Acurácia do escore de referência endoscópico para esofagite eosinofílica em crianças / Accuracy of the eosinophilic esophagitis endoscopic reference score in children

ABSTRACT Background: To assess the efficacy of applying the endoscopic reference score for EoE (EREFS) in children with symptoms of esophageal dysfunction naïve to proton pump inhibitor (PPI) therapy. Methods: An observational cross-sectional study was conducted by reviewing reports and photographs of upper gastrointestinal endoscopies (UGE) and esophageal biopsies of patients with symptoms of esophageal dysfunction. Patients who were treated with PPI or had other conditions that may cause esophageal eosinophilia were excluded. Results: Of the 2,036 patients evaluated, endoscopic findings of EoE were identified in 248 (12.2%) and more than one abnormality was observed in 167 (8.2%). Among all patients, 154 (7.6%) presented esophageal eosinophilia (≥15 eosinophils per high power field) (P<0.01). In this group, 30 patients (19.5%) had normal endoscopy. In patients with EoE, edema (74% vs 6.5%, P<0.01) and furrows (66.2% vs 2.4%, P<0.01) were more prevalent than in the control group. Association of edema and furrows was more frequent in patients with EoE than in the control group (29.2% vs 1.6%, P<0.01, OR=24.7, CI=15.0-40.5). The presence of more than one endoscopic finding had sensitivity of 80.5%, specificity of 93.4%, positive predictive value (PPV) of 50%, negative predictive value (NPV) of 98.3%, and accuracy of 92.4%. Conclusion: In conclusion, this study showed that endoscopic features suggestive of EoE had high specificity and NPV for diagnosing EoE in children naïve to PPI therapy. These findings highlight the importance of the EREFS in contributing to early identification of inflammatory and fibrostenosing characteristics of EoE, making it possible to identify and to avoid progression of the disease.

RESUMO Contexto: Avaliar a eficácia da aplicação do escore de referência endoscópico para EoE (EREFS) em crianças com sintomas de disfunção esofágica sem tratamento prévio com inibidores da bomba de prótons (IBP). Métodos: Foi realizado um estudo transversal observacional por meio de revisão de laudos e fotos de endoscopia digestiva alta (EDA) e biópsias de esôfago de pacientes com sintomas de disfunção esofágica. Pacientes tratados com IBP ou com outras condições que podem causar eosinofilia esofágica foram excluídos. Resultados: Dos 2.036 pacientes avaliados, os achados endoscópicos de EoE foram identificados em 248 (12,2%) e mais de uma anormalidade foi observada em 167 (8,2%). Entre todos os pacientes, 154 (7,6%) apresentaram eosinofilia esofágica (≥15 eosinófilos por campo de grande aumento) (P<0,01). Nesse grupo, 30 pacientes (19,5%) apresentaram endoscopia normal. Em pacientes com EoE, edema (74% vs 6,5%, P<0,01) e linhas verticais (66,2% vs 2,4%, P<0,01) foram mais prevalentes quando comparados ao grupo controle. A associação de edema e linhas verticais foi mais frequente em pacientes com EoE do que no grupo controle (29,2% vs 1,6%, P<0,01, OR=24,7, IC=15,0-40,5). A presença de mais de um achado endoscópico teve sensibilidade de 80,5%, especificidade de 93,4%, valor preditivo positivo de 50%, valor preditivo negativo de 98,3% e acurácia de 92,4%. Conclusão: Em conclusão, esse estudo mostrou que as características endoscópicas sugestivas de EoE apresentam especificidade e VPN elevados para o diagnóstico da enfermidade em crianças sem tratamento prévio com IBP. Estes achados reforçam a importância do EREFS em contribuir para a identificação precoce de características inflamatórias e fibroestenosantes, possibilitando identificar e evitar a progressão da doença.

Drainage of Pancreatic Pseudocysts Using Lumen-apposing Metal Stents (LAMS): Experience in Two Referral Centers in Colombia

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.

Introducción: el drenaje guiado por ultrasonido endoscópico (USE) y el uso de stent metálico luminal de aposición (LAMS) son de elección en el manejo de los pseudoquistes pancreáticos sintomáticos. Objetivo: evaluar la efectividad y seguridad del LAMS para el drenaje por USE de pseudoquistes pancreáticos sintomáticos en dos centros de referencia en Colombia. Materiales y métodos: estudio de cohorte prospectivo multicéntrico entre junio de 2019 y diciembre de 2021, se incluyeron a 13 pacientes con diagnóstico de pseudoquistes pancreáticos sintomáticos sometidos a drenaje por USE con LAMS. Se evaluaron como desenlaces el éxito técnico, el éxito clínico y la extracción exitosa del stent. Y los desenlaces de seguridad incluyeron eventos adversos relacionados con el stent y los eventos adversos generales. Se realizó seguimiento a 8 semanas, en las que se recopilaron datos relacionados con el retiro del stent. Resultados: la edad promedio fue 53,4 años, 8/13 fueron hombres. El tamaño medio del pseudoquiste fue de 9,56 ± 2,3 cm. El éxito técnico fue del 100% y el éxito clínico fue 92,3%. Los stents fueron retirados en promedio a las 8 ± 2 semanas. El tiempo medio del procedimiento desde la punción hasta el despliegue del stent fue 3,2 ± 2,4 minutos. En el control imagenológico hubo un adecuado drenaje de las colecciones en todos los casos. Hubo baja frecuencia de complicaciones, se documentó sangrado en 1 caso con requerimiento quirúrgico. Conclusiones: el uso de LAMS es seguro y efectivo en el manejo de pseudoquistes pancreáticos sintomáticos, disminuye la estancia hospitalaria y sobrecostos. La sintomatología clínica prima en la decisión de intervención.

