ABSTRACT
Resumen La sedación es una técnica anestésica de amplio uso en los procedimientos endoscópicos digestivos actuales dado su claro beneficio en la tolerancia y comodidad para el paciente y el endoscopista. El medicamento de mayor uso en la actualidad para utilizarse como monosedación es el propofol, pero los esquemas balanceados utilizando más de un medicamento ahora son ampliamente usados en endoscopia diagnóstica o terapéutica. La sedación balanceada utilizando propofol y remifentanilo permite la potenciación sinérgica de un sedante con un opioide de ultracorta acción, lo que a su vez favorece la disminución respectiva de cada dosis. Se presenta una serie de 1148 pacientes llevados a endoscopia digestiva alta diagnóstica con dosis promedio de remifentanilo de 0,9 µg/kg de peso y de propofol de 0,47 mg/kg de peso, sin eventos adversos graves, con excelente satisfacción para el endoscopista y con muy bajo costo de la dosis por medicamento, con lo que se infiere que es un esquema seguro y eficiente.
Abstract Sedation is an anesthetic technique that is widely used in current digestive endoscopic procedures because of its clear benefits for patients' tolerance and comfort and for the endoscopist. Propofol is the most commonly used drug in monosedation, but balanced regimens using more than one drug are now widely used in diagnostic and therapeutic endoscopy. Balanced sedation using Propofol and Remifentanil allows synergistic potentiation of a sedative with an ultra-short acting opioid which in turn favors decreases of each dose. This is a series of 1,148 patients who underwent diagnostic endoscopy under balanced sedation with average Remifentanil doses of 0.9 mcg/kg of body weight and average Propofol doses of 0.47 mg/kg of body weight. There were no serious adverse events, endoscopists were highly satisfied with the procedures, and costs per drug dose were very low. This is clearly a safe and efficient scheme.
Subject(s)
Endoscopy, Digestive System , Propofol , Analgesics, OpioidABSTRACT
La mucosa gástrica heterotópica en esófago cervical (MGHEC) es una condición probablemente subdiagnosticada. La gran mayoría de los pacientes son asintomáticos y su detección es un hallazgo incidental. En los pacientes sintomáticos, las manifestaciones se asocian con cambios no neoplásicos o neoplásicos, que permiten categorizarlos en cinco tipos. A la categoría tipo III corresponde el caso presentado del paciente, con disfagia y globus faríngeo por MGHEC de compromiso circunferencial con estenosis franqueable. Al momento de esta publicación, solo se encontraron siete casos similares en la literatura mundial. La detección de MGHEC (apoyada en nuevas tecnologías de imagen como la cromoendoscopia) puede ser un indicador de calidad en el desempeño endoscópico, similar a la detección de adenomas en colonoscopia.
Heterotopic gastric mucosa in the cervical esophagus is a condition that is probably underdiagnosed. The vast majority of patients are asymptomatic, and detection is an incidental finding. In symptomatic patients, manifestations are associated with non-neoplastic or neoplastic changes that allow categorization into five types. The case presented here is a patient who had Type III with dysphagia and pharyngeal globus due to heterotopic gastric mucosa in the cervical esophagus with circumferential presentation with stenosis. At the time of publication, only seven similar cases could be found in the literature. Detection, supported by new imaging technologies such as chromoendoscopy, may be an indicator of the quality of endoscopic performance in a manner that is similar to detection of adenomas in colonoscopy.
Subject(s)
Humans , Female , Middle Aged , Esophagus , Gastric MucosaABSTRACT
An epidemiological survey about the incidence of upper gastrointestinal bleeding during 3 periods (1980, 1985 and 1990), was performed in 9 chilean hospitals. Its annual incidence decreased in 1990, when compared to 1980. Likewise the etiologies changes, with an increase in the incidence of duodenal ulcers and a decrease in the incidence of erosive gastritis and bleeding of unknown origin in 1990. A seasonal variation with higher bleeding rates in autumn was also recorded
Subject(s)
Humans , Gastrointestinal Hemorrhage/epidemiology , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/epidemiology , Gastrointestinal Hemorrhage/etiology , Hospitals/statistics & numerical data , Health SurveysABSTRACT
The prevalence of helicobacter pylori infection was studied in 152 subjects with a normal upper gastrointestinal endoscopy, 125 with duodenal ulcer, 25 with gastric ulcer, 46 with erosive gastritis and 9 with erosive duodenitis. Two biopsies fron duodenum, antrum and fub¿ndus were obtained from each subject during endoscopy for histological diagnosis and Helicobacter pylori search. None of the patients with normal endoscopy and 2 percent of patients with duodenal ulcer had Helicobacter pylori in duodenal biopsies. These last patients had a significantly higher frecuency of Helicobacter pylori in the antrum (71 percent) than the rest of the studied groups. Five percent of subjects with normal endoscopy and 5 percent of those with duodenal ulcer had Helicobacter pylori in the antrum. An active gastritis was demonstrated in almost all patients with Helicobacter infection. Instestinal metaplasia occurred almost exclusively in the abscence of Helicobacter Pylori infection
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Helicobacter pylori/isolation & purification , Duodenitis/microbiology , Gastritis/microbiology , Duodenal Ulcer/microbiology , Stomach Ulcer/microbiology , Helicobacter pylori/pathogenicity , Gastroscopy , Duodenum/microbiology , Gastrointestinal Diseases/microbiology , Gastrointestinal Diseases/pathology , Metaplasia/microbiology , Pyloric Antrum/microbiology , Gastric Fundus/microbiologyABSTRACT
The aim of this work was to study the prevalence of biliary diseases and digestive symptoms in normal adult women. Four hundred nineteen women were chosen; of these 145 were discarded due to previous gastrointestinal disease (20), previous gastrointestinal complaints (38) and previous cholecystectomy (85). Two hundred seventy six women were subjected to abdominal ultrasound examination; of these, 53 had cholelithiasis and in three a gallbladder cancer was suspected (and confirmed by surgery). Considering women with previous cholecystectomy, cholelithiasis and gallbladder cancer, a 33.6 per cent prevalence of biliary diseases can be inferred. An interrogation about gastrointestinal symptoms was performed to women subjected to ultrasound examinations by 2 professionals unware of ultrasound results. A high frequency of pyrosis, food intolerance and constipation was found, not observing differences between women with or without cholelithiasis. However, these last women had a higher frequency of upper abdominal pain. Both groups had also a high rate of previous surgical procedures
Subject(s)
Humans , Female , Adult , Middle Aged , Cholelithiasis/epidemiology , Gastrointestinal Diseases/epidemiology , Colic/epidemiology , Serial Cross-Sectional Studies , Heartburn/epidemiologyABSTRACT
Se realizó un estudio prospectivo en 53 pacientes con cáncer gástrico sometidos a gastrectomía total comparando la técnica manual frente a la mecánica, en la anastomosis esofagoyeyunal. En 35 pacientes se realizó la técnica manual y en 18 la técnica con stapler. No hubo mortalidad operatoria en la serie. El tiempo operatorio, la incidencia de fístula y otras complicaciones postoperatorias fueron similares en ambos grupos. La frecuencia de infección de la herida operatoria, la presencia de absceso subfrénico y la estadía postoperatoria fueron significativamente menores en pacientes sometidos a la técnica mecánica. Este procedimiento es fácil de realizar, es reproducible de un cirujano a otro, no requiere de gran experiencia previa como la técnica manual y es una buena alternativa cuando es necesario hacer una anastomosis esofagoyeyunal alta