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Acta Medica Philippina ; : 1-15, 2024.
Article in English | WPRIM | ID: wpr-1006393


Background and Objective@#Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this. @*Methods@#This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines. @*Results@#The UP-PGH CRC KAP (University of the Philippines – Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire’s validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively).Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense. @*Conclusion@#The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.

Knowledge , Attitude
Arq. gastroenterol ; 61: e23143, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1557118


ABSTRACT Background: Colorectal cancer is the third most common cancer, and prevention relies on screening programs with resection complete resection of neoplastic lesions. Objective: We aimed to evaluate the best snare polypectomy technique for colorectal lesions up to 10 mm, focusing on complete resection rate, and adverse events. Methods: A comprehensive search using electronic databases was conducted to identify randomized controlled trials comparing hot versus cold snare resection for polyps sized up to 10 mm, and following PRISMA guidelines, a meta-analysis was performed. Outcomes included complete resection rate, en bloc resection rate, polypectomy, procedure times, immediate, delayed bleeding, and perforation. Results: Nineteen RCTs involving 8720 patients and 17588 polyps were included. Hot snare polypectomy showed a higher complete resection rate (RD, 0.02; 95%CI [+0.00,0.04]; P=0.03; I 2=63%), but also a higher rate of delayed bleeding (RD 0.00; 95%CI [0.00, 0.01]; P=0.01; I 2=0%), and severe delayed bleeding (RD 0.00; 95%CI [0.00, 0.00]; P=0.04; I 2=0%). Cold Snare was associated with shorter polypectomy time (MD -46.89 seconds; 95%CI [-62.99, -30.79]; P<0.00001; I 2=90%) and shorter total colonoscopy time (MD -7.17 minutes; 95%CI [-9.10, -5.25]; P<0.00001; I 2=41%). No significant differences were observed in en bloc resection rate or immediate bleeding. Conclusion: Hot snare polypectomy presents a slightly higher complete resection rate, but, as it is associated with a longer procedure time and a higher rate of delayed bleeding compared to Cold Snare, it cannot be recommended as the gold standard approach. Individual analysis and personal experience should be considered when selecting the best approach.

RESUMO Contexto: O câncer colorretal é o terceiro câncer mais comum na população, e a prevenção é principalmente baseada em programas de screening, com a ressecção completa de lesões neoplásicas. Múltiplas técnicas de ressecção estão disponíveis, mas ainda há controvérsias sobre a melhor abordagem, especialmente em relação à taxa de ressecção completa e à taxa de sangramento tardio. Objetivo: Nosso objetivo foi avaliar a melhor técnica de polipectomia com alça para lesões colorretais de até 10 mm. Métodos: Foi realizada uma busca abrangente em bancos de dados eletrônicos (MEDLINE e EMBASE) para identificar ensaios clínicos randomizados que comparassem a ressecção com alça quente versus alça fria para pólipos de até 10 mm, seguindo as diretrizes PRISMA. Os desfechos incluíram taxa de ressecção completa, taxa de ressecção em bloco, tempo de polipectomia, tempo total do procedimento, sangramento imediato, sangramento tardio e perfuração. Resultados: Dezenove ensaios clínicos randomizados foram incluídos, totalizando 8.720 pacientes e 17.588 pólipos. A polipectomia com alça quente foi associada a uma maior taxa de ressecção completa (RD, 0,02; IC95% [+0,00, 0,04]; P=0,03; I 2=63%), embora também tenha sido associada a uma taxa mais alta de sangramento tardio (RD 0,00; IC95% [0,00, 0,01]; P=0,01; I 2=0%) e de sangramento tardio grave (RD 0,00; IC95% [0,00, 0,00]; P=0,04; I 2=0%). A polipectomia com alça fria foi associada a um menor tempo de polipectomia (MD -46,89 segundos; IC95% [-62,99, -30,79]; P<0,00001 I 2=90%) e a um menor tempo total de colonoscopia (DM -7,17 minutos; IC95% [-9,10, -5,25]; P<0,00001 I 2=41%). Não houve diferença significativa na taxa de ressecção em bloco (RD, 0,00; IC95% [-0,01, 0,01]; P=0,20; I 2=30%) ou na taxa de sangramento imediato (RD -0,00; IC95% [-0,01, 0,00]; P=0,34; I 2=11%). Não foram relatados casos de perfuração em nenhum dos grupos. Conclusão: A polipectomia com alça quente apresenta uma taxa ligeiramente mais alta de ressecção completa, mas, como está associada a um tempo de procedimento mais longo e a uma taxa mais alta de sangramento tardio em comparação com a polipectomia com alça fria, não pode ser recomendada como a abordagem padrão. A análise individualizada e a experiência pessoal devem ser consideradas ao escolher a melhor abordagem.