Manejo de perforaciones, fugas y fístulas del tracto gastrointestinal con clip sobre el endoscopio. Experiencia de un centro oncológico Latinoamericano / Management of perforations, leaks and fistulas of the gastrointestinal tract with over the scope clip. Experience at a Latin American cancer center

Introducción. Las fístulas derivadas de enfermedades neoplásicas del tracto digestivo, así como las fugas posteriores a procedimientos quirúrgicos, no son infrecuentes y ocasionan una morbilidad importante cuando se manejan de forma quirúrgica. También durante los procedimientos endoscópicos se pueden presentar perforaciones y, si se logra un manejo no operatorio, se alcanza una adecuada recuperación. El objetivo de este estudio fue describir las características clínicas y los resultados de los pacientes con perforaciones, fístulas y fugas del tracto gastrointestinal, manejadas endoscópicamente con clip sobre el endoscopio. Métodos. Estudio descriptivo, retrospectivo, de pacientes con perforación, fuga o fístula postoperatoria, llevados a endoscopía digestiva con colocación de clip sobre el endoscopio, en el Instituto Nacional de Cancerología en Bogotá, D.C., Colombia, entre enero de 2016 y abril de 2020. Resultados. Se incluyeron 21 pacientes, 52,4 % de ellos mujeres. La mediana de edad fue de 66 años y del diámetro del defecto fue de 9 mm. En el 95 % se logró éxito técnico. Hubo éxito clínico temprano en el 85,7 % de los casos. El 76,1 % de los pacientes permanecieron sin síntomas a los 3 meses de seguimiento. Conclusiones. El manejo de perforaciones, fugas y fístulas con clip sobre el endoscopio parece ser factible y seguro. En la mayoría de estos pacientes se logró la liberación del clip y la identificación endoscópica del cierre inmediatamente después del procedimiento; sin embargo, en el caso de las fístulas, no se alcanzó el éxito clínico tardío en todos los casos

Introduction. Fistula of the digestive tract derived from neoplastic diseases as well as leaks following surgical procedures are not uncommon and usually cause significant morbidity when are managed surgically. Diagnostic and therapeutic endoscopic procedures may present perforations during their performance; if they are managed non-operatively, an adequate recovery is obtained. The purpose of this study was to describe the clinical characteristics and the short- and long-term outcomes of patients with perforations, fistulas and leaks of the gastrointestinal tract managed endoscopically with over the scope clip (OTSC). Methods. Descriptive, retrospective study of patients brought to digestive endoscopy with OTSC placement with diagnosis of postoperative perforation, leak or fistula at the National Cancer Institute in Bogota, Colombia, between January 2016 and April 2020. Results. Twenty-one patients were taken for OTSC application for the management of perforations, leaks and fistulas of the gastrointestinal tract, 52.4% of them were women. The median age was 66 years. The median diameter of the defect was 9 mm. Technical success was achieved in 95%. Early clinical success was described in 85.7% of the cases; 76.1% of patients remained symptom-free at 3-month follow-up. Conclusions. Management of perforations, leaks and fistulas with OTSC appears to be feasible and safe. In most of these patients, clip release and endoscopic identification of closure was achieved immediately after management; however, in the case of fistulas, late clinical success was not achieved in all cases

Disposición regular de vénulas colectoras (RAC) como predictor de ausencia de infección por Helicobacter pylori con endoscopios convencionales en población latina, rendimiento diagnóstico por subgrupos

Introducción : La disposición regular de vénulas colectoras tiene alto valor para predecir la ausencia de infección gástrica por Helicobacter pylori, los estudios que validaron este hallazgo se realizaron con imágenes de magnificación y cromoendoscopia digital, es común realizar endoscopias con equipos convencionales de luz blanca sin magnificación. Objetivo : Este estudio pretende validar este hallazgo como predictor de ausencia de infección por H. pylori utilizando equipos de endoscopia con luz blanca convencional sin magnificación. Materiales y métodos : Se realizó un estudio observacional identificando la presencia de RAC con endoscopio convencional, la determinación de Helicobacter pylori se estableció por histopatología. Se calculó sensibilidad, especificidad, valor predictivo positivo (VPP) y valores predictivos negativos (VPN) en relación con la presencia de RAC y el estado de infección por H. pylori. Resultados : 241 pacientes fueron incluidos encontrando una sensibilidad de 5%, con especificidad de 89%. La prevalencia de H. pylori disminuyo con la edad. Conclusión : Este estudio reporta una baja sensibilidad con elevada especificidad de la distribución regular de vénulas colectoras para establecer el estado de infección por H. pylori. El desempeño diagnóstico fue inferior al reportado en estudios llevados a cabo con cromo endoscopia con magnificación.

Introduction : The regular arrangement of collecting venules has high value to predict the absence of gastric infection by Helicobacter Pylori, the studies that have validated this finding were carried out with magnification images and digital chromoendoscopy, it is common to perform endoscopies with conventional white light equipment without magnification. Objective : This study aims to validate this finding as a predictor of the absence of H. Pylori infection using endoscopy equipment with conventional white light without magnification. Material and methods : An observational study was carried out identifying the presence of RAC with a conventional endoscope, the determination of Helicobacter pylori was established by histopathology. Sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) were calculated in relation to the presence of RAC and the H. pylori infection status. Results : 241 patients were included, finding a sensitivity of 5%, with a specificity of 89%. The prevalence of H. Pylori decreased with age. Conclusion : This study reports a low sensitivity with a high specificity of the regular distribution of collecting venules to establish the state of infection by H. Pylori. The diagnostic performance was lower than that reported in studies carried out with chromium endoscopy with magnification.

Hemorragia del tracto digestivo superior, enfoque para el médico general / Upper digestive tract bleeding, approach for the general Practitioner / Hemorragia do trato digestivo superior, enfoque para o médico geral

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.

Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.

A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.

