Evaluation of pH and residual gastric volume after colon preparation with mannitol: prospective randomized study comparing procedure performed after 3 hours versus 6 hours

OBJECTIVES: Our goal was to compare the hydrogen potential (pH) and residual gastric volume (RGV) of patients undergoing colonoscopy after 3 and 6 hours of colon preparation with mannitol. METHODS: We described a prospective randomized trial with a 50:50 allocation rate of two distinct times of colonoscopy after colon preparation with 10% mannitol. We included outpatients aged over 18 years, with no history of gastric surgeries and an American Society of Anesthesiologists (ASA)-rated anesthetic risk below III. Colonoscopy was performed after upper digestive endoscopy at two different times: 3 versus 6-hour after mannitol ingestion. During upper gastrointestinal endoscopy, we measured RGV and evaluated pH with a digital pH meter. Clinical trials.gov: 71123317.9.3001.0065 RESULTS: We randomized a total of 100 participants to the 3 and 6-hour groups, with the patients in the 6-hour group being younger and presenting a higher body mass index (BMI). The intervention did not result in any statistically significant differences between the two groups, neither for the RGV (p=0.98) or the pH (p=0.732). However, the subgroup of patients with diabetes mellitus showed statistically significant higher RGV values in the 3-hour group. CONCLUSION There was no difference between RGV and pH values at 3 versus 6-hour after bowel preparation with mannitol, except for RGV in diabetic patients at 3 hours. As prolonged fasting protocols may result in adverse events such as dehydration and electrolyte imbalance, we can infer that colonic preparation with mannitol in shorter fasting periods, such as 3 hours, can be adopted safely and routinely.

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.

Neoplasia mucinosa papilar intraductal (NMPI) / Intraductal papillary mucinous neoplasm (IPMN)

A neoplasia mucinosa papilar intraductal (IPMN) é um tumor cístico do pâncreas. Os primeiros relatos de IPMN datam do início da década de 80. Sua incidência ainda é desconhecida, porém a prevalência dessas neoplasias em um estudo realizado com a população de Minessota nos Estados Unidos, mostrou 2.04 casos para 100.000 hab4. A etiologia permanece obscura, mas a evidência crescente sugere o envolvimento de várias vias responsáveis pelo aparecimento da neoplasia, incluindo uma associação com síndromes hereditárias. IPMN ocorre mais comumente nos homens, com idade média ao diagnóstico entre 64 e 67 anos. No momento do diagnóstico, podem ainda ser benignos, com ou sem displasia ou francamente malignos, se apresentando já como um carcinoma invasivo. Em geral, os pequenos IPMNs localizados nos ramos secundários são benignos, particularmente em doentes assintomáticos, nesses casos podem ser submetidos a tratamentos conservadores. Em contraste, os tumores do ducto principal devem ser ressecados e cuidadosamente examinados à procura de um componente invasivo. Na ausência de invasão, a sobrevida é excelente, 94-100%. Para os doentes com carcinoma invasivo IPMN-associado, o prognóstico é melhor do que aqueles com um adenocarcinoma ductal isolado, com uma sobrevivência de 5 anos de 40% a 60% em algumas séries. No entanto, nenhuma vantagem de sobrevivência pôde ser demonstrada em relação aos tipos histológicos (tubular convencional versus mucinosos). Diversas variantes histomorfológicas são reconhecidas, embora o significado clínico desses subtipos não está bem definido.

Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer: initial experience of a western center

BACKGROUND: Endoscopic submucosal dissection is a new Japanese technique characterized by en-bloc resection of the entire lesion irrespective of size, with lower local recurrence when compared to endoscopic mucosal resection. OBJECTIVE: To evaluate the feasibility, early results and complications of the endoscopic submucosal dissection technique for treating early gastric and esophageal cancer at the Endoscopic Unit of Clinics Hospital and Cancer Institute of the São Paulo University. MATERIALS AND METHODS: Twenty patients underwent endoscopic resection using the endoscopic submucosal dissection technique for early gastric or esophageal cancer. The patients were evaluated prospectively as to the executability of the technique, the short-term results of the procedure and complications. RESULTS: Sixteen gastric adenocarcinoma lesions and six esophageal squamous carcinoma lesions were resected. In the stomach, the mean diameter of the lesions was 16.2 mm (0.6-3.5 mm). Eight lesions were type IIa + IIc, four were type IIa and four IIc, with thirteen being well differentiated and three undifferentiated. Regarding the degree of invasion, five were M2, seven were M3, two were Sm1 and one was Sm2. The mean duration of the procedures was 85 min (20-160 min). In the esophagus, all of the lesions were type IIb, with a mean diameter of 17.8 mm (6-30 mm). Regarding the degree of invasion, three were M1, one was M2, one was M3 and one was Sm1. All had free lateral and deep margins. The mean time of the procedure was 78 min (20-150 min). CONCLUSION: The endoscopic submucosal dissection technique was feasible in our service with a high success rate.

Dermatoses pré-cancerosas e tumores malignos cutâneos em Mogi das Cruzes, SP / Pre-cancerous dermatoses and cutaneous malignant tumours in Mogi das Cruzes, SP

Os autores realizaram estudo epidemiológico de dermatoses pré-cancerosas e tumores malignos cutâneos, constando da análise 2.651 prontuários de pacientes atendidos no ambulatório da Disciplina de Dermatologia do Curso de Medicina da UMC, de janeiro de 1988 a dezembro de 1997. Houve registro de 114 casos de dermatoses pré-cancerosas isoladas, 41 de dermatoses pré-cancerosas associadas ao câncer cutâneo e 100 de câncer cutâneo. Observou-se predomínio de doenças pré-cancerosas e tumores malignos nos indivíduos de raça branca do sexo feminino, exceto o carcinoma espinocelular. A idade média foi de 30 anos para as doenças pré-cancerosas e 65 anos para os cânceres cutâneos