J. coloproctol. (Rio J., Impr.) ; 44(1): 17-21, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1558293


Abstract Introduction Colorectal cancer (CRC) is the second most prevalent cancer in the world, and the fecal immunochemical test (FIT) can be mentioned among the CRC screening methods based on the detection of occult blood in the feces, which may indicate upper gastrointestinal (UGI) malignancies; therefore, patients with a positive FIT but normal colonoscopy may be considered for a UGI endoscopy. Materials and Methods The present study was conducted on patients with a positive FIT who were submitted to colonoscopy with normal results. They subsequently underwent endoscopy for the detection of UGI disorders. Results We included 121 patients (64.5% of women and 35.5% of men; average age: 58.85 ± 12.93 years), 72.7% of whom were positive for Helicobacter pylori. The predominant result of the UGI endoscopy was normal, followed by erythema of the gastric mucosa, and anemia and dyspepsia were the most common clinical findings. The most common pathological result was chronic gastritis, followed by acute gastritis. Only one patient presented stomach cancer (adenocarcinoma). Conclusion Considering the small prevalence of cancer in the UGI endoscopies of patients with positive FIT and normal colonoscopy, to the performance of UGI endoscopy in these patients may not be necessary.

J. coloproctol. (Rio J., Impr.) ; 43(4): 310-315, Oct.-Dec. 2023. ilus, tab
Article in English | LILACS | ID: biblio-1528948


Serrated polyposis syndrome is considered the most prevalent colonic polyposis syndrome in the world. Its importance has been increasingly discussed due to the significant increase in the risk of developing colorectal cancer in its affected individuals, similarly to other well-known polyposis syndromes, such as familial adenomatous polyposis. Serrated lesions of the colon play a major role in this syndrome represented by hyperplastic polyps, serrated sessile lesions and traditional serrated adenomas. Among these lesions, the sessile serrated lesion stands out, considered the main precursor lesion of the serrated pathway of colon carcinogenesis. Diagnosis of serrated polyposis syndrome is given through colonoscopy examination. Diagnostic criteria are: 1) 5 or more serrated lesions proximal to the rectum, all >4mm in size, with at least two >9mm in size; or 2) 20 serrated lesions of any size located anywhere in the large intestine, with >4 lesions proximal to the rectum. The ideal treatment is removal of all relevant serrated lesions by colonoscopy. In case of failure of endoscopic therapy, surgery is indicated. This manuscript is based on two case reports and a literature review and aims to broaden the discussion about the subject. (AU)

Humans , Female , Middle Aged , Aged , Colonic Polyps/diagnosis , Colonic Polyps/therapy , Colonic Polyps/epidemiology , Colonoscopy
Braz. J. Anesth. (Impr.) ; 73(6): 751-757, Nov.Dec. 2023. tab, graf
Article in English | LILACS | ID: biblio-1520380


Abstract Background: Our objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. Methods: We conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL-1 plus 0.5 μg.mL-1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 plus 0.5 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. Results: The median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0-0) vs. 0 (0-0) (p = 0.239) and 1 (0-1) vs. 3 (1-4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group - 2 (0-2) vs. 1 (0-1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 μ vs. 195 ± 44 μ (p = 0.040)). Conclusions: During colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Propofol , Unconsciousness , Single-Blind Method , Colonoscopy , Anesthetics, Intravenous , Hypnotics and Sedatives
Rev. cir. (Impr.) ; 75(6)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535663


Objetivo: Dar a conocer las últimas recomendaciones para la sospecha, el diagnóstico y el tratamiento médico y quirúrgico del síndrome de Ogilvie. Material y método: Estudio descriptivo, retrospectivo, observacional; en formato de caso clínico y revisión de la literatura actual, a través de PubMed, Scielo y otros motores de búsqueda de artículos científicos. Discusión y Conclusiones: La seudoobstrucción colónica aguda o síndrome de Ogilvie consiste en un íleo adinámico severo y dilatación masiva de asas del colon en ausencia de obstrucción mecánica. Se presenta, principalmente, en pacientes postquirúrgicos o severamente enfermos. Tienen riesgo de perforación aproximado del 3% y una mortalidad del 50%, la mayoría de los pacientes responden al manejo médico conservador. La descompresión colonoscópica puede ser necesaria en pacientes que no responden al tratamiento médico de soporte y a la descompresión farmacológica con neostigmina. Distintos grados de isquemia y/o perforación colónica obligan la reso-lución quirúrgica urgente en algunos casos, lo que define la morbimortalidad. Es importante la sospecha clínica de este síndrome para evitar complicaciones posiblemente fatales.

Objective: To present the latest recommendations for the suspicion, diagnosis and medical and surgical treatment of Ogilvie syndrome. Materials and methods: Descriptive, retrospective, observational study; in clinical case format and review of the current literature, through PubMed, Scielo and other search engines for scientific articles Discussion and Conclusions: Acute colonic pseudo-obstruction or Ogilvie syndrome consists of a severe adynamic ileus and massive dilatation of the colonic loops in the absence of mechanical obstruction. It occurs in post-surgical or severely ill patients. They have a risk of perforation of approximately 3% and a mortality of 50%, most patients respond to conservative medical management. Colonoscopic decompression may be necessary in patients who do not respond to supportive medical treatment and drug decompression with neostigmine. Different degrees of colonic ischemia and / or perforation require urgent surgical resolution in some cases, which defines morbidity and mortality. Clinical suspicion of this syndrome is important to avoid possibly fatal complications.

Article in English | LILACS-Express | LILACS | ID: biblio-1535944


Primary anorectal melanoma is a rare malignant melanocytic neoplasm; its principal manifestation is rectal bleeding. It has an ominous prognosis with a five-year survival rate of 10%. The case of a 56-year-old woman with rectal bleeding and the sensation of a rectal mass is presented. A polypoid lesion, resected transanally, was documented in the distal rectum during the colonoscopy. The histological study confirmed a primary anorectal melanoma.

El melanoma anorrectal primario es una neoplasia melanocítica maligna poco frecuente, su principal manifestación es el sangrado rectal. Tiene un pronóstico ominoso con una tasa de sobrevida del 10% a 5 años. Se presenta el caso de una mujer de 56 años con rectorragia y sensación de masa rectal. Durante la colonoscopia se documentó una lesión polipoide en el recto distal, que se resecó por vía transanal. El estudio histológico confirmó la presencia de un melanoma anorrectal primario.

J. coloproctol. (Rio J., Impr.) ; 43(4): 286-291, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528937


Objective: To evaluate the application of proactive pro-drug therapy (TDM) at week six in users of infliximab therapy in ulcerative colitis patients and to analyze the need for further disease optimization. Method: This is a retrospective analysis that will be carried out simultaneously at the Hospital de Clínicas de Passo Fundo and at the Endoclin Diagnostic Center in the city of Passo Fundo, with secondary data collection between January 2020 and May 2022. The sample included patients from both sexes, regardless of age, who are being followed up in the services mentioned above, by signing the informed Free and Clarified Consent Term. Results: 63.2% of patients required optimization of their treatment based on the serum level assessment at week six. Conclusion: Proactive TDM performed at week six benefits patients in order to complete indications for treatment to avoid lack of drug response and complications from the disease. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Colitis, Ulcerative/therapy , Drug Monitoring , Health Profile , Retrospective Studies , Infliximab/therapeutic use
Arq. gastroenterol ; 60(4): 463-469, Oct.-Nov. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527860


ABSTRACT Background: Colorectal cancer (CRC) has high mortality rates worldwide. In Brazil, it is the second most common cancer in both sexes. Delay in detecting premalignant lesions contributes to increased morbidity and mortality. In this scenario, the Piranhas project was created to track CRC in a low-income population in the hinterland of Alagoas. Objective: The study aimed to establish the main strategies and verify the feasibility of implementing a CRC tracking program and demonstrate the results obtained in the CRC Prevention Campaign in Piranhas/AL. Methods: The program took place in Piranhas, Alagoas, Brazil, through public-private partnerships. Individuals aged between 50 and 70 years of age were included for screening with a fecal occult blood test (FOBT) and colonoscopy in positive cases. Patient data were collected on standard forms. Results: A total of 2152 patients, aged between 50 and 70 years, were screened, 130 of which underwent colonoscopy. Several preneoplastic lesions were detected in 58 patients. The adenoma detection rate (ADR) was 33.85%. Conclusion: The study proved to be effective and viable since 44.6% of the program participants, who underwent screening with FOBT, followed by colonoscopy in positive cases, had some type of preneoplastic lesion. In addition, the program generated a significant social impact on the population of Piranhas due to the opportunity to diagnose and treat CRC precursor lesions.

RESUMO Contexto: O câncer colorretal (CCR) possui altas taxas de mortalidade em todo mundo. No Brasil é o segundo câncer mais comum em ambos os sexos. O atraso na detecção de lesões pré-malignas contribui com o aumento da morbimortalidade. Neste cenário, o projeto Piranhas foi criado para rastrear o CCR em uma população carente do sertão alagoano. Objetivo: O estudo teve como meta estabelecer as principais estratégias e verificar a viabilidade da implementação de um programa de rastreamento do CCR, assim como demonstrar os resultados obtidos na Campanha de prevenção de CCR no município de Piranhas/AL. Métodos: O programa aconteceu em Piranhas, Alagoas, Brasil, através de parcerias público-privadas. Foram incluídos indivíduos entre 50 e 70 anos para triagem com pesquisa de sangue oculto nas fezes (PSOF) e colonoscopia dos casos positivos. Os dados dos pacientes foram coletados em formulários padrão. Resultados: Foram rastreados um total de 2152 pacientes com idade entre 50 e 70 anos, sendo destes, 130 submetidos à colonoscopia. Várias lesões pré-neoplásicas foram detectadas em 58 pacientes. A taxa de detecção de adenoma foi de 33,85%. Conclusão: O estudo demonstrou-se eficaz e viável, uma vez que 44,6% dos participantes do programa que realizaram a triagem com PSOF seguido de colonoscopia nos casos positivos apresentava algum tipo de lesão pré-neoplásica. Além disso, o programa gerou grande impacto social na população de Piranhas, pela oportunidade de diagnóstico e tratamento de lesões precursoras do CCR.