Caracterización clínica, endoscópica e histológica de la enfermedad inflamatoria intestinal

Introducción: La enfermedad inflamatoria intestinal es un padecimiento crónico de causa multifactorial, en los últimos años se ha incrementado el número de casos diagnosticados, por lo que su enfoque clínico-endoscópico e histopatológico es de vital importancia para proveer atención integral a los pacientes. Objetivo: Caracterizar clínica-endoscópica e histopatológicamente la enfermedad inflamatoria intestinal. Métodos: Se realizó un estudio observacional transversal, el universo estuvo constituido por 78 pacientes diagnosticados con enfermedad inflamatoria intestinal y la muestra quedó conformada por 54 pacientes. La información fue recogida en formulario a propósito de la investigación. Resultados: Predominaron los pacientes con edad de 50 años o más. Primó el sexo femenino y el color de la piel blanca. El síntoma cardinal más frecuente fue la diarrea y el tiempo de evolución que primó fue de cuatro a seis meses. La localización más frecuente de las lesiones fue el colon izquierdo y primó la colitis ulcerativa como principal variante. Predominó la mucosa de aspecto granular y las lesiones continuas en los rasgos endoscópicos, así como la distorsión de criptas y la inflamación de la lámina propia dentro de la histología. Sobresalió como principal complicación la fístula y de estos casos la mayoría requirió tratamiento quirúrgico. Conclusiones: Mayor afectación a pacientes de mediana edad, sexo femenino y de raza blanca. Principal síntoma asociado es la diarrea. Variante con mayor superioridad es la colitis ulcerativa. Adecuada correlación clínico-endoscópica e histopatológica. Las principales complicaciones encontradas fueron los trayectos fistulosos y la estenosis intestinal que requirieron en su mayoría tratamiento quirúrgico.

Introduction: Inflammatory bowel disease is a chronic disease of multifactorial etiology that in recent years has increased the number of diagnosed cases, so the clinical-endoscopic and histopathological approach is of vital importance to provide comprehensive care to patients. Objective: To characterize the inflammatory bowel disease clinical-endoscopic and histopathologically. Methods: A cross-sectional observational study was carried out. The universe was composed of 78 patients diagnosed with inflammatory bowel disease and the sample was made up of 54 patients. The data obtained from biopsy ballots were collected in a form. Results: Patients aged between 50 and 69 years old predominated. Female sex and white skin color prevailed. The cardinal symptom that predominated was diarrhea followed by enterorrhagia and the time of evolution that prevailed was 4 to 6 months. The most frequent location of the lesions was the left colon and ulcerative colitis predominated as the main variant. Continuous lesions and granular appearance of the mucosa predominated in endoscopic features, while in histological features crypt distortion and inflammatory infiltrate of the same layer prevailed. Among the complications, the fistula stood out and most of these patients required surgical treatment. Conclusions: Greater affectation in middle ages, female and white skin color patients. The main associated symptom is diarrhea. The most common variant was ulcerative colitis. Adequate clinical-endoscopic and histopathological correlation was evidenced. The main complication was the fistulous tracts and intestinal stenosis, that mostly require surgical treatment.

Tratamento não-cirúrgico de fístula de alto débito pós-"bypass" gástrico em paciente portador de superobesidade: relato de caso / Non-surgical treatment of high-output fistula after gastric bypass in a patient with superobesity: case report

Introdução: A cirurgia bariátrica é atualmente o tratamento indicado para a obesidade mórbida e a técnica do bypass gástrico em Y de Roux (BGYR) largamente utilizada em todo o mundo, mesmo para pacientes superobesos. No Brasil, o BGYR é a técnica de escolha da maioria dos cirurgiões bariátricos. As deiscências de anastomose ou da linha de grampeamento estão entre as complicações cirúrgicas mais temidas. Relato de Caso: Paciente com fístula da anastomose gastrojejunal após bypass gástrico em Y de Roux comunicando com a ferida operatória, foi tratado com sucesso com tratamento endoscópico conservador. Após o diagnóstico, o paciente foi submetido à endoscopia digestiva alta em ambiente de centro cirúrgico com passagem de sonda nasoenteral. Onze dias após, foi realizada uma segunda endoscopia com dilatação da anastomose gastrojejunal com vela de Savary-Gillard. A fístula fechou em 21 contando da data de seu diagnóstico. Conclusão: A partir desse relato, conclui-se que a abordagem conservadora de fístulas pós-BGYR em pacientes estáveis com auxílio endoscópico para o posicionamento da sonda nasoenteral e dilatação com vela pode reservar bons resultados terapêuticos para a condução dessa complicação e evitar intervenções cirúrgicas mais complexas.

Introduction: Bariatric surgery is currently the indicated treatment for morbid obesity and the Roux-en-Y gastric bypass (RYGB) technique is widely used worldwide, even for super obese patients. In Brazil, RYGB is the most chosen technique of bariatric surgeons. Although, anastomosis or stapling line dehiscences are one of the most feared surgical complications. Case Report: A patient with gastrojejunal anastomosis fistula after Rouxen-Y gastric bypass communicating with the surgical wound was successfully treated with conservative endoscopic treatment. After diagnosis, the patient underwent upper digestive endoscopy in operating room with introduction of a nasoenteral tube. Eleven days later, a second endoscopy was performed with dilation of the gastrojejunal anastomosis with a Savary-Gilliard bougie. The fistula closed at the day 21 counting from the date of his diagnosis. Conclusion: From this report, it's concluded that the conservative approach of post-RYGB fistulas in stable patients with endoscopic aid for positioning the nasoenteral tube and dilation with a bougie can reserve good therapeutic results for the management of this complication and avoid more surgical interventions complex.

Gastric twist after sleeve gastrectomy: a proposal for endoscopic classification / Torção gástrica após gastrectomia vertical: uma proposta de classificação endoscópica

ABSTRACT - BACKGROUND: The twisting of the gastric tube is one of the main causes of persistent reflux and food intolerance after sleeve gastrectomy (SG). To date, there is no classification for gastric twist after SG. OBJECTIVE: This study aimed to propose an endoscopic classification for this condition and outline the clinical profile of these patients with sleeve gastrectomy. METHODS: Patients in the postoperative period of SG presenting endoscopic findings of gastric twist were included. All patients underwent an esophagogastroduodenoscopy 12 months after SG. The classification proposed consists of three degrees: degree I: mild rotation of the staple line without relevant shrinkage of the gastric lumen; degree II: moderate rotation of the staple line, leading to a focal area of fixed narrowing that requires additional maneuvers for its transposition; and degree III: severe rotation of the staple line leading to stenosis, with increased difficulty for transposition or complete blockage. RESULTS: Out of 2,723 patients who underwent SG, 45 (1.6%) presented gastric twist. Most patients were female (85%), with mean age of 39±10.4 years. In all, 41 (91.1%) presented degree I, 3 (6.7%) presented degree II, and 1 (2.2%) had degree III. Most patients were asymptomatic (n=26). Vomiting was the most prevalent symptom (15.5%). Statistically significant correlation of twisting degrees was not observed for both the presence of symptoms and the degrees of esophagitis. CONCLUSION: Gastric twist after SG is rare, with generally mild and asymptomatic presentation. The endoscopic classification was not statistically related to clinical presentation but set the ground for further analysis.

