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2.
Rev. méd. hondur ; 89(1, supl): 23-27, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1280947

ABSTRACT

Antecedentes: La hemorragia gastrointestinal oculta representa aproximadamente del 5%-10% del total de las hemorragias digestivas. Descripción del caso clínico: Paciente femenina de 62 años, procedente de Santa Cruz de Yojoa, Cortés, sin comorbilidades, con episodios intermitentes de melena de un año de evolución; evaluada y manejada con hierro parenteral y transfusiones sanguíneas. Se le realizó protocolo diagnóstico, sin encontrar origen del sangrado. Fue sometida a laparoscopía diagnóstica en junio del 2019, realizándole apendicectomía, resección yeyunal, colecistectomía y ooforectomía; cursando asintomática luego de la cirugía. En diciembre, reinicia con melena, 3-4 episodios diarios, abundante cantidad (aproximadamente 300 ml). Evaluada nuevamente sin lograr identificar el origen del sangrado, por lo cual se realizó vídeo capsula endoscópica que reportó, restos hemáticos sin observar sitio de sangrado. Se llevó a cabo enteroscopía de empuje y duodenoscopía observando sitio de sangrado cercano a la papila duodenal. Se decide realizar angiotomografía, la cual fue compatible con sangrado digestivo a nivel de la II y III porción del duodeno. Luego se efectúa arteriografía selectiva de vasos abdominales, evidenciando fuga de medio de contraste originada en la rama de la arteria hepática derecha de origen en la mesentérica superior. Finalmente se procedió a la aplicación de 2 hemoclip vía endoscópica obteniendo un resultado satisfactorio.Conclusiones: El tipo de lesión responsable de la hemorragia del intestino delgado depende de la edad del paciente. Los factores de riesgo de hemorragia recurrente por angioectasia incluyen el número de lesiones, la edad avanzada, comorbilidades y la terapia anticoagulante...(AU)


Subject(s)
Humans , Female , Middle Aged , Endoscopy, Gastrointestinal/methods , Angiodysplasia , Gastrointestinal Hemorrhage/diagnosis , Intestine, Small
3.
Rev. argent. coloproctología ; 30(4): 114-118, dic. 2019. ilus, graf
Article in Spanish | LILACS | ID: biblio-1096800

ABSTRACT

Los lipomas del colon ocupan el tercer lugar en frecuencia de aparición de tumores benignos. Estos tumores están formados por tejido adiposo bien diferenciado con un estroma fibroso. La gran mayoría de estos lipomas es asintomática, algunos en raras ocasiones presentan complicaciones de urgencia. El fin de esta publicación es presentar un caso de obstrucción de colon por lipoma. (AU)


Benign colonic lesions are infrequent and account for a low percentage of all colonic tumors. Among the benign tumors, lipomas are third in frequency. They are composed of mature adipose tissue with fibrous stroma. Most of them are asymptomatic but in rare instances, they may present as surgical emergencies. We present one case of colonic obstruction caused by lipomas. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Colonic Neoplasms/complications , Intussusception/etiology , Intussusception/diagnostic imaging , Lipoma/complications , Endoscopy, Gastrointestinal/methods , Colonoscopy/methods , Laparoscopy/methods , Colonic Neoplasms/surgery , Intussusception/surgery , Lipoma/surgery
4.
Rev. chil. infectol ; 36(1): 101-105, feb. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003658

ABSTRACT

Resumen La estrongiloidiasis es una enfermedad desatendida en Latinoamérica. Las manifestaciones gastrointestinales son inespecíficas y la obstrucción duodenal es una complicación infrecuente. Presentamos el caso clínico de un varón de 31 años, procedente de la selva central de Perú, que ingresó por una obstrucción intestinal alta, con úlceras y una estenosis duodenal evidenciadas en la endoscopia digestiva alta. El informe histopatológico reveló la presencia de larvas de Strongyloides stercoralis. La evolución clínica y endoscópica fueron favorables con el tratamiento con ivermectina. Existen poco más de 20 casos publicados de obstrucción duodenal por S. stercoralis. Adicionalmente, se confirmó una infección por HTLV-1, asociación descrita frecuente.


Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.


Subject(s)
Humans , Animals , Male , Adult , Strongyloidiasis/complications , Strongyloides stercoralis/isolation & purification , Duodenal Obstruction/parasitology , Strongyloidiasis/pathology , Biopsy , HTLV-I Infections/parasitology , Tomography, X-Ray Computed/methods , Endoscopy, Gastrointestinal/methods , Duodenal Obstruction/pathology , Duodenal Obstruction/diagnostic imaging , Gastric Mucosa/parasitology , Gastric Mucosa/pathology , Larva
5.
Rev. medica electron ; 41(1): 189-195, ene.-feb. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-991337

ABSTRACT

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.


ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.


Subject(s)
Humans , Male , Aged, 80 and over , Pylorus/abnormalities , Pylorus/physiopathology , Pylorus/diagnostic imaging , Endoscopy, Gastrointestinal/methods , Diverticulum, Colon/diagnostic imaging , Duodenal Ulcer/diagnostic imaging , Proton Pump Inhibitors/therapeutic use , Aspirin/therapeutic use , Melena/diagnosis , Barium Enema/methods , Smokers , Hypertension/diagnosis
8.
Arch. argent. pediatr ; 116(6): 409-414, dic. 2018. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-973685

ABSTRACT

Antecedentes. La ingesta de sustancias cáusticas en pediatría constituye una causa frecuente de atención médica en Urgencias. El uso indiscriminado de limpiadores químicos y la facilidad de adquisición son factores determinantes para estas lesiones. Población y métodos. Estudio descriptivo analítico. Se incluyeron niños < 16 años, entre enero de 1998 y diciembre de 2017. Se identificó el agente químico cáustico ingerido por el niño como ácido o alcalino. Se realizó una endoscopía digestiva para tipificar el grado de quemadura. Se comparó el grado de quemadura con el tipo de cáustico; por medio de la prueba de chi² o exacta de Fisher, se consideró significativo el valor de P < 0,05. Resultados. Ingresaron 133 niños en Urgencias por ingesta de cáusticos. El agente cáustico fue ácido en el 41 % y alcalino en el 59 %. El agente ácido más frecuente fue el ácido muriático (36,8 %), mientras que el alcalino fue la sosa (soda) cáustica (41,4 %). La quemadura del esófago fue más frecuente en la ingesta de sosa en comparación con otros cáusticos (p= 0,001), mientras que la quemadura del estómago (p= 0,001) y del duodeno (p= 0,002) fue estadísticamente significativa en la ingesta de ácido muriático. El grupo de edad que más frecuentemente ingirió algún cáustico (93,2 %) fueron los menores de 5 años. Conclusiones. El cáustico ingerido con mayor frecuencia fue un agente alcalino, que provocó quemadura esofágica, mientras que un agente ácido provocó quemaduras en el estómago y el duodeno evidenciadas por endoscopía.


Background. Caustic ingestion in pediatrics is a common cause of visits to the Emergency Department. An indiscriminate use of cleaning chemicals and an easy access to them are determining factors for these injuries. Population and methods. Descriptive, analytical study. Children aged < 16 years hospitalized between January 1998 and December 2017 were included. The ingested caustic substance was identified as acid or alkaline. A gastrointestinal endoscopy was done to establish the burn grade. The grade of the burn was compared to the type of caustic substance using the χ² test or the Fisher's exact test; a P value < 0.05 was considered significant. Results. A total of 133 children were admitted to the Emergency Department due to caustic ingestion. The caustic agent was acid in 41 % of cases and alkaline, in 59 %. The most common acid caustic substance was muriatic acid (36.8 %) and the most common alkaline caustic agent was caustic soda (41.4 %). An esophageal burn was the most common consequence of caustic soda ingestion compared to other caustic agents (p = 0.001), whereas muriatic acid ingestion was the most statistically significant cause of stomach burn (p = 0.001) and duodenal burn (p = 0.002). The age group that most commonly ingested some caustic agent (93.2 %) corresponded to children younger than 5 years. Conclusions. The most common type of ingested caustic agent was alkaline, which caused esophageal burn; whereas, the ingestion of an acid caustic substance caused stomach and duodenal burns, as evidenced by endoscopy.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Burns, Chemical/diagnosis , Caustics/poisoning , Endoscopy, Gastrointestinal/methods , Gastrointestinal Tract/injuries , Stomach/injuries , Acids/poisoning , Burns, Chemical/etiology , Burns, Chemical/epidemiology , Epidemiology, Descriptive , Age Factors , Duodenum/injuries , Alkalies/poisoning , Emergency Service, Hospital , Esophagus/injuries
10.
Arq. gastroenterol ; 55(supl.1): 52-55, Nov. 2018. graf
Article in English | LILACS | ID: biblio-973906

ABSTRACT

ABSTRACT BACKGROUND: New endoscopic treatments for gastroesophageal reflux (GERD) are developed every year and are indicated in cases that are refractory to conventional therapies as well as after surgical treatment failure. OBJECTIVE: To present the first cases of endoscopic therapy for GERD performed in Brazil. METHODS: Use of radiofrequency with the Stretta procedure in symptomatic volunteers diagnosed with GERD. RESULTS The technique was performed in three patients after they were included in the study protocol. No patient had complications, and all patients were discharged on the same day, either without medication or taking it sporadically for symptom control. CONCLUSION: Endoscopic treatment for GERD using radiofrequency was effective in the cases presented herein with no technical complications.


RESUMO CONTEXTO: Novos tratamentos endoscópicos para refluxo gastroesofágico são desenvolvidos a cada ano, sendo indicados em casos refratários às terapias convencionais, bem como após a falha do tratamento cirúrgico. OBJETIVO: Apresentar os primeiros casos de terapia endoscópica para tratamento do refluxo gastroesofágico realizado no Brasil. MÉTODOS: Uso de radiofrequência com o procedimento de Stretta em voluntários sintomáticos e diagnosticados com DRGE. RESULTADOS: A técnica foi realizada em três pacientes depois de terem sido incluídos no protocolo de estudo. Nenhum paciente teve complicações, e todos receberam alta hospitalar no mesmo dia, mantendo-se sem medicação ou fazendo uso esporádico para o controle de sintomas. CONCLUSÃO: Tratamento endoscópico para doença do refluxo gastroesofágico com uso de radiofrequência foi eficaz nos casos aqui apresentados e sem complicações técnicas.


Subject(s)
Humans , Male , Adult , Gastroesophageal Reflux/surgery , Endoscopy, Gastrointestinