An 86-year-old male patient with a history of arterial hypertension was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever that started 5 days before admission. Blood analysis revealed a hemoglobin level of 14.3

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Acute post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a feared and potentially fatal complication that can be as high as up to 30% in high-risk patients. Pre-examination measures, during the examination and after the examination are the key to technical and clinical success with a decrease in adverse events. Several studies have debated on the subject, however, numerous topics remain controversial, such as the effectiveness of prophylactic medications and the amylase dosage time. This review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

Fauze MALUF-FILHO, Spencer CHENG e Gustavo de Oliveira LUZ RESUMO -Objetivos -Procurou-se avaliar o papel atual dos procedimentos terapêuticos endoscópicos no manejo do pacientes com carcinoma epidermóide do esôfago. Levantamento de dados -Utilizando o banco de dados do PubMed (U.S. National Library of Medicine), analisaram-se as publicações sobre o tema nos últimos 10 anos, cotejando-as com a experiência desenvolvida no Serviço de Endoscopia Gastrointestinal do Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo. Síntese dos dados -Neste campo, destacam-se a ressecção endoscópica do câncer esofágico precoce e a tunelização do tumor avançado daquele órgão. A ressecção endoscópica da mucosa do câncer epidermóide precoce do esôfago é indicada quando a lesão é confi nada ao epitélio (m1) ou à lamina própria (m2). A taxa de sobrevida conhecida de 5 anos após a ressecção endoscópica da mucosa do tumor epidermóide intramucoso do esôfago aproxima-se de 95%. Conclusões -Baseado nas evidências disponíveis, parece razoável indicar a ressecção endoscópica da mucosa como tratamento de primeira escolha para pacientes com carcinoma esofágico epidermóide intramucoso. Existem vários métodos endoscópicos paliativos para o alívio da disfagia em câncer esofágico avançado. A escolha variará de acordo com as características anatômicas e a localização do tumor, as preferências do paciente, a disponibilidade e a capacitação do centro assistencial. A taxa de sucesso técnico da colocação de próteses metálicas auto-expansíveis em estenose maligna praticamente atinge 100%. A taxa de efeito paliativo em longo prazo da disfagia aproxima-se de 80%, o que faz com que esta opção seja, até o momento, o tratamento paliativo de escolha para os sintomas de obstrução causados pelo câncer esofágico de células escamosas. DESCRITORES -Neoplasias esofágicas. Carcinoma de células escamosas. Esofagoscopia.

Background and aimEndoscopic ultrasound (EUS)-guided drainage is the gold standard approach for the treatment of encapsulated pancreatic collections (EPCs) including pseudocyst and walled-off pancreatic necrosis (WON), and is associated with an equivalent clinical efficacy to surgical drainage with fewer complications and less morbidity. Drainage may be achieved via several types of stents including a fully covered self-expandable metallic stent (SEMS) and lumen-apposing metal stent (LAMS). However, to date there have been no randomized trials to compare these devices. This study aimed to compare the efficacy and safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. MethodsA phase IIB randomized trial was designed to compare the SEMS versus LAMS for the treatment of EPCs. Technical success, clinical success, adverse events (AEs), and procedure time were evaluated. A sample size of 42 patients was determined. ResultsThere was no difference between the two groups in technical (LAMS 80.95% vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no difference in AEs including stent migration rate and mortality. The procedure time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, p=0.001). There was also a difference in the number of intra-procedure complications (5 LAMS vs 0 SEMS, p=0.048). ConclusionSEMS and LAMS have similar technical, clinical, and radiological success as well as AEs. However, SEMS has a shorter procedure time and fewer intra-procedure complications compared to non-electrocauteryenhanced LAMS in this phase IIB randomized controlled trial (RCT). The choice of the type of stent used for EUS drainage of EPCs should consider device availability, costs, and personal and local experience.