RESUMO - RACIONAL: A torção do tubo gástrico ou twist é uma das principais causas de refluxo persistente e intolerância alimentar após a gastrectomia vertical (GV). Até o momento, não há uma classificação proposta para a torção gástrica após GV. OBJETIVO: Propor uma classificação endoscópica para essa condição e descrever o perfil clínico desses pacientes. MÉTODOS: Pacientes no pós-operatório de GV apresentando achados endoscópicos de twist foram incluídos. Os pacientes foram submetidos a uma esofagogastroduodenoscopia 12 meses após a cirurgia. A classificação consiste em três graus. Grau I: rotação leve da linha de grampos, sem redução relevante do lúmen gástrico. Grau II: rotação moderada da linha de grampos, levando a uma área de estreitamento focal que requer manobras adicionais para a progressão do aparelho. Grau III: rotação severa da linha de grampos, levando à estenose, com grande dificuldade de progressão ou obstrução completa. RESULTADOS: Dos 2.723 pacientes que foram submetidos à GV, 45 (1,6%) apresentaram twist. A maioria dos pacientes era do sex feminino (85%), com idade média de 39±10.4 anos. Quarenta e um (91,1%) apresentaram twist grau I, 3 (6,7%) apresentaram twist grau II e apenas 1 (2,2%) apresentou twist grau III. A maioria dos pacientes eram assintomáticos (n=26). O sintoma mais prevalente foi vômito (15,5%). Não foi observada correlação estatisticamente significante entre o grau de twist e a presença de sintomas ou esofagite. CONCLUSÃO: Twist após GV é raro e geralmente assintomático. A classificação endoscópica proposta não foi estatisticamente relacionada com apresentação clínica, porém estabelece um referencial para análises futuras.

Caracterización clínico-histopatológica de la gastritis crónica / Clinical-histopathological characterization of chronic gastritis

La gastritis es una enfermedad con una alta morbilidad a nivel mundial, el principal factor de riesgo es la infección por Helicobacter pylori. Objetivo: Describir las características clínicas, histopatológica y endoscópicas en una población con gastritis crónica. Material y métodos: Se realizó un estudio observacional de tipo descriptivo, retrospectivo, se incluyeron 49 pacientes que acudieron a la consulta externa del área de gastroenterología, de 18 a 65 años, a quienes se realizó el estudio histopatológico y endoscópico en el Servicio de Gastroenterología en el Hospital General Quevedo, de Los Ríos-Ecuador, durante septiembre 2017 ­ septiembre 2018. Resultados: Se observó predominio del género masculino (65%); en mayores de 40 años (55%), la epigastralgía y la sensación de acidez estomacal, 39% y 35% respectivamente, fueron los síntomas más frecuentes, La positividad para Helicobacter pylori, alcanzó el 86%, y la lesión no erosiva un 73%, existió mayor presencia de la forma no atrófica (84%) sobre la atrófica. Conclusiones: La gastritis crónica predominó en el grupo etario mayor a 40 años y de género masculino, siendo los factores de riesgo de mayor prevalencia la infección por Helicobacter pylori y los asociados al consumo de antiinflamatorios no esteroideos, mala alimentación, alcohol y tabaco, los síntomas como epigastralgía y la sensación de acidez estomacal fueron los más frecuentes. El hallazgo endoscópico fue mayor para las formas no erosivas, y de acuerdo a la histopatología la gastritis no atrófica antral moderada fue la más frecuente(AU)

Gastritis is a disease with high morbidity worldwide, the main risk factor is Helicobacter pylori infection. Objective: To describe the clinical, histopathological and endoscopic characteristics in a population with chronic gastritis. Material and methods: An observational, descriptive, retrospective study was carried out, including 49 patients who attended the outpatient consultation of the gastroenterology area, aged 18 to 65 years, who underwent a histopathological and endoscopic study in the Gastroenterology Service at the Quevedo General Hospital, Los Ríos-Ecuador, during September 2017 - September 2018. Results: A predominance of the male gender was observed (65%); In people over 40 years of age (55%), epigastralgia and the sensation of heartburn, 39% and 35% spectively, were the most frequent symptoms, the positivity for Helicobacter pylori, reached 86%, and the non-erosive lesion 73 %, there was a greater presence of the non-atrophic form (84%) over the atrophic one. Conclusions: Chronic gastritis predominated in the age group over 40 years of age and male, the most prevalent risk factors being Helicobacter pylori infection and those associated with the consumption of non-steroidal anti-inflammatory drugs, poor diet, alcohol and tobacco. symptoms such as epigastric pain and the sensation of heartburn were the most frequent. The endoscopic finding was greater for non-erosive forms, and according to histopathology, moderate antral non-atrophic gastritis was the most frequent(AU)

Condiciones laborales, calidad y percepciones sobre el ejercicio de la profesión: encuesta a médicos endoscopistas digestivos en Argentina / Working conditions, quality and perceptions about the practice of medicine: a survey of digestive endoscopists in Argentina