Rev. gastroenterol. Perú ; 43(4)oct. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1536359


El tamizaje por colonoscopia es un método efectivo para prevenir cáncer de colon a traves de la detección de pólipos sobre los cuales se desarrolla en un mayor porcentaje el cáncer de colon; sin embargo la detección de estas lesiones varía en los diferentes segmentos del colon y de ellos en colon derecho su tasa detección suele ser menor. Objetivo: El objetivo de este estudio es evaluar si la doble revisión endoscópica de colon derecho durante la colonoscopia es un mecanismo para mejorar su rendimiento en cuanto a la tasa de detección de pólipos (TDP) y la tasa de detección de adenomas (TDA). Materiales y métodos: Revisión sistemática y metaanálisis de la literatura de estudios clínicos aleatorizados que realizaron una doble revisión del colon derecho por colonoscopia comparado con una revisión simple para mejorar la detección de pólipos y adenomas. El protocolo de esta revisión se publicó en PROSPERO bajo el código CRD42022356509. Resultados: Se incluyeron 5 estudios que incluyeron 2729 participantes. Se informó la detección de pólipos en 585/1197 pacientes (48,87%) después de la segunda revisión, en comparación con 537/1206 (44,52%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,09 (IC 95%: 0,97-1,23) (I2 fue de 44%). Se informó la detección de adenomas en 830/1513 pacientes (54,75%) después de la segunda revisión, en comparación con 779/1509 (51,62%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,06 (IC 95%: 1,00-1,13) (I2 fue de 0%). Conclusión: La segunda examinación del colon derecho por colonoscopia puede tener una modesta mejoría en la detección de pólipos y adenomas.

Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. Objective: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). Materials and methods: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. Results: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). Conclusion: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.

Rev. Assoc. Med. Bras. (1992, Impr.) ; 69(9): e20230302, set. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1514746


SUMMARY OBJECTIVE: Colorectal cancer is one of the most common malignancies. Survival rates are directly related to the stage of cancer at the time of diagnosis, emphasizing the value of early diagnosis. Positron emission tomography with 18F-fluorodeoxyglucose is the gold standard imaging technique in staging, monitoring after treatment, and follow-up. We aimed to assess the importance of incidental 18F-fluorodeoxyglucose uptake by colon and rectum in positron emission tomography-computed tomography imaging to determine a significant cutoff value for further investigation using colonoscopy and histopathological assessment. METHODS: We performed a retrospective analysis of patients with both 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scan and colonoscopy during 1 year and included the cases who had undergone a colonoscopy within 3 months following the positron emission tomography/computed tomography scan due to an incidental positive finding. Patients with a diagnosed colorectal malignancy or with a history of previous colorectal operations were excluded. RESULTS: A total of 81 patients were included in this study. Among 81 colonoscopic evaluations, histopathology revealed malignancy in 8 patients, and the prevalence of incidental colorectal cancer 18F-fluorodeoxyglucose uptake was found to be 9.87%. SUVmax was found to be significantly related to malignancy and other colonoscopic findings (p<0.001). SUVmax cutoff value to suggest colorectal cancer was found to be median [7.9 (4.1-12.7)] (p<0.001). CONCLUSION: Regarding the studies determining a significant cutoff value, incidental colonic 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography should lead the clinician to further investigation with colonoscopic biopsy, although the cutoff values for SUVmax are not certain and different in almost every published study, and negative positron emission tomography.computed tomography findings should not completely rule out malignancy, especially in high-risk patients.

Rev. colomb. gastroenterol ; 38(3)sept. 2023.
Article in English | LILACS-Express | LILACS | ID: biblio-1535922


Introduction: Good bowel preparation is essential for a quality colonoscopy. Thus, evaluating the risk factors associated with poor preparation is necessary. This problem has not been widely addressed in Colombia. Aim: To identify the factors associated with poor intestinal preparation. Materials and methods: Observational, analytical, cross-sectional, multicenter study in patients > 18 years of age who underwent colonoscopy and attended gastroenterology services between January and June 2020 in Bogotá. A Boston scale > 6 was defined as good preparation, and a Boston scale ≤ 6 was defined as poor preparation. Results: 265 patients were included, of whom 205 (77.4%) were well prepared and 60 (22.6%) had inadequate preparation. Factors associated with poor bowel preparation were age older than 60 years (odds ratio [OR]: 1.359; 95% confidence interval [CI]: 1.059-1.745; p = 0.026); male sex (OR: 1.573; 95% CI: 1.128-2.194; p = 0.012); obesity (BMI > 30 kg/m2; OR: 2.539; 95% CI: 1.388-4.645; p = 0.002); constipation (OR: 1.924; 95% CI: 1.154-3.208; p = 0.014); the use of antidepressants (OR: 2.897; 95% CI: 1.199-6.997; p = 0.014) and calcium antagonists (OR: 2.445; 95% CI: 1.292-4.630; p = 0.005), and having abdominopelvic surgeries (OR: 1.325 95% CI: 1.042-1.684, p = 0.034). Regarding the procedure, there was less polyp detection per patient (p = 0.04) and less minute (p = 0.020) and flat (p = 0.047) polyp detection in the poor bowel preparation group. Conclusions: This is the first study in Colombia in which the factors associated with poor intestinal preparation are described and include variables not explored in other studies. The results found are similar to those reported in the literature. These studies should be promoted with more patients, establishing a score for predicting poor preparation.

