ABSTRACT
El sarcoma de Kaposi (SK) es una neoplasia maligna angioproliferativa de bajo grado, causada por la infección por virus herpes humano tipo 8 (HHV-8). El tracto gastrointestinal está involucrado en el 40% de los casos y constituye la neoplasia maligna gastrointestinal más común en pacientes con sida. Se presenta el caso de un paciente 32 años con antecedente de VIH de larga data, sin tratamiento, que relató episodios de proctorragia intermitente y pérdida de peso en los últimos dos meses. Presentaba lesiones cutáneas elevadas en forma de placas violáceas que predominaban en tronco y miembros superiores. Se realizó videocolonoscopía, la que evidenció en el área próxima a la válvula ileocecal y en el colon ascendente, lesiones sobreelevadas, eritematosas, friables y sangrantes, las cuales se biopsiaron. El estudio anatomopatológico reportó un perfil inmunohistoquímico compatible con SK. Al momento de la escritura de este artículo el paciente se encontraba bajo tratamiento quimioterápico (doxorrubicina liposomal, seis ciclos) e iniciando tratamiento antirretroviral (lamivudina tenofovir dolutegravir). Se presenta el siguiente caso para destacar la importancia del enfoque multidisciplinario del paciente con VIH/sida y fundamentalmente el rol de la endoscopía digestiva tanto alta como baja en pacientes con dolor abdominal, sangrado digestivo u otros síntomas abdominales, con el fin de descartar patologías del tracto gastrointestinal y, particularmente, el SK
Kaposi's sarcoma (KS) is a low-grade angioproliferative malignancy caused by infection with human herpes virus -8. The gastrointestinal tract is involved in 40% of cases, being the most common gastrointestinal malignancy in patients with AIDS. We present the case of a 32-year-old patient with a long-standing history of HIV without treatment, who reported episodes of intermittent proctorrhagia and weight loss in the last two months. He presented raised skin lesions in the form of violaceous plaques that predominate on the trunk and upper limbs. A videocolonoscopy was performed, revealing raised, erythematous, friable, bleeding lesions near the ileocecal valve and in the ascending colon, which were biopsied. The anatomopathological study shows an immunohistochemical profile compatible with KS. At the time of writing this article, the patient was under chemotherapy treatment (liposomal doxorubicin, 6 cycles) and starting antiretroviral treatment (lamivudine - tenofovir - dolutegravir). The following case is presented to highlight the importance of the multidisciplinary approach of the patient with HIV / AIDS and fundamentally the role of both upper and lower digestive endoscopy in those cases that present with abdominal pain, digestive bleeding and other abdominal symptoms, in order to rule out gastrointestinal tract pathologies and particularly KS
Subject(s)
Humans , Female , Adult , Sarcoma, Kaposi/diagnosis , Endoscopy, Gastrointestinal , Acquired Immunodeficiency Syndrome/immunology , HIV/immunology , Gastrointestinal Tract/pathologyABSTRACT
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
Subject(s)
Humans , Endoscopy, Digestive System , Intestinal Fistula , Intestinal Perforation , Endoscopy, Gastrointestinal , Anastomotic LeakABSTRACT
Introducción: El cáncer de estómago representa la segunda causa de muerte relacionada con neoplasias en el mundo, es responsable del 8 al 10 por ciento de todas las muertes por cáncer. A pesar de un marcado descenso en su incidencia, constituye una de las principales causas de muerte por cáncer en Cuba y el mundo. Objetivo: Describir el comportamiento clínico epidemiológico en los pacientes con cáncer gástrico. Métodos: Se realizó un estudio observacional, descriptivo, transversal de los pacientes con diagnóstico de cáncer gástrico que acudieron a consulta en el Hospital Universitario General Calixto García, en el período comprendido entre enero de 2014 y diciembre de 2018. El universo estuvo constituido por 146 pacientes. Los datos fueron obtenidos de las historias clínicas y procesados mediante estadística descriptiva. Resultados: De los pacientes estudiados, 67,6 por ciento pertenecían al sexo masculino y tenían entre 60 y 79 años; 51,7 por ciento presentó como factor de riesgo el hábito de fumar. Un total de 124 pacientes padecieron de dolor abdominal. El 100 por ciento de los exámenes complementarios realizados fueron endoscopia y biopsia. Se observó el adenocarcinoma moderadamente diferenciado en un total de 80 pacientes. Al 100 por ciento se le realizó tratamiento quirúrgico. La técnica quirúrgica más empleada fue la gastrectomía subtotal. Conclusiones: Las edades avanzadas de la vida, los antecedentes de úlcera gástrica, el tabaquismo y el alcoholismo son factores epidemiológicos característicos de la población de enfermos aquejados de cáncer gástrico. Los elementos clínicos identificados fueron los habitualmente descritos en la literatura médica. La cirugía en la actualidad es la única modalidad con potencial curativo(AU)
Introduction: Stomach cancer accounts for the second cause of death related to neoplasms worldwide; it is responsible for 8 percent to 10 percent of all cancer deaths. In spite of a marked decrease in its incidence, it constitutes one of the main causes of cancer death in Cuba and worldwide. Objective: To describe the clinical-epidemiological characteristics of patients with gastric cancer. Methods: An observational, descriptive and cross-sectional study was carried out with patients with a diagnosis of gastric cancer who attended consultation at Calixto García General University Hospital in the period from January 2014 to December 2018. The universe consisted of 146 patients. The data were obtained from medical records and processed by descriptive statistics. Results: Of the patients studied, 67.6 percent were male and aged 60-79 years. 51.7 percent presented smoking as a risk factor. A total of 124 patients suffered from abdominal pain. 100 percent of the complementary examinations performed were endoscopy and biopsy. Moderately differentiated adenocarcinoma was observed in a total of 80 patients. The surgical treatment was performed in 100 percent. The most commonly used surgical technique was subtotal gastrectomy. Conclusions: The research suggests that, currently, early diagnosis and surgery is the only modality with curative potential, being able to raise the quality of life, as well as to improve morbidity and mortality rates in the population(AU)
Subject(s)
Humans , Male , Female , Stomach Neoplasms/epidemiology , Risk Factors , Endoscopy, Gastrointestinal/methods , Helicobacter pylori/drug effects , Epidemiology, Descriptive , Cross-Sectional Studies , Observational StudyABSTRACT
Abstract Graft-versus-host disease is a common complication after stem cell transplantation. The digestive tract is affected in many patients who suffer from it, with consequences that can be fatal. The proper approach, which includes endoscopic studies, allows ruling out differential diagnoses and managing the disease early.
Resumen La enfermedad de injerto contra huésped es una complicación frecuente después del trasplante de células madre. El tracto digestivo se afecta en una gran proporción de los pacientes que la sufren, con consecuencias que pueden llegar a ser fatales. El abordaje adecuado, que incluye el uso de estudios endoscópicos, permite descartar diagnósticos diferenciales y brindar un manejo temprano de la enfermedad.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Stem Cell Transplantation/adverse effects , Gastrointestinal Diseases/etiology , Graft vs Host Disease/diagnosis , Biopsy , Endoscopy, Gastrointestinal , Diagnosis, Differential , Gastrointestinal Diseases/pathology , Graft vs Host Disease/pathology , Intestines/pathologyABSTRACT
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.
Subject(s)
Humans , Gastrointestinal Hemorrhage , Peptic Ulcer , Anti-Inflammatory Agents, Non-Steroidal , Endoscopy, Gastrointestinal , Helicobacter pylori , Gastrointestinal Tract , Emergency Service, Hospital , Esophagitis , Proton Pump Inhibitors , Mallory-Weiss Syndrome , NeoplasmsABSTRACT
Objetivo: Analisar a incidência de eventos adversos relacionados aos procedimentos endoscópicos gastrointestinais. Método: Estudo de casos múltiplos em serviços ambulatoriais de endoscopia gastrointestinal Tipo III, na cidade de Salvador, Bahia, analisando: Núcleos de Segurança do Paciente; eventos adversos e descontaminação dos endoscópicos. Resultados: Participaram 28,5% dos serviços ambulatoriais de endoscopia gastrointestinal da cidade estudada. Existem Núcleos de Segurança do Paciente, que atuam segundo Planos de Segurança do Paciente, mas sem profissional com dedicação exclusiva. Apenas um serviço monitora pacientes após a endoscopia, fato que dificulta a identificação dos efeitos adversos após procedimentos nessas organizações. Existem protocolos básicos de segurança do paciente na maioria dos serviços. A incidência total de efeitos adversos é 0,3%; e 0,8% para a endoscopia digestiva alta e colonoscopias. Bacteremias, dor abdominal, sangramento e perfuração intestinal são os danos mais frequentes. Todos os ser-viços possuem boa estrutura organofuncional para a realização dos processos de limpeza e desinfecção dos endoscópios. Conclusão: Os serviços pos-suem Núcleos de Segurança do Paciente, e implementam protocolos de segurança recomendados. Os efeitos adversos identificados estão em consonân-cia com a literatura; entretanto, esses dados podem estar subnotificados, uma vez que esses serviços não dispõem de um sistema ativo de vigilância de eventos adversos após exames endoscópicos.
Objective: To analyze the incidence of adverse events related to gastrointestinal endoscopic procedures. Method: Multiple case study in Type III gastrointestinal endoscopy outpatient services, in the city of Salvador, Bahia, analyzing: Patient Safety Centers (Núcleos de Segurança do Paciente NSP); adverse events and endoscopic decontamination. Results: 28.5% of the gastrointestinal endoscopy outpatient services in the city participated in the study. There are NSPs, which work according to Patient Safety Plans, but without a dedicated professional. Only one service monitors patients after endoscopy, which makes it difficult to identify adverse effects after procedures in these organizations. Basic patient safety protocols exist in most services. The total incidence of adverse effects is 0.3%; and 0.8% for upper digestive endoscopy and colonoscopies. Bacteremia, abdominal pain, bleeding, and intestinal per-foration are the most frequent damages. All services have a good organofunctional structure for cleaning and disinfecting endoscopes. Conclusion: The services have NSPs and implement recommended safety protocols. The adverse effects identified are in line with the literature; however, these data may be underreported, since these services do not have an active surveillance system for adverse events after endoscopic examinations.
Objetivo: Analizar la incidencia de eventos adversos (EA) relacionados con los procedimientos endoscópicos gastrointestinales. Método: Estudio de casos múltiples en servicios ambulatorios de endoscopia digestiva tipo III (SAEG), en Salvador, BA, analizando: Centros de Seguridad del Paciente (CSP); eventos adversos y descontaminación endoscópica. Resultados: Participó el 28,5% de la SAEG. Hay CSP, que funcionan según Planes de Seguridad del Paciente, pero sin un profesional con dedicación exclusiva. Solo un servicio monitorea a los pacientes después de la endoscopia, hecho que dificulta la identificación de EA después de los procedimientos en estas organizaciones. En la mayoría de los servicios existen protocolos básicos de seguridad del paciente. La incidencia total de EA es del 0,3% y del 0,8% para endoscopias digestivas altas y colonoscopias. La bacteriemia, el dolor abdominal, el san-grado y la perforación intestinal son los daños más frecuentes. Todos los servicios cuentan con una buena estructura órgano-funcional para la limpieza y desinfección de endoscopios. Conclusión: Los servicios cuentan con CSP e implementan los protocolos de seguridad recomendados. Los EA identifica-dos están en línea con la literatura, sin embargo, estos datos pueden estar subreportados, ya que estos servicios no cuentan con un sistema de vigilancia activa de eventos adversos después de los exámenes endoscópicos.
Subject(s)
Humans , Security Measures , Endoscopy, Gastrointestinal , Patient Safety , Decontamination , Ambulatory Care , Household WorkABSTRACT
Introducción: el pénfigo vulgar comprende un grupo de enfermedades heterogéneas autoinmunes ampollosas de la piel y las mucosas. La afectación esofágica en el pénfigo vulgar es rara, con una prevalencia incierta que requiere un abordaje diagnóstico y terapéutico detallado. Caso clínico: mujer de 37 años, con antecedentes de tratamiento con inhibidores de la Cox-2 debido a hernia discal. Se envió a Gastroenterología por pérdida de peso de aprox. 5kg en un mes. La paciente tuvo presencia de disfagia, odinofagia y dolor retroesternal con pobre tolerancia a la vía oral. Se hizo endoscopía que reportó esofagitis disecante superficial y gastropatía eritematosa de antro; el duodeno estaba en estado normal. Los hallazgos se correlacionaron con el diagnóstico de pénfigo vulgar con afectación exclusiva a esófago. En la valoración no se identificaron lesiones en piel, cavidad oral u otras mucosas. Se hizo nueva endoscopía como control y se encontró inmunofluorescencia de biopsia esofágica reactiva a IgG 2. Se dio manejo inicial con glucocorticoides, antiinflamatorios e inmunosupresores. Conclusiones: la importancia del estudio del pénfigo radica no solo en la alta morbimortalidad asociada, sino en lo raro y complejo de su detección, pues los pacientes suelen tardar varios meses en tener un diagnóstico certero y aún más en conseguir las metas terapéuticas. Es prioritaria la difusión del estudio del pénfigo entre los profesionales de lasalud involucrados en su detección.
Background: Pemphigus vulgaris comprises a group of heterogeneous blistering autoimmune diseases of the skin and mucosa. Esophageal involvement within pemphigus vulgaris is rare with an uncertain prevalence that requires a detailed diagnostic and a therapeutic approach. Clinical case: 37-year-old female, with a history of treatment with Cox-2 inhibitors due to herniated disc. She is sent to the Gastroenterology Service for weight loss of approximately 5 kilos in a month, with the presence of dysphagia, odynophagia and retrosternal pain with poor toleranceto the oral route. Endoscopy was performed, which reported esophagitis dissecans superficialis (EDS), erythematous gastropathy of the antrum and normal duodenum. Findings were correlated with the diagnosis ofpemphigus vulgaris with exclusive involvement of the esophagus. The evaluation did not identify lesions on the skin, oral cavity or other mucous membranes. A new endoscopy was performed as a control and it was found immunofluorescence of the esophageal biopsy reactive to IgG 2. Initial management was given with glucocorticoids, anti-inflammatories and immunosuppressants. Conclusions: The importance of the study ofpemphigus lies not only in the high associated morbidity and mortality, but also in its intrinsic rarity and the complexity of its detection, given that patients usually take several months to have an accurate diagnosis and even more time to achieve therapeutic goals. It is a priority the dissemination of the study of pemphigus among health professionals involved in its detection.
Subject(s)
Humans , Female , Adult , Endoscopy, Gastrointestinal , Pemphigus , Autoimmune Diseases , Diagnostic Imaging , EsophagusABSTRACT
Resumen: Introducción: el cáncer gástrico es la quinta neoplasia en frecuencia a nivel mundial. Su diagnóstico suele ser tardío. La estenosis gastroduodenal es una complicación frecuente, que condiciona el pronóstico y el tratamiento. Contamos con varias modalidades en cuanto a la paliación de esta complicación. Destacamos el tratamiento quirúrgico mediante derivación digestiva (gastroenteroanastomosis), y el tratamiento endoscópico, mediante colocación de un stent o prótesis metalica autoexpandible (PMA). El objetivo es exponer el caso clínico de una paciente portadora de un cáncer gástrico avanzado complicado con estenosis gastroduodenal en la cual se optó por la colocación de una PMA. La bibliografía comparativa entre ambas técnicas es controvertida. Existen estudios importantes que recomiendan la técnica quirúrgica frente a la endoscópica, y viceversa. Con este fin se han realizado múltiples trabajos. Los posibles beneficios de la paliación endoscópica son: menor estadía hospitalaria, rápido reintegro a la vía oral. El caso clínico expuesto por el contrario no se benefició de la menor estadía hospitalaria, en parte, por ser necesaria su internación por comorbilidades médicas. No presentó complicaciones posteriores relacionadas al procedimiento. Conclusiones: la elección de la técnica a utilizar deberá ser individualizada, teniendo en cuenta el paciente, sus comorbilidades, recursos técnicos, experiencia del personal, y recursos económicos. Se necesitan más estudios para demostrar beneficio de la técnica paliativa más adecuada.
Abstract: Introduction: gastric cancer is the fifth neoplasm in terms of global incidence and its diagnosis often comes late. Gastric outlet obstruction is a frequent complication that influences prognosis and treatment. Among the various modalities available for palliation of this complication, we stand out two: surgical treatment by means of a digestive derivation: gastrojejunostomy and endoscopic treatment, by placing a stent or a steel mesh self-expanding endoprosthesis (EMP). The study aims to present the clinical case of a patient carrier of advanced gastric cancer with gastric outlet obstruction, who was treated by placing a self-expandable metallic stent. Comparative bibliography of both techniques is controversial. A number of important studies recomend the surgical technique instead of endoscopic treatment, and viceversa. For this reason, several studies have been conducted. The potential benefits of endoscopic palliation are the following: shorter hospital stay, fast return to oral intake. However the clinical case presented did not benefit from a shorter hospital stay, since it required longer hospitalization, partly due to medical comorbilities. There were no complications after the procedure. Conclusions: the specific technique to treat the condition needs to be chosen for each individual case, considering the particular patient and his or her comorbilities, technical resources, the experience of the medical staff and economic resources. More studies are necessary to prove the benefits of the most appropriate palliative technique.
Resumo: Introdução: o câncer gástrico é a quinta neoplasia em frequência no mundo. Seu diagnóstico costuma ser tardio. A estenose gastroduodenal é uma complicação frequente, que determina o prognóstico e o tratamento. Existem várias modalidades quanto à paliação desta complicação entre os quais destacamos o tratamento cirúrgico por derivação digestiva: gastro enteroanastomose e o tratamento endoscópico, com colocação de Stent ou Prótese Metálica Autoexpansível (PMA). O objetivo deste trabalho é apresentar o caso clínico de um paciente com câncer gástrico avançado complicado por estenose gastroduodenal em que se optou pela colocação de PMA. A bibliografia comparativa entre as duas técnicas é controversa. Existem estudos importantes que preconizam a técnica cirúrgica em detrimento da endoscópica e vice-versa. Para isso, vários trabalhos foram realizados. Os possíveis benefícios da paliação endoscópica são: menor tempo de internação, rápida reintrodução à via oral. Neste caso o paciente não se beneficiou do menor tempo de internação, em parte, porque a internação foi necessária por comorbidades médicas. Não foram observadas complicações subsequentes relacionadas ao procedimento. Conclusões: a escolha da técnica a ser utilizada deve ser individualizada, levando em consideração o paciente, suas comorbidades, os recursos técnicos, a experiência da equipe e os recursos econômicos. Mais estudos são necessários para demonstrar o benefício da técnica paliativa mais adequada.
Subject(s)
Stomach Neoplasms/complications , Constriction, Pathologic/surgery , Endoscopy, Gastrointestinal , Self Expandable Metallic StentsABSTRACT
Background and Objective: Dyspepsia is one of the most common complaints encountered in the general outpatient and gastroenterology clinics in Nigeria. Histopathological assessment of endoscopic gastric mucosa biopsy is crucial to delineate the exact cause of dyspepsia to guide patients' management. This study aimed to determine and document the histopathological basis of dyspepsia among dyspeptic patients at our facility. Material sand Methods: This was a three year descriptive retrospective study and the materials consisted of all gastric endoscopic biopsies taken from clinically diagnosed dyspeptic patients sent to the Department of Histopathology of the Federal Medical Centre, Owerri, Nigeria. Results: The biopsies were from 64 (53.2%) male patients and 56 (46.8%) female patients, giving a male to female ratio of 1.14:1. The age range of the patients was 28-82 years with a mean of 56 years at presentation. Helicobacter Pylori (H. Pylori) bacilli were identified in the samples of 42 (35%) patients but absent in samples of 78 (65%) patients. The histopathological pattern of the aetiological basis of dyspepsia in this study consisted of gastritis (96, 80%), functional (17, 14.2%), adenocarcinoma (4, 3.3%) and polyps (3, 2.5%). H. Pylori bacilli were seen only in patients with gastritis (42/96, 43.8%), and it affected 19 (45.2%) male patients and 23 (54.8%) female patients. Chronic active H. Pylori associated gastritis (24, 25%) was the most common form of gastritis seen during the study period. Conclusion: The main organic cause of dyspepsia in our setting was chronic gastric followed in the distant by gastric adenocarcinoma and polyp. Dyspepsia and H. Pylori associated gastritis did not show a significant gender predilection
Subject(s)
Humans , Endoscopy, Gastrointestinal , Dyspepsia , Biopsy , AdenocarcinomaABSTRACT
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.
Subject(s)
Humans , Male , Adult , Obesity, Morbid , Gastric Bypass , Anastomotic Leak , Endoscopy, Gastrointestinal , Bariatric Surgery , Conservative TreatmentABSTRACT
OBJECTIVES@#To study the clinical manifestations and gastroscopic characteristics of upper gastrointestinal ulcer in children.@*METHODS@#A retrospective analysis was performed for the children who underwent gastroscopy and were found to have upper gastrointestinal ulcer for the first time at the Endoscopy Center of Shengjing Hospital, China Medical University, from January 2011 to May 2021. According to the cause of the disease, they were divided into primary ulcer group (primary group; n=148) and secondary ulcer group (secondary group; n=25). The clinical data were compared between the two groups.@*RESULTS@#A total of 173 children with upper gastrointestinal ulcer were enrolled, with a male/female ratio of 3.9:1. Compared with girls, boys had significantly higher proportions of duodenal ulcer and primary ulcer (P<0.05). Compared with the children aged below 6 years, the children aged 6-14 years had higher proportions of duodenal ulcer and primary ulcer and lower proportions of giant ulcer and multiple ulcers. Of the 148 children in the primary group, 95 (64.2%) had Helicobacter pylori infection. Abdominal pain was the most common clinical symptom and was observed in 101 children (68.2%). Duodenal ulcer was common and was observed in 115 children (77.7%), followed by gastric ulcer in 25 children (16.9%) and esophageal ulcer in 7 children (4.7%). Multiple ulcers were observed in 32 children (21.6%). Seventy children (47.3%) experienced complications, among which bleeding was the most common complication and was observed in 63 children (43.6%). Of the 25 children in the secondary group, abdominal pain was the most common clinical symptom and was observed in 9 children (36.0%), with a significantly lower incidence rate than the primary group (P<0.05); foreign body in the digestive tract was the most common cause of ulcer and was observed in 17 children (68%), followed by abdominal Henoch-Schönlein purpura in 5 children (20.0%) and Crohn's disease in 3 children (12.0%). The secondary group had a significantly higher proportion of multiple ulcer or giant ulcer than the primary group (P<0.05).@*CONCLUSIONS@#Upper gastrointestinal ulcer is more common in boys than girls, and duodenal ulcer and primary ulcer are more common in boys. Children aged 6-14 years often have duodenal ulcer and primary ulcer, and giant ulcer and multiple ulcers are relatively uncommon. Primary ulcer in children has a variety of clinical manifestations, mainly abdominal pain, and duodenal ulcer is relatively common, with bleeding as the main complication. The clinical symptoms and endoscopic manifestations of secondary ulcer are closely associated with the primary causes, and it is more likely to induce huge ulcers and multiple ulcers.
Subject(s)
Abdominal Pain , Child , Duodenal Ulcer/epidemiology , Endoscopy, Gastrointestinal/adverse effects , Female , Helicobacter Infections/diagnosis , Helicobacter pylori , Humans , Male , Retrospective Studies , UlcerABSTRACT
After nearly 40 years of development, digestive endoscopy in children has been widely applied, and it has helped to expand the spectrum of pediatric digestive system diseases and greatly improve the diagnosis and treatment of pediatric digestive system diseases. Pediatric digestive endoscopy has become a subject. However, there are some problems such as the unbalanced development of pediatric digestive endoscopy across China, the lack of homogeneity in diagnosis and treatment system, the tendency of adult-oriented diagnosis and treatment techniques, and the localization of training quality, which affect the standardized and healthy development of pediatric digestive endoscopy. The diagnosis and treatment with digestive endoscopy in children should adhere to both pediatric characteristics and technological innovation to propose the concept of comfort, emphasize the importance of standardization (including the space and process for endoscopic diagnosis and treatment, perioperative evaluation, training mode, and access qualification), standardize the minimally invasive techniques, and develop artificial intelligence. It is of great importance to formulate related consensus statements and guidelines on the basis of medical safety and the features of the growth and development of children, so as to achieve the high-quality development of pediatric digestive endoscopy, effectively improve the diagnosis and treatment levels of pediatric digestive endoscopy, and bring benefits to more pediatric patients.
Subject(s)
Artificial Intelligence , Child , China , Consensus , Digestive System Diseases/diagnosis , Endoscopy, Gastrointestinal , HumansABSTRACT
INTRODUCTION@#In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting.@*METHODS@#The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process.@*RESULTS@#The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists.@*CONCLUSION@#These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Subject(s)
Conscious Sedation , Endoscopy, Gastrointestinal , Hospitals , Humans , Hypnotics and Sedatives , SingaporeSubject(s)
Humans , Low Cost Technology , Costs and Cost Analysis , Aerosols , Endoscopy , COVID-19 , Endoscopy, Gastrointestinal , Equipment and SuppliesABSTRACT
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)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anti-Inflammatory Agents, Non-Steroidal , Helicobacter pylori/drug effects , Dyspepsia/etiology , Gastric Mucosa/pathology , Gastritis/physiopathology , Peptic Ulcer , Signs and Symptoms , Biopsy , Pharmaceutical Preparations , Endoscopy, Gastrointestinal , Acidity , GastroenterologyABSTRACT
ABSTRACT BACKGROUND: The COVID-19 pandemic has changed digestive endoscopy services around the world. OBJECTIVE: This study aimed to measure the number of urgent/emergency endoscopic procedures performed in a Brazilian hospital, comparing it to the same period in the previous year, and to identify risk factors in COVID-19 patients undergoing endoscopic procedures for upper gastrointestinal bleeding (UGIB). METHODS: This was a retrospective, cross-sectional, observational, single-center study. The study evaluated urgent/emergency endoscopic procedures performed on adult patients from March to August in 2019 and 2020. The COVID-19 patients included were diagnosed using RT-PCR, aged over 18 years with complete medical record information. The variables evaluated were age, sex, comorbidities, length of stay, D-dimer, need for intensive care unit (ICU) and mechanical ventilation. Student's t-test for independent samples or the non-parametric Mann-Whitney test was used to compare quantitative variables. Categorical variables were analyzed using Fisher's exact test. A P-value <0.05 indicated statistical significance. RESULTS: A total of 130 urgent/emergency endoscopic procedures were performed in 2020 and 97 in 2019. During the study period, 631 patients were hospitalized due to COVID-19, of whom 16 underwent urgent/emergency endoscopic procedures, 10 (1.6%) due to UGIB. Of the variables analyzed, the need for ICU and/or mechanical ventilation during hospitalization was statistically significant as a risk factor for UGIB. CONCLUSION: This study showed increased urgent/emergency endoscopic procedures during the pandemic at the study site. Among the patients hospitalized with the novel coronavirus, there is a higher risk for UGIB in those needing ICU and/or mechanical ventilation.
RESUMO CONTEXTO: A pandemia da COVID-19 tem alterado o funcionamento de serviços de endoscopia digestiva pelo mundo. OBJETIVO: O presente estudo tem por objetivo medir o número de exames endoscópicos de urgência/emergência realizados em um hospital público brasileiro, comparando-o ao mesmo período do ano anterior, além de avaliar os fatores de risco dos pacientes com COVID-19 que realizaram exame endoscópico por hemorragia digestiva alta (HDA). MÉTODOS: Estudo retrospectivo, transversal, observacional e unicêntrico. Foram avaliados todos os exames endoscópicos de urgência/emergência realizados em pacientes acima de 18 anos, nos períodos de março a agosto dos anos de 2019 e 2020. Os pacientes com COVID-19 incluídos foram diagnosticados por RT-PCR, acima de 18 anos, com informações completas em prontuário. As variáveis avaliadas foram: tipo de exame endoscópico, idade, sexo, comorbidades, tempo de internação, d-dímero, necessidade de UTI e ventilação mecânica durante a internação. A comparação dos grupos em relação a variáveis quantitativas foi feita através do teste t de Student para amostras independentes ou o teste não-paramétrico de Mann-Whitney. As variáveis categóricas foram avaliadas pelo teste exato de Fisher. Valores de P<0,05 indicaram significância estatística. RESULTADOS: Observaram-se 130 exames endoscópicos de urgência/emergência no período avaliado em 2020, e 97 em 2019. No período do estudo foram internados 631 pacientes por COVID-19, dos quais 16 realizaram exame endoscópico de urgência/emergência, sendo 1,6% por HDA. Dentre as variáveis analisadas, necessidade de UTI e/ou ventilação mecânica durante o internamento foram estatisticamente significativos como risco para desenvolvimento de HDA. CONCLUSÃO: O presente estudo mostra que para a realidade local houve incremento de exames endoscópicos de urgência/emergência durante a pandemia. Dentre os pacientes internados com o novo coronavírus, há maior risco de HDA naqueles que necessitam de UTI e/ou ventilação mecânica.
Subject(s)
Humans , Adult , Pandemics , COVID-19 , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Endoscopy, Gastrointestinal , SARS-CoV-2 , Gastrointestinal Hemorrhage/etiology , Middle AgedABSTRACT
Resumen Introducción: la pandemia por SARS-CoV-2 ha conllevado la reestructuración de las unidades de endoscopía digestiva en el mundo, lo cual ha limitado los procedimientos endoscópicos y priorizado indicaciones de emergencia como la hemorragia digestiva alta (HDA). No obstante, existe escasa evidencia respecto a su impacto en la evolución y resultados. Objetivo: evaluar el manejo de la HDA en el contexto de la pandemia del coronavirus por SARS-CoV-2. Materiales y métodos: estudio observacional, descriptivo, retrospectivo de marzo a agosto de 2020 en pacientes con diagnóstico de HDA e infección por SARS-CoV-2. Resultados: de 4320 pacientes con infección por SARS-CoV-2, 51 presentaron HDA al ingreso. La mediana de edad fue de 70 años. El 58,8 % era de sexo masculino. El 56,9 % tenía una puntuación de Glasgow-Blatchford (SGB) ≥12. El 21,6 % requirió soporte de oxígeno. Solo 34 pacientes (66,7 %) recibieron tratamiento médico; asimismo, 17 (33,3 %) recibieron tratamiento médico más endoscopia digestiva alta (EDA); de estos, a 6 (35,3 %) se les realizó endoscopia terapéutica. La enfermedad ulcerosa péptica fue el hallazgo más frecuente. Al comparar el tipo de tratamiento recibido, no hubo diferencias significativas entre el número de transfusiones de glóbulos rojos, resangrado, reingreso por HDA, estancia hospitalaria ni mortalidad secundaria a la HDA. La mortalidad global fue del 25,4 % (13 pacientes) y se debió, principalmente, al compromiso respiratorio por SARS-CoV-2. Conclusiones: se observa una reducción en el número de EDA de emergencia por HDA en la pandemia actual, así como un tiempo mayor al estándar para su realización. Más del 80 % de los pacientes que recibieron solo tratamiento médico evolucionaron favorablemente, y solo un tercio de los pacientes a quienes se les realizó una EDA requirió terapéutica endoscópica.
Abstract Introduction: The SARS-CoV-2 pandemic has led to the restructuring of digestive endoscopy units around the world, limiting endoscopic procedures and prioritizing emergency indications such as upper gastrointestinal hemorrhage (UGH). However, there is little evidence regarding its impact on evolution and outcomes. Objective: To evaluate the management of UGH in the context of the SARS-CoV-2 coronavirus pandemic. Materials and methods: Observational, descriptive, retrospective study carried out between March and August 2020 in patients with diagnosis of UGH and SARS-CoV-2 infection. Results: Of 4 320 patients with SARS-CoV-2 infection, 51 had UGH on admission. The median age of the population was 70 years and 58.8% were male. Glasgow-Blatchford Bleeding Score (GBS) of ≥12 was obtained in 56.9%. Oxygen support was required by 21.6%. 34 (66.7%) patients received medical treatment only, while 17 (33.3%) received medical treatment plus upper gastrointestinal endoscopy (UGE), of which 6 (35.3%) underwent therapeutic endoscopy. Peptic ulcer disease was the most frequent finding. When comparing the type of treatment received, there were no significant differences between the number of red blood cell transfusions, rebleeding, re-admission due to UGH, hospital stay, or mortality secondary to UGH. Overall mortality was 25.4% (13 patients), mainly due to respiratory failure due to SARS-CoV-2. Conclusions: A reduction in the number of emergency upper gastrointestinal endoscopies for UGH was observed during the current pandemic, as well as a longer than standard time for their performance. More than 80% of patients who received medical treatment alone evolved favorably and only one third of the patients who underwent UGE required endoscopic therapy.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Therapeutics , SARS-CoV-2 , Gastrointestinal Hemorrhage , Oxygen , Patients , Retrospective Studies , Endoscopy, Gastrointestinal , Erythrocyte Transfusion , Endoscopy , Hospitals , Length of StayABSTRACT
Resumen Introducción: El cáncer gástrico, a nivel mundial, tiene una incidencia variable y es una de las causas más frecuentes de muerte. En Ecuador ocupa el segundo lugar de muerte en los hombres y la cuarta en las mujeres por cáncer gástrico. Objetivos: Establecer las características sociodemográficas, clínicas, histológicas y endoscópicas, y determinar una correlación entre la localización e histología en una población de pacientes con cáncer gástrico en el Hospital de Especialidades de Guayaquil, Dr. Abel Gilbert Pontón. Materiales y métodos: Estudio de prevalencia analítico y prospectivo. Se incluyeron las endoscopias digestivas altas de consulta externa y emergencia con signos de sospecha de cáncer gástrico realizadas en el Hospital de Especialidades de Guayaquil, Dr. Abel Gilbert Pontón, Ecuador, entre enero de 2018 y diciembre de 2019. Resultados: En el estudio se incluyeron 62 pacientes con diagnóstico de adenocarcinoma gástrico, el sexo masculino representó el 72,6 % en relación con el sexo femenino, con el 27,4 %; el rango de edad fue entre los 27 y 95 años, el promedio de edad es de 60,96 ± 15,1 y la edad de mayor presentación fue de 60 a 70 años. El síntoma que predominó fue el dolor, en un 98,4 %, y la pérdida de peso, en un 64,5 %; su localización más frecuente fue el antro (50,0 %), su morfología de mayor presentación es el Borrmann tipo III y, con respecto al tipo histológico, se encontró el tipo intestinal (64,5 %) y el difuso (29,0 %). El tipo intestinal se presentó en edad más avanzada en un 60 %-69 %, fue más frecuente en el cuerpo (71,4 %) y su localización fue más proximal, en comparación con el tipo difuso, que se presentó más en edad temprana (27-39 años), fue más frecuente en el antro (32,3 %) y su localización fue más distal. Conclusiones: El cáncer gástrico se diagnostica en estadios avanzados, más en hombres que en mujeres y se puede afirmar que en nuestro hospital la localización del cáncer gástrico tipo intestinal se presentó en edades avanzadas, más frecuentemente a nivel proximal y en la clasificación del cáncer gástrico avanzado Borrmann tipo III, lo cual podría tener influencia en el tratamiento y pronóstico. Además, los resultados obtenidos justifican la implementación de programas de detección oportuna y tratamiento de esta grave enfermedad.
Abstract Introduction: Gastric cancer is one of the most common causes of death worldwide, with a varying incidence. In Ecuador, it is the second leading cause of death in men and the fourth in women. Objectives: To establish the socio-demographic, clinical, histological, and endoscopic characteristics of patients with gastric cancer and to determine the correlation between location and histology in this population treated at the Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón. Materials and methods: Analytical and prospective prevalence study. Outpatient and emergency upper gastrointestinal endoscopies with signs of suspected gastric cancer performed at the Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón - Ecuador between January 2018 through December 2019 were included. Results: The study included 62 patients diagnosed with gastric adenocarcinoma. 72.6% were male and 27.4% were female; the age range was between 27 and 95 years, with an average of 60.96 ± 15.1 years, the age of onset being between 60 and 70 years. Pain was the most frequent symptom in 98.4% of cases, followed by weight loss in 64.5%. The antrum was the most common site of cancer (50.0%), and Borrmann type III was the most common morphology. Intestinal cancer was found in 64.5% of cases, while diffuse gastric cancer was found in 29.0%. Intestinal cancer was more common in older ages (60-69%) and the most frequent site of presentation was the body of the stomach (71.4%) with a proximal location. In contrast, diffuse gastric cancer was more frequent in younger patients aged between 27-39 years, more often in the antrum (32.3%) at a more distal location. Conclusions: Gastric cancer is more often found in men and is usually diagnosed in advanced stages. Intestinal gastric cancer was most commonly seen at advanced ages in our hospital, most frequently at the proximal site and in the Borrmann type III according to the classification of advanced gastric cancer, affecting its treatment and prognosis. The results obtained support the implementation of programs to diagnose and treat this severe disease in a timely manner.