RESUMEN Introducción : Existen desafíos importantes para lograr un adecuado desempeño profesional. Objetivo : Evaluar las características del ámbito laboral y percepciones sobre la calidad profesional y el ejercicio de la medicina. Materiales y métodos : Estudio exploratorio y transversal, encuesta online (septiembre a noviembre de 2020). Se evaluaron las características del ámbito laboral, calidad en endoscopía, redes sociales, conflictos de intereses y rol de las sociedades científicas. Resultados : 208 profesionales. Edad promedio 48,5 años, 66,8% sexo masculino. Promedio de egreso 23 años; el 88,9% (n=185) tenía especialidad certificada y el 85,6% eran gastroenterólogos (n=178). Lugares de trabajo promedio: 2,6; 108 trabajaban menos de 40 h. semanales (52%), 127 (61%) realizan tareas de gestión y el 63,9% guardias pasivas (n=133). El 13,5% (n=28) considera que existen disparidades entre varones y mujeres. El 70,2% (n=146) experimentó Burnout y 86 (41,3%) experimentaron o fueron testigos de abuso. Promedio mensual de procedimientos 87,6 (5-300). La mayoría realiza estudios diagnósticos y terapéuticos básicos. El 63,4% (n=132) consideró adecuada la tecnología con la que trabaja. El 65% (n=136) reutiliza accesorios y el 54,8% (n=114) conoce su tasa de detección de adenomas. 76 médicos (36,5%) usa redes sociales para difusión de su práctica. El 28,4% (n=59) reconoció conflictos de intereses. Existe una opinión favorable para que las sociedades científicas participen en la defensa de intereses económicos y un elevado nivel de insatisfacción económica con la profesión. Conclusión : Esta encuesta brinda información valiosa para mejorar los programas de formación. Es necesario mejorar las condiciones laborales y la calidad de procesos y procedimientos.

ABSTRACT Introduction : The practice of medicine today represents a challenge. Objective: To evaluate the characteristics of the work environment and perceptions about the practice of medicine. Materials and methods : Exploratory and transversal studio, online survey (September to November 2020). The characteristics of the work environment, quality in endoscopy, social networks, conflicts of interest and role of scientific societies were evaluated. Results : 208 professionals. Average age 48.5 years, 66.8 % male. Average age of graduated 23 years; 88.9% (n=185) had a certified specialty and 85.6% were gastroenterologists (n=178). Average workplaces: 2.6; 108 worked less than 40 hours a week (52%), 127 (61%) has management tasks and 63.9% passive guards (n=133). 13.5% (n=28) believe that there are disparities between men and women. 70.2% (n=146) experienced Burnout and 86 (41.3%) experienced or witnessed abuse. Monthly average of procedures 87.6 (5-300). Most perform basic diagnostic and therapeutic studies. 63.4% (n=132) considered the technology with which they work is adequate. 65% (n=136) reuse accessories and 54.8% (n=114) know their adenoma detection rate. 76 physicians (36.5%) use social media to spread the way to disseminate his practice. 28.4% (n=59) recognized conflicts of interest. There is a positive opinion for scientific societies to be involved in the defense of economic interests and a high level of economic dissatisfaction with the profession. Conclusion : This survey provides valuable information to improve training programs. There is a need to improve working conditions and the quality of processes and procedures.

Perfil epidemiológico de pacientes com hemorragia gastrointestinal alta não varicosa decorrente de doença péptica em um hospital brasileiro terciário de referência / Epidemiological profile of patients with non-variceal upper gastrointestinal bleeding secondary to peptic disease in a tertiary referral brazilian hospital

ABSTRACT BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease.

RESUMO CONTEXTO: A hemorragia digestiva alta não varicosa (HDANV) secundária à úlcera péptica é uma emergência médica digestiva e pode ser uma reação adversa a medicamento severa. OBJETIVO: Estimar a frequência de HDANV secundária à doença péptica. MÉTODOS: Estudo prospectivo e epidemiológico realizado em um hospital brasileiro terciário de referência, no período de julho de 2016 a dezembro de 2019. Os laudos de endoscopia gastrointestinal alta foram avaliados diariamente. O diagnóstico de HDANV secundária para úlcera péptica foi definido por achados endoscópicos de úlcera péptica e lesões gástricas erosivas e sintomas clínicos. A frequência de diagnóstico de HDANV secundária à úlcera péptica foi estimada por meio da razão entre o número de pacientes diagnosticados e o número de pacientes submetidos à endoscopia gastrointestinal alta no mesmo período. RESULTADOS: Um total de 2.779 laudos endoscópicos (2.503 pacientes) foram avaliados e 178 pacientes foram elegíveis. A frequência total de diagnóstico de HDANV secundária à úlcera péptica foi de 7,1%. A frequência anual de diagnósticos entre 2017 e 2019 variou de 9,3% a 5,7%. A maioria dos pacientes era do sexo masculino (72,8%); auto-declarado branco (71,8%); idoso (56,7%); e não possuía histórico familiar ou pessoal de doenças gastrointestinais (60,1%). 90% dos pacientes apresentaram úlcera péptica e melena (62,8%). Os pacientes faziam uso crônico de ácido acetilsalicílico como antiagregante plaquetário (29,3%), outros antiplaquetários (21,9%) e anticoagulantes orais (11,2%); e fizeram uso e uso de anti-inflamatórios não esteroidais na semana anterior ao início dos sintomas clínicos de HDANV (25,8%). CONCLUSÃO: Cerca de sete em cada 100 pacientes admitidos em um hospital terciário e submetidos à endoscopia gastrointestinal alta foram diagnosticados com HDANV secundária à úlcera péptica.