Introducción: una buena preparación intestinal es fundamental para una colonoscopia de calidad. Por eso es importante evaluar los factores de riesgo asociados a una mala preparación. Este problema no se ha abordado ampliamente en Colombia, por lo cual el objetivo de este estudio es identificar los factores asociados a una mala preparación intestinal. Métodos: estudio observacional, analítico, transversal, multicéntrico en pacientes > 18 años sometidos a colonoscopia que asistieron a los servicios de gastroenterología entre enero y junio de 2020 en la ciudad de Bogotá. Se definió como buena preparación una escala de Boston > 6, y como mala preparación una escala de Boston ≤ 6. Resultados: se incluyeron a 265 pacientes, de los cuales 205 (77,4%) estaban bien preparados y 60 (22,6%) tenían una preparación inadecuada. Los factores asociados a mala preparación intestinal fueron edad mayor de 60 años (odds ratio [OR]: 1,359; intervalo de confianza [IC] del 95%: 1,059-1,745; p = 0,026); sexo masculino (OR: 1,573; IC 95%: 1,128-2,194; p = 0,012); obesidad (IMC > 30 kg/m2; OR: 2,539; IC 95%: 1,388-4,645; p = 0,002); estreñimiento (OR: 1,924; IC 95%: 1,154-3,208; p = 0,014); el uso de antidepresivos (OR: 2,897; IC 95%: 1,199-6,997; p = 0,014) y antagonistas del calcio (OR: 2,445; IC 95%:1,292-4,630; p = 0,005) y tener cirugías abdominopélvicas (OR: 1,325; IC 95%: 1,042-1,684; p = 0,034). En cuanto al procedimiento, hubo una menor cantidad de detección de pólipos por paciente (p = 0,04) y menor detección de pólipo diminuto (p = 0,020) y plano (p = 0,047) en el grupo de mala preparación intestinal. Conclusiones: este es el primer estudio en Colombia en el cual se describen los factores asociados a la mala preparación intestinal e incluye variables no exploradas en otros estudios. Los resultados encontrados son similares a los reportados en la literatura. Se debe impulsar este tipo de estudios con una mayor cantidad de pacientes y plantear un puntaje de predicción de mala preparación.

Rev. colomb. gastroenterol ; 38(3)sept. 2023.
Article in English | LILACS-Express | LILACS | ID: biblio-1535926


Intestinal spirochaetosis refers to the colonization of the colorectal epithelium by anaerobic spirochetes of the genus Brachyspira. It is more frequently identified in developing countries or when sanitation conditions are suboptimal. It can affect anyone, although it is more common in gay men, particularly those infected with the human immunodeficiency virus (HIV). Its most common symptom is chronic watery diarrhea. A colonoscopy may be expected. We present the clinical case of a young male patient with chronic diarrhea of several years of evolution resolved by specific treatment. In addition, a review of the literature on this disease is provided.

La espiroquetosis intestinal se define como la colonización del epitelio colorrectal por espiroquetas anaerobias del género Brachyspira. Se identifica con mayor frecuencia en países en vías de desarrollo o cuando las condiciones de salubridad son subóptimas. Puede afectar a cualquier persona, aunque es más común en hombres homosexuales particularmente infectados por virus de la inmunodeficiencia humana (VIH). Su síntoma más frecuente es la diarrea crónica acuosa. La colonoscopia puede ser normal. Se presenta el caso clínico de un paciente masculino joven con diarrea crónica de varios años de evolución que se resuelve al brindar tratamiento específico. Además, se realiza, una revisión de la literatura sobre esta enfermedad.

Rev. cir. (Impr.) ; 75(4)ago. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1515235


Objetivo: Reporte de dos casos en que se extrajo por vía anal con colonoscopía, cuerpos extraños injeridos por vía oral. Material y Método: Discusión del cuadro clínico, imágenes, y manejo. En ambos casos luego de la confirmación imagenológica de la presencia de los cuerpos extraños en el tracto digestivo bajo se procedió a su extracción con colonoscopía. Resultados: Ambos casos se presentaron de forma inusual, se confirmo la presencia y ubicación de los cuerpos extraños con imagenología y colonoscopía. Se realizó la extracción por vía endoscópica sin incidentes. Discusión: Nuestros dos casos son inusuales, con escasa evidencia en la literatura internacional, en ambos casos se pudieron presentar complicaciones importantes y requerir cirugía. Afortunadamente se pudieron resolver por vía endoscópica. Conclusión: Los cuerpos extraños del tracto digestivo bajo, injeridos por vía oral son infrecuentes, la imagenología y la sospecha clínica son esenciales para su correcto diagnóstico y planificación terapéutica. Consideramos que la extracción con colonoscopía es una estrategia a considerar en estos casos.

Objective: Report of two cases in which foreign bodies ingested orally were extracted through the anal route with colonoscopy. Material and Method: Discussion of the clinical picture, images, and management. In both cases, after imaging confirmation of the presence of foreign bodies in the lower digestive tract, they were extracted with colonoscopy. Results: Both cases presented in an unusual way, the presence and location of the foreign bodies were confirmed with imaging and colonoscopy. Endoscopic removal was performed without incident. Discussion: Our two cases are unusual, with little evidence in the international literature, in both cases important complications could have occurred and surgery was required. Fortunately they could be resolved endoscopically. Conclusion: Orally ingested foreign bodies in the lower digestive tract are rare; imaging and clinical suspicion are essential for correct diagnosis and therapeutic planning. We believe that extraction with colonoscopy is a strategy to consider in these cases.

