bronchoscopist satisfaction with the procedure. Patients and methods: The prospective study included patients undergoing EBUS under sedation in a tertiary hospital. Results: A total of 90 patients underwent EBUS under sedation with remifentanil and propofol, at infusion rates of 0.13 (0.09-0.17) μkg-1 min-1 and 2.34 (1.5-3.6)mgkg-1 h-1, respectively. Just over four fifths of the patients (81%) coughed at some point during the ultrasound procedure. In 8% of patients the procedure was promptly discontinued due to coughing and desaturation. There were no major complications directly related to sedation. Bronchoscopists and patients rated their satisfaction with the procedure as excellent or good in most cases. There was no statistically significant relationship between the number of coughing episodes during the procedure and any of the following variables: positive cough test, a habitual cough, tobacco dependence, or severity of chronic obstructive pulmonary disease. Conclusions: Remifentanil and propofol administered by an anesthesiologist enabled spontaneously breathing patients to undergo linear EBUS, although with a high incidence of coughing and particularly desaturation. No predictors for coughing during EBUS were identified. [ABSTRACT FROM AUTHOR]

Endosonography (EUS), which combines routine endoscopy and ultrasound examination, has been rarely used in the routine diagnostic of portal hypertension. Gastroduodenoscopy is still the method of choice for the diagnosis of varices but it only allows for analysis of superficial varices. Endosonography offers much more detailed analysis of several features of portal hypertension, not detected with routine endoscopy. In this report we systematically review the current and potential future applications of EUS in the diagnostics of gastric varices. [ABSTRACT FROM AUTHOR]