Search

Resumen Introduccion La erradicacion de la infeccion por Helicobacter pylori representa un desafio clinico. Objetivo Evaluar la eficacia y seguridad de la terapia cuadruple con esomeprazol mas una capsula 3 en 1 que contiene subcitrato de bismuto, metronidazol y tetraciclina, mas probioticos en pacientes diagnosticados de infeccion por H. pylori en la practica clinica habitual. Metodos Estudio prospectivo, intervencional, unicentrico y abierto realizado en pacientes consecutivos con indicacion confirmada de erradicacion de infeccion por H. pylori . Los pacientes fueron tratados con 3 capsulas de Pylera ® 4 veces al dia (desayuno, comida, merienda y cena), mas 40 mg de esomeprazol, 2 veces al dia durante 10 dias (30 min antes de desayuno y cena) y probioticos durante 30 dias. La erradicacion de la infeccion por H. pylori se confirmo mediante la prueba del aliento con urea marcada realizada al menos 28 dias despues del final del tratamiento. Resultados Un total de 100 pacientes fueron incluidos consecutivamente. Veinticinco (25,0%) pacientes tenian historia previa de tratamiento de su infeccion por H. pylori . En la poblacion por intencion de tratar, las tasas de erradicacion fueron del 90,7% (68/75) y del 80,0% (20/25) en los pacientes tratados con Pylera ® como primera linea o como terapia de rescate, respectivamente. Dieciocho pacientes (18%) presentaron, al menos, un acontecimiento adverso, la mayoria (89%) leves. Conclusion Diez dias de tratamiento con un regimen cuadruple de bismuto, metronidazol y tetraciclina mas esomeprazol y probioticos es una estrategia eficaz y segura en pacientes con infeccion por H. pylori .

Introduction The eradication of Helicobacter pylori infection represents a clinical challenge. Objective To evaluate the efficacy and safety of quadruple therapy with esomeprazole plus a 3-in-1 capsule containing bismuth subcitrate, metronidazole and tetracycline, plus probiotics in patients diagnosed with H. pylori infection in routine clinical practice. Methods A prospective, interventional, single-centre and open-label study in consecutive patients with a confirmed indication for eradication of H. pylori infection. Patients were treated with three capsules of Pylera® four times a day (breakfast, lunch, afternoon snack and dinner), plus 40 mg of esomeprazole twice daily for 10 days (30 min before breakfast and dinner) and probiotics for 30 days. Eradication of H. pylori infection was confirmed by labelled urea breath test performed at least 28 days after the end of treatment. Results A total of 100 patients were consecutively enrolled. Twenty-five patients (25.0%) had a prior history of treatment for their H. pylori infection. In the intention-to-treat population, eradication rates were 90.7% (68/75) and 80.0% (20/25) in patients treated with Pylera® as the first line or as rescue therapy, respectively. Eighteen patients (18%) had at least one adverse event, most of which (89%) were mild. Conclusion Ten days of treatment with a quadruple regimen of bismuth, metronidazole and tetracycline plus esomeprazole and probiotics is an effective and safe strategy in patients with H. pylori infection.

Resumen Introduccion Presentamos nuestra experiencia en el tratamiento endoscopico del diverticulo de Zenker. Pacientes y metodo Tres pacientes con diverticulos de Zenker de tamano medio fueron sometidos a una cricofaringomiotomia endoscopica realizada con un esfinterotomo de aguja modificado a traves de un gastroscopio terapeutico. El procedimiento se realize en la unidad de endoscopia digestiva bajo sedacion consciente sin apoyo anestesico. Resultado La cricofaringomiotomia endoscopica se completo en una unica sesion sin complicaciones inmediatas ni tardias. En los 3 pacientes desaparecio completamente la disfagia y todos fueron dados de alta a las 48 h con indicacion de dieta solida. Tras 12,18 y 17 meses de seguimiento no ha reaparecido la disfagia ni otros sintomas atribuibles al diverticulode Zenker. Conclusion La cricofaringomiotomia mediante endoscopio flexible es un tratamiento simple, eficaz y seguro del diverticulo de Zenker que ahorra la cirugia abierta cervical y la anestesia general.

We report our experience in the endoscopic (flexible) treatment of Zenker's diverticulum.Three patients with medium-sized Zenker's diverticula were treated by endoscopic cricopharyngeal myotomy with a modified needle-knife sphincterotome through a therapeutic gastroscope. The procedure was performed in the digestive endoscopy unit under conscious sedation without anesthetic support.Endoscopic cricopharyngeal myotomy was completed in a single session without immediate or late complications. In all three patients dysphagia disappeared and all were discharged at 48 hours with a solid diet. After 12, 18 and 17 months of follow-up there has been no recurrence of dysphagia or other symptoms attributable to Zenker's diverticulum.Flexible endoscopic cricopharyngeal myotomy is a simple, effective and safe treatment of Zenker's diverticulum that avoids the need for open cervical surgery and general anesthesia.

Warm Water Ampullary Washing: A Potential Needle-Knife Sphincterotomy Sparing Technique Emilio De la Morena, Elena Perez de Arellano, Yago Gonzalez-Lama, Esperanza Tomas-Moros Background: Needle-knife sphincterotomy (NKS) is an alternative endoscopic sphincterotomy (ES) technique used when selective biliary canulation (SBC) fails, but it is difficult to learn and is an independent risk factor for postERCP pancreatitis. Easier and safer canulation, NKS sparing, handlings are thus desirable. Objective: To report our preliminary results with a new canulation facilitating technique, the warm water ampullary washing (WAW). Method: WAW is performed when guide-wire assisted SBC fails and sphincter of Oddi spasm is one major presumptive cause of the failure. The ampoule is washed with 50 cc of tap water empirically titrated at 38-40 C using a canulotome inserted a few millimetres in the papillary orifice caring not to nail the tip to permit the duodenal reflux of the water and prevent pancreatic injection. After WAW a second SBC attempt is tried and if it fails again a NKS is performed. Results: Along one year 66 ES were indicated in 75 patients. Initially CSB and ES were performed in 54 (82%) and NKS in 5. WAW was tried in 7 and allowed CSB and ES in 4. Thus the final number of ES performed was 58 (88%) and the theoretic 12 (18%) NKS dropped to the real 8 (12%) (pZNS). The 4 WAW issues had healthy papillae (HP) (2 normal and 2 mild papillitis) whereas the 3 WAW failures had ill papillae (IP) (2 severe papillitis, 1 impacted stone). All 8 patients who required NKS had IP. Among the 3 WAW failures 1 mild pancreatitis was registered. Compared with 225 historical controls NKS dropped from 16% to 12% (pZNS). However NKS in IP patients rose from 7% to 12% (pZNS) and NKS in HP patients fell from 9% to 0 (pZ0.00002). Conclusion: With these results we hypothesise that WAW facilitates the SBC and allows ES in HP patients sparing NKS in them and limiting it to IP patients.