Rev. gastroenterol. Perú ; 43(3)jul. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1536346


Cáncer colorrectal post-colonoscopia (CCRP) es el tumor que aparece posterior a una colonoscopia normal antes de cumplirse el tiempo establecido para seguimiento endoscópico. Origen multifactorial, refleja la calidad de la colonoscopia y las diferentes biologías tumorales entre los cánceres colorrectales detectados (CCRD) y el CCRP. Nuestro objetivo es describir las características del CCRP en nuestro medio, identificar factores de riesgo, discriminar sus causas según la Organización Mundial de Endoscopia (OME) y determinar el efecto en la sobrevida del paciente. El estudio se realizó en pacientes con cáncer-colorrectal (CCR) atendidos en consulta de gastro-oncología de dos instituciones en Medellín-Colombia, entre enero de 2012 y diciembre de 2021 que se habían sometido a una colonoscopia en los 6 a 36 meses anteriores a la colonoscopia en la que se diagnosticó el CCR. 919 pacientes durante 10 años por CCR, 68 casos de CCRP (6,9%), se encontró que se presenta con más frecuencia en pacientes mayores (74 vs. 66 años; p=0,03), con antecedentes de pólipos adenomatosos (36,8% vs. 20,1%; p=0,01) y en colon derecho (57,4% vs. 40,6%; p=0,006), con una tendencia en pacientes con diverticulosis (41,2% vs. 31,3%; p=0,05) y diabetes (25% vs. 14%; p=0,06); menor sobrevida a 5 y 10 años (58%-55,2% vs. 67%-63%; p<0,001). Según la OME, los CCRP se presentaron en 61,3% por lesiones omitidas en colonoscopias inadecuadas, 29% colonoscopias adecuadas y 9,7% resecciones incompletas de adenomas. En conclusión, la tasa de CCRP fue de 6,9%, con mayor propensión en pacientes de mayores, antecedente de resección de pólipos, y en colon derecho. Acorde a la OME, las lesiones omitidas más frecuentemente se relacionaron con colonoscopias inadecuadas. Los pacientes con CCRP tienen menor sobrevida.

Post-colonoscopy colorectal cancer (PCCRC) is a tumor that appears after a normal colonoscopy before the established time for the endoscopic follow up. Its origin reflects the quality of the colonoscopy and the different tumoral biologics between the CRC and the CRCPC. Our aim is to describe the characteristics of the PCCRC in our region, to identify risk factors, to discriminate the potential causes according to the World Endoscopý Organization (WEO) and to determine its impact in the patient's survival. We studied patients with colorectal cancer (CRC) attended at the gastro-oncology clinic of two institutions of Medellin-Colombia, between January 2012 and December 2021 that had been submitted to a colonoscopy between 6-36 months before the colonoscopy in which the CRC was diagnosed. 919 patients during 10 years for CRC, 68 cases of PCCRC (6.9%); It was more frequent in older patients (74 vs. 66 years; p=0.03), with background of adenomatous polyps (36.8% vs. 20.1%; p=0.01) and in right colon (57.4% vs. 40.6%; p=0.006), with a tendency in patients with diverticulosis (41.2% vs. 31.3%; p=0.05) and diabetes (25% vs. 14%; p=0.06); less survival at 5 and 10 years (58% and 55.2% vs. 67% and 63%; p<0.001). According to the WEO, the PCCRC presents in 61.3% because of abnormal findings omitted in inadequate colonoscopies, 29% in a suitable colonoscopy and 9.7% incomplete resections of adenomas. In conclusion, the rate of PCCRC was 6.9% with more propension in older patients, a background of polyp resection, and proximal colon. According to the WEO, the abnormal findings omitted more frequently were related with inadequate colonoscopies. The patients with PCCRC had less survival.

Arq. gastroenterol ; 60(2): 264-270, Apr.-June 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1447387


ABSTRACT Background: Several publications have shown greater acceptance of less restrictive diets for colonoscopy preparation, without impairing the quality of the preparation, when compared to the clear liquid diet. Objective: To evaluate the quality, tolerance and preference regarding the colonoscopy preparation of a low-fiber, normocaloric diet compared with a hypocaloric liquid diet. Methods: This is a randomized, controlled, observer-blind study to compare two low-fiber colonoscopy preparation diets (hypocaloric liquid diet vs. normocaloric diet). The Boston Bowel Preparation Scale was used to evaluate the qua­lity of the preparations, being considered adequate BBPS ≥6 in the global assessment and ≥2 in each segment. The same laxative was used in both groups as well as the "split-dose" regimen. Results: A total of 136 individuals were enrolled in each group. Adequate preparation was achieved in 90.4% of the individuals allocated to the liquid diet group and 92.6% to the normocaloric group. There was no significant difference in the quality of preparation and tolerance between groups. A higher patient acceptance to repeat the procedure if necessary was observed in the normocaloric diet group compared with the liquid diet group (P=0.005). Conclusion: The normocaloric diet has shown to be not inferior to the liquid diet regarding the quality of the colonoscopy preparation. Patient tolerance rates were similar between both diets, but a higher accep­tance rate was observed with the normocaloric diet as compared with the liquid diet.

RESUMO Contexto: Diversas publicações têm evidenciado uma maior aceitação de dietas menos restritivas para preparo de colonoscopia, sem prejuízo na sua qualidade, quando comparadas com a dieta de líquidos claros. Objetivo: Avaliar a qualidade, tolerância e preferência do preparo para colonoscopia de uma dieta líquida hipocalórica, quando comparada com uma dieta normocalórica, ambas pobres em fibras. Métodos: Trata-se de um estudo randomizado, controlado, observador "cego", para comparar duas dietas de preparo para colonoscopia (dieta líquida hipocalórica e dieta normocalórica, ambas pobres em fibras). Foi utilizada a escala de Boston para avaliar a qualidade do preparo, sendo considerado adequado BBPS ≥6 na avaliação global e ≥2 em cada segmento. Foram prescritos o mesmo laxativo e o regime "dose fracionada" para ambos os grupos. Resultados: Foram incluídos 136 indivíduos em cada grupo. O preparo adequado foi alcançado em 90,4% dos indivíduos alocados no grupo da dieta líquida e 92,6% da normocalorica. Não houve diferença significativa na qualidade do preparo e na tolerância entre ambas as dietas. Observou-se maior aceitação de repetir o procedimento se necessário, no grupo da dieta normocalórica quando comparado ao da dieta líquida (P=0,005). Conclusão: A dieta normocalórica não é inferior que à líquida na qualidade do preparo para colonoscopia, ambas apresentam tolerância similar, porém com maior aceitação da dieta normocalórica quando comparada à líquida.

Arq. gastroenterol ; 60(2): 224-229, Apr.-June 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1447389


ABSTRACT Background: Serrated lesions are the precursors of up to one-third of colorectal cancer (CRC) cases and share molecular and epidemiological features with interval CRC. Previous studies have reported wide variation in serrated polyp prevalence and diverse magnitude of its relationship with synchronous advanced adenomas. Objective: Describe the prevalence of serrated polyps and evaluate their association with synchronous advanced adenomas. Methods: The study is a retrospective analysis of 1208 colonoscopies performed in patients aged 45 to 75, predominantly for CRC screening. Data on the prevalence of serrated polyps subsets and advanced adenomas were collected, and multivariate analysis were performed to identify the association between serrated polyps and synchronous advanced adenomas. Results: The prevalence of clinically significant serrated polyps (CSSP), large serrated polyps (LSP), and sessile serrated adenomas (SSA) were 11.3%, 6%, and 3.7%. CSSP were associated with synchronous advanced adenomas (OR 2.121, 95%CI 1.321-3.406), regardless of proximal (OR 2.966, 95%CI 1.701-5.170) or distal (OR 1.945, 95%CI 1.081-3.499) location, while LSP (OR 2.872, 95%CI 1.425-5.787) and SSA (OR 5.032, 95%CI 2.395-10.576) were associated with proximal advanced adenomas. Conclusion: The prevalence of CSSP and advanced adenomas were alike. CSSP is a risk factor for advanced adenomas, and the strength of this association is stronger for proximal advanced adenomas. LSP and SSA are associated with proximal advanced adenomas.

RESUMO Contexto: Lesões serrilhadas são precursoras de até um terço dos casos de câncer colorretal (CCR) e compartilham características moleculares e epidemiológicas com o CCR de intervalo. Estudos prévios relataram ampla variação na prevalência de pólipos serrilhados e na magnitude da sua relação com adenomas avançados sincrônicos. Objetivo: Descrever a prevalência de pólipos serrilhados colorretais e avaliar sua associação com adenomas avançados sincrônicos. Métodos: O estudo é uma análise retrospectiva de 1208 colonoscopias realizadas em pacientes com idades entre 45 e 75 anos, predominantemente para rastreamento de CCR. Dados sobre a prevalência de subtipos de pólipos serrilhados e de adenomas avançados foram coletados, e análises multivariadas foram realizadas para identificar a associação entre pólipos serrilhados e adenomas avançados sincrônicos. Resultados: A prevalência de pólipos serrilhados clinicamente significativos (PSCS), pólipos serrilhados grandes (PSG) e adenomas sésseis serrilhados (ASS) foi de 11,3%, 6% e 3,7%, respectivamente. PSCS foram associados a adenomas avançados sincrônicos (OR 2,121, IC95% 1,321-3,406), independentemente da localização proximal (OR 2,966, IC95% 1,701-5,170) ou distal (OR 1,945, IC95% 1,081-3,499), enquanto PSG (OR 2,872, IC 95%1,425-5,787) e ASS (OR 5,032, IC95% 2,395-10,576) foram associados a adenomas avançados proximais. Conclusão: A prevalência de PSCS e de adenomas avançados foi semelhante. PSCS é um fator de risco para adenomas avançados, e a força dessa associação é maior para adenomas avançados proximais. PSG e ASS estão associados a adenomas avançados proximais.

Arq. gastroenterol ; 60(2): 188-193, Apr.-June 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1447396


ABSTRACT Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.

RESUMO A colite microscópica é uma doença intestinal inflamatória crônica caracterizada por diarreia não sanguinolenta que pode variar de leve a grave. Atribui-se que cerca de 10-20% das diarreias crônicas são devidas à colite microscópica. Os três fatores determinantes para o diagnóstico são sintomas clínicos característicos, quadro endoscópico normal do cólon e quadro histológico patognomônico. Este manuscrito tem como objetivo atualizar e trazer recomendações para os profissionais envolvidos (gastroenterologista, endoscopista e patologista) no diagnóstico de colite microscópica. Adicionalmente, uma breve recomendação sobre o tratamento.

Rev. cir. (Impr.) ; 75(3)jun. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1515221


Introducción: La colonoscopia es una herramienta básica en el estudio de patologías del área colorrectal, así como uno de los pilares del screening del cáncer de colon y recto. Sin embargo, no es un procedimiento exento de riesgos, algunos de ellos con elevada morbimortalidad. Caso Clínico: Varón de 55 años con enolismo crónico y hepatopatía por Virus Hepatitis C y Enfermedad Pulmonar Obstructiva Crónica. En estudio por diarrea se solicita una ecografía de abdomen donde, como único hallazgo, se muestra una lesión de 7 mm a nivel de páncreas y una colonoscopia con intención diagnóstica que no muestra alteraciones significativas. Con la sospecha de que la lesión pancreática pudiese ser la causa del cuadro diarreico, se realiza un escáner abdominal donde se muestra una colección subcapsular a nivel esplénico de 11 × 3 cm compatible con hematoma sin signos de sangrado activo. Dada la estabilidad hemodinámica, se inicia manejo conservador, con empeoramiento del dolor abdominal e hipotensión en las siguientes 12 h. Se repite prueba de imagen objetivando aumento de hematoma esplénico y líquido libre intraabdominal. Se indica cirugía urgente donde se evidencia hemoperitoneo secundario a lesión esplénica que obliga a realizar esplenectomía. Conclusión: La presencia de una posible lesión esplénica yatrogénica se debe tener en cuenta en el diagnóstico diferencial en un paciente con dolor abdominal de inicio agudo y anemización o alteración del estado hemodinámico dentro de las primeras 24-48 h tras la realización de una colonoscopia.

Introduction: Colonoscopy is a basic tool in the study of pathology of the colorectal area, as well as one of the pillars of colon and rectal cancer screening. However, it is not a risk-free procedure, some of them with high morbimortality. Case Report: 55-year-old male with chronic alcoholism and hepatopathy due to HCV, COPD. During a study for diarrhea, an ultrasound of the abdomen revealed a 7 mm pancreas tumor, and a diagnostic colonoscopy showed no significant alterations. With the suspicion that the pancreatic lesion could be the cause of the diarrhea, an abdominal scan was performed showing a subcapsular collection at the splenic level of 11 × 3 cm compatible with hematoma without signs of active bleeding. Due to the hemodynamic stability, conservative management was decided, with worsening abdominal pain and hypotension in the following 12 hours. A new imaging test showed an enlarged splenic hematoma and free abdominal fluid suggestive of hemoperitoneum. Urgent surgery found hemoperitoneum secondary to splenic lesion and splenectomy was required. Conclusion: The presence of a possible iatrogenic splenic lesion should be considered in the differential diagnosis in a patient with acute onset abdominal pain and anemia or hemodynamic status alteration within the first 24-48 hours after colonoscopy.

J. coloproctol. (Rio J., Impr.) ; 43(2): 75-81, Apr.-June 2023. graf, ilus
Article in English | LILACS | ID: biblio-1514427


Introduction: Anal examination and videoanoscopy (VA) are rarely performed during colonoscopies. In recent years, there has been a considerable increase in lesions of sexually transmitted anal and rectal infections, but these conditions are not noticed or reported during routine colonoscopy. Objective: To raise awareness regarding the fortuitous findings of lesions and sexually transmitted infections (STIs) in colonoscopy exams and to demonstrate that anal examination and VA provide important information and should be routinely performed. Methods: We conducted a descriptive retrospective study in 16,132 patients screened by colonoscopy and VA between 2006 and 2018. Among numerous other findings, the presence of anal condylomata and sexually transmitted retitis or perianal dermatitis was observed. The rates of each finding were calculated, and the patients were subdivided by sex and into age groups by blocks of ten years. Results: Among the 16,132 colonoscopies performed, 26 cases of condyloma (0.16%) and 50 cases of proctitis or perianal dermatitis suspicious for STI (0.33%) were found. Conclusion: Performing anal examination and VA systematically in all routine colonoscopies enabled the identification of numerous anal conditions, including several fortuitous cases of STIs. The study proposes that anal examination and VA should be performed in all routine colonoscopies and, in suspected cases, complementary tests for STIs. (AU)

Anal Canal/injuries , Anus Neoplasms/diagnosis , Colonoscopy , Papillomavirus Infections/diagnosis , Carcinoma in Situ/diagnosis , Papillomavirus Infections/therapy , Dermatitis, Contact/diagnosis