Abordaje endoscópico en el manejo de la fuga post manga gástrica / Endoscopic approach in the management of post gastric sleeve leakage

INTRODUCCIÓN. La fuga post manga gástrica es una complicación de los proce-dimientos bariátricos quirúrgicos, con prevalencia del 2,1%, en el que se emplea el abordaje endoscópico, describir su seguridad y éxito es relevante. OBJETIVO. Describir el abordaje endoscópico en el manejo de la fuga post manga gástrica. MATERIALES Y MÉTODOS. Revisión bibliográfica y análisis sistemático de artículos científicos. De un total de 384 artículos, 11 publicaciones de texto completo fueron seleccionados; 9 artículos fueron estudios retrospectivos y 2 revisiones sistemáticas. Los términos de búsqueda sobre el tratamiento endoscópico en fuga post manga gástrica se basaron en datos PubMed que cumplieron los criterios: leak, fístula, par-tial gastrectomy, gastrointestinal endoscopy. RESULTADOS. La literatura reportó se-guridad con cero mortalidad y tasa de éxito para sutura endoscópica del 80,0%, over the scope clip 86,3%, drenaje interno endoscópico 83,41%, septotomía endoscópica 100,0%, stents endoscópicos hasta del 95,0% y terapia vacuum endoscópica 87,5%. CONCLUSIÓN. Se evidenció que el abordaje endoscópico en el manejo de la fuga post manga gástrica fue seguro y exitoso; se necesita personal experto en las dife-rentes modalidades terapéuticas reportadas.

INTRODUCTION. Post gastric sleeve leakage is a complication of surgical bariatric procedures, with a prevalence of 2,1%, in which the endoscopic approach is used, describing its safety and success is relevant. OBJECTIVE. To describe the endos-copic approach in the management of post gastric sleeve leak. MATERIALS AND METHODS. Bibliographic review and systematic analysis of scientific articles. From a total of 384 articles, 11 full-text publications were selected; 9 articles were retrospective studies and 2 systematic reviews. Search terms on endoscopic treatment in postgastric sleeve leak were based on PubMed data that met the criteria: leak, fistula, partial gastrectomy, gastrointestinal endoscopy. RESULTS. The literature re-ported safety with zero mortality and success rate for endoscopic suture 80,0%, over the scope clip 86,3%, endoscopic internal drainage 83,41%, endoscopic septotomy 100,0%, endoscopic stents up to 95,0% and endoscopic vacuum therapy 87,5%. CONCLUSION. It was evidenced that the endoscopic approach in the management of post gastric sleeve leak was safe and successful; expert personnel are needed in the different therapeutic modalities reported

El Hybrid-APC en el tratamiento endoscópico del esófago de Barrett / The Hybrid-APC in the endoscopic treatment of Barrett'sesophagus

RESUMEN Fundamento: debido al riesgo de evolución insatisfactoria de los pacientes con esófago de Barrett hacia el adenocarcinoma esofágico, es necesaria la aplicación de técnicas seguras y efectivas que logren prevenir el desenlace hacia lesiones malignas esofágicas. El Hybrid-APC (Argón plasma coagulación) es una de estas técnicas que permiten detener la historia natural del esófago de Barrett en su etapa inicial. Objetivo: realizar una revisión y reflexión acerca del tratamiento endoscópico del esófago de Barrett con el Hybrid-APC. Métodos: se realizó una búsqueda en los motores Google, PudMed, SciELO regional, SciELO Public Health, National Library of Medicine PudMed. En la estrategia de la búsqueda se utilizaron los términos: esófago de Barrett, tratamiento endoscópico, Hybrid-APC. Se evaluaron los documentos en extensos y se desarrolló un documento resumen de la información recolectada. En la búsqueda bibliográfica realizada se encontraron 20 trabajos relacionados con esófago de Barrett, tratamiento endoscópico 10 y específico del uso del Hybrid-APC cinco. Resultados: los estudios reportaron la efectividad y seguridad de la ablación con el Hybrid-APC en el tratamiento endoscópico del esófago de Barrett con displasia de bajo grado; y en la displasia de alto grado y carcinoma in situ remanente, luego de una resección mucosa endoscópica. Conclusiones: el tratamiento endoscópico del esófago de Barrett con Hybrid-APC, se considera una técnica alternativa para detener la evolución de esta enfermedad hacia el adenocarcinoma. Esto generará motivación para entrenamientos y su puesta en práctica de forma generalizada.

ABSTRACT Background: due to the risk of unsatisfactory evolution of patients with Barrett's esophagus (EB) towards esophageal adenocarcinoma, it is necessary to apply safe and effective techniques that prevent the outcome towards esophageal malignant lesions. The Hybrid-APC (argon plasma coagulation) is one of these techniques that allow stopping the natural history of EB in its initial stage. Objective: to conduct a review and reflection on the endoscopic treatment of Barrett's esophagus with the Hybrid-APC. Methods: a search was conducted on Google, PudMed, SciELo regional, SciELo Public Health, National Library of Medicine PudMed engines. The search strategy used the terms: Barrett's esophagus, endoscopic treatment, Hybrid-APC. Extensive documents were evaluated and a summary document of the information collected was developed. The literature search found 20 works related to Barrett's esophagus, ten on endoscopic treatment, and five on specific to the use of Hybrid-APC. Results: studies reported the effectiveness and security of the ablation with the Hybrid-APC in the endoscopic treatment of Barrett's esophagus with low degree dysplasia, and in the high degree dysplasia and remnant carcinoma in situ, after the endoscopic mucous resection. Conclusions: the endoscopic treatment of Barrett's esophagus with Hybrid-APC is considered an alternative technique to stop the evolution of this pathology towards adenocarcinoma. This will generate motivation for training and its implementation in a generalized way.

O índice esplênico como preditor de sangramento e recidiva varicosa no seguimento tardio de paciente esquistossomóticos após tratamento endoscópico exclusivo / The splenic index as predictor of bleeding and variceal recurrence in the late follow-up of schistosomotic patients after exclusive endoscopic treatment

RESUMO - RACIONAL: O tratamento endoscópico das varizes esofágicas tem sido utilizado como principal intervenção em pacientes com hipertensão portal secundária à esquistossomose, mas com taxas significativas de recorrência de varizes esofágicas e ressangramento. Os resultados em longo prazo do tratamento endoscópico exclusivo são pouco estudados quanto à relação das dimensões esplênicas neste contexto. OBJETIVO: Avaliar, por meio da ultrassonografia, o índice esplênico e a dimensão longitudinal (craniocaudal) do baço como preditores de ressangramento e recorrência de varizes no seguimento tardio de pacientes esquistossomóticos não operados, após erradicação endoscópica das varizes esofágicas. MÉTODOS: Estudo observacional retrospectivo por meio da análise de prontuários de pacientes com diagnóstico de esquistossomose hepatoesplênica. A curva ROC foi usada para determinar o melhor ponto de corte para o índice esplênico médio como preditor de recorrência e sangramento. RESULTADOS: Foram analisados 54 pacientes, durante o período de 2002 a 2018. O tempo médio de seguimento foi de 8 anos. O índice esplênico provou ser um teste sensível em valores acima de 144 como preditor de ressangramento. Na análise da dimensão longitudinal, o valor acima de 20 cm apresentou teste estatisticamente significativo para recorrência de varizes e valor acima de 19 cm apresentou-se como teste muito sensível e estatisticamente significativo para ressangramento. CONCLUSÃO: A análise do índice esplênico e da dimensão craniocaudal, obtidos por ultrassonografia, podem predizer recorrência de varizes e ressangramento após erradicação endoscópica exclusiva.

ABSTRACT - BACKGROUND: Endoscopic treatment for esophageal variceal has been used as the main intervention in patients with portal hypertension secondary to schistosomiasis, but with significant rates of recurrence of esophageal variceal and rebleeding. The long-term results of exclusive endoscopic treatment are poorly studied as the relationship of the splenic dimensions in this context. AIM: The aim of this study was to identify, through ultrasonography, whether the splenic index and the longitudinal (craniocaudal) dimension of the spleen are the predictors of rebleeding and variceal recurrence in late follow-up of patients with nonoperated schistosomiasis, after endoscopic eradication of esophageal variceal. METHODS: This is a retrospective and observational study analyzing the medical records of patients diagnosed with hepatosplenic schistosomiasis. The receiver operating characteristic curve was used to determine the best cutoff point for the mean splenic index as a predictor of recurrence and bleeding. Results: A follow-up of 54 patients were analyzed during the period from 2002 to 2018. The mean follow-up time was 8 years. The splenic index with value >144 was proved to be a sensitive test for rebleeding. In the analysis of the longitudinal dimension, the spleen length of >20 cm showed a statistically significant test for recurrence of variceal and a length >19 cm presented as a very sensitive and statistically significant test for rebleeding. CONCLUSION: Splenic index and craniocaudal dimension analysis, obtained by ultrasonography, can predict recurrence of varicose veins and rebleeding after exclusive endoscopic treatment.

Filtración de anastomosis colorrectal tratada con E-VAC con espuma de polivinilo podría reducir el tiempo de tratamiento / Colorectal anastomotic leak treated with E-VAC with polyvinyl sponge could reduce treatment time

RESUMEN Las filtraciones de anastomosis colorrectales tienen una incidencia de 5 a 15% y su manejo depende de las manifestaciones clínicas, la distancia desde el margen anal y su ubicación intra o extra peritoneal. En algunos casos seleccionados el manejo endoscópico ha demostrado ser un tratamiento efectivo. En el presente reporte de caso se utilizó el sistema de drenaje rectal transanal asistido por vacío descrito por Weidenhagen et al., para el tratamiento de una fuga anastomótica pero se utilizó una espuma de polivinilo en vez la espuma tradicionalmente usada de poliuretano con el fin de disminuir el número de cambios de la espuma y el tiempo de tratamiento.

ABSTRACT Colorectal anastomosis leaks have an incidence of 5 to 15% and their management depends on the clinical manifestations, the distance to the anal verge and the intra or extra peritoneal location. In some selected cases, endoscopic management has proven to be an effective treatment. In this case report, the vacuum-assisted transanal rectal drainage system described by Weidenhagen et al. was used for the treatment of an anastomotic leak. We used a polyvinyl sponge instead of the polyurethane sponge traditionally used with the intention to reduce sponge changes and treatment time.

Es el Tipo de Sangre un Factor de Riesgo para el Cáncer Gástrico?, estudio observacional / Is Blood Type a Risk Factor for Gastric Cancer?, observational study

Introducción:Existen estudios que asocian a los grupos sanguíneos con el desarrollo de cáncer gástrico, estableciendo una relación entre los individuos con grupo sanguíneo A y la predisposición a esta neoplasia, sin embargo estos reportes podrían estar sesgados por la prevalencia poblacional del tipo sanguíneo de la región. El objetivo de este estudio es establecer la relación predicha en una zona de alta prevalencia de tipo sanguíneo O. Métodos: Este estudio observacional, analítico fue llevado a cabo en pacientes que se realizaron biopsia de estómago vía endoscópica atendidos en el Instituto de Cáncer SOLCA Cuenca en el período 2013 ­2018; el muestreo es no probabilístico de todos los casos posibles. Para el análisis se conforma el grupo 1 (G1) con pacientes con Biopsia Positiva para Cáncer Gástrico, el grupo 2 con pacientes con Biopsia negativa para Cáncer Gástrico. Se realiza análisis de asociación con Razón de Prevalencia (RP). Resultados: Fueron 433 casos de cáncer gástrico en G1y 2606 casos negativos para Cáncer Gástrico en G2. La prevalencia del tipo de sangre "O" en G1fue 328/433 casos (75.75%) Vs. 1946/2606 casos (74.67%); la prevalencia del tipo de sangre "A" en G1 fue 71/433 casos (16.4%) Vs 485/2606 casos (18.61%) en G2; RP=0.875 (IC95% 0.69 -1.11), P=0.27. Conclusiones: No se demostró asociación entre el tipo de sangre y la presencia de Cáncer Gástrico en el presente reporte.

Introduction:There are studies that associate blood groups with the development of gastric cancer, establishing a relationship between individuals with blood group A and a predisposition to this neoplasia, however these reports could be biased by the population prevalence of the blood type of the region. The objective of this study is to establish the predicted relationship in an area with a high prevalence of blood type O. Methods: This observational, analytical study was carried out in patients who underwent endoscopic stomach biopsy treated at the SOLCA Cuenca Cancer Institute in the period 2013 -2018; the sampling is non-probability of all possible cases. For the analysis, group 1 (G1) is made up of patients with a Positive Biopsy for Gastric Cancer, group 2 with patients with a negative Biopsy for Gastric Cancer. Association analysis with Prevalence Ratio (PR) is performed. Results: There were 433 cases of gastric cancer in G1 and 2606 negative cases for Gastric Cancer in G2. The prevalence of blood type "O" in G1 was 328/433 cases (75.75%) Vs. 1946/2606 cases (74.67%); the prevalence of blood type "A" in G1 was 71/433 cases (16.4%)Vs 485/2606 cases (18.61%) in G2; PR = 0.875 (95% CI 0.69 -1.11), P = 0.27. Conclusions: No association between blood type and the presence of Gastric Cancer was demonstrated in this repor

Lipomatosis gástrica: reporte de un caso / Gastric lipomatosis: a case report

Resumen La lipomatosis gástrica es una enfermedad infrecuente caracterizada por múltiples lesiones tumorales benignas (lipomas), que acorde a su tamaño pueden producir una variedad de síntomas. Por lo general, la enfermedad es documentada incidentalmente en estudios imagenológicos que se realizan para estudiar otras enfermedades y los hallazgos patológicos contribuyen a tener una certeza en el diagnóstico de esta patología. Por el momento, no hay un tratamiento definido para las masas pequeñas y asintomáticas, mientras que para las masas grandes (> 3-4 cm) o sintomáticas se sugiere la resección quirúrgica de las lesiones.

Abstract Gastric lipomatosis is a rare disease characterized by multiple lipomas, benign tumors which can produce a variety of symptoms according to their size. In general, the disease is incidentally documented in imaging studies done to study other diseases. Pathological findings can contribute to the certainty of diagnosis. At the moment, there is no definite treatment for small, asymptomatic masses, but surgical resection is suggested for masses that are larger than 3 or 4 cm and for those that are symptomatic.

Carcinoma gástrico: revisión bibliográfica / Gastric Carcinoma: literature review

Resumen El carcinoma gástrico hoy en día es una de las principales causas de mortalidad a nivel mundial por neoplasias y especialmente en países como Costa Rica, que se cataloga como un país de alta incidencia. Existen múltiples factores de riesgo, siendo el primero y más importante la infección por Helicobacter pylori, que desencadena una cascada de diferentes lesiones, iniciando en atrofia gástrica, que puede llegar a finalizar en cáncer invasivo. Existen otros factores que pueden influir en un ambiente pro-carcinogénico tales como fumado, obesidad, la dieta, entre otros. Múltiples naciones han desarrollado diferentes guías de tamizaje para disminuir la mortalidad; sin embargo, en países con alta incidencia sigue siendo el estándar realizar estudios de imagen y endoscopia luego de determinada edad dependiendo de factores de riesgo.

Abstract Gastric carcinoma is nowadays one of the main causes of mortality worldwide due to neoplasms and especially in countries such as Costa Rica, which is classified as a high incidence country. There are multiple risk factors, starting with Helicobacter pylori infection being the most important one; after the infection a cascade with different lesions is triggered, first it begins with gastric atrophy and then eventually lead to an invasive cancer. There are other factors that can influence a pro-carcinogenic environment such as smoking, obesity, diet, among others. Multiple nations have developed different screening guidelines to reduce mortality, however in countries with high incidence it is still the gold-standard to perform imaging and endoscopy studies after a certain age and depending on risk factors.

Tratamiento quirúrgico de la hemorragia digestiva alta por enfermedad de Dieulafoy / Surgical treatment of upper gastrointestinal bleeding dueto Dieulafoy disease

La enfermedad de Dieulafoy constituye menos del 2 % de las causas de hemorragia digestiva alta. Corresponde a la presencia de un vaso sanguíneo arterial de trayecto tortuoso, que protruye a través de un defecto mucoso localizado, generalmente, proximal en el estómago. Se presenta como una hematemesis masiva, a veces recu-rrente, con inestabilidad hemodinámica. La endoscopia es el método diagnóstico y terapéutico de elección. Si esta fracasa, está indicado practicar una angiografía selectiva que permita identificar el punto sangrante y producir un embolismo. En algunas ocasiones, ninguna de estas dos técnicas consigue detener la hemorragia, en cuyo caso está indicada una cirugía urgente. Se deben practicar resecciones gástricas limitadas (gastrectomías en cuña o tubulares) a la zona sangrante localizada mediante las pruebas anteriores; así, se evitan grandes gastrectomías que implican la práctica de anastomosis por el gran riesgo de dehiscencia que estas últimas cuando hay inestabilidad hemodinámica.Se presenta el caso de un paciente con hemorragia digestiva alta secundaria a enfermedad de Dieulafoy, que precisó intervención quirúrgica urgente por la imposibilidad de resolver el sangrado mediante endoscopia. Se describen el diagnóstico y el tratamiento de la enfermedad de Dieulafoy como causa de hemorragia digestiva alta en el adulto, y se presenta una revisión de la literatura científica

Dieulafoy's disease constitutes less than 2% of the causes of upper gastrointestinal bleeding. It corresponds to the presence of a tortuous arterial blood vessel which protrudes through a localized mucosal defect, usually proximal in the stomach. It presents as a massive hematemesis, sometimes recurrent, with hemodynamic instability.Endoscopy is the diagnostic and therapeutic method of choice. If this fails, it is indicated to perform a selective angiography to identify the bleeding point and embolize it. In some cases, none of these two techniques manages to stop the bleeding, in which case urgent surgery is indicated. Limited gastric resections (wedge or tubular gastrectomies) should be performed to the bleeding area, thus avoiding large gastrectomies that involve anastomosis due to the high leak risk they have in hemodynamically unstable patients.We present the case of a patient with upper gastrointestinal bleeding secondary to Dieulafoy's disease, who required urgent surgical intervention due to the impossibility of resolving the bleeding endoscopically. The diagnosis and treatment of Dieulafoy's disease as a cause of upper gastrointestinal bleeding in adults are described and a review of the scientific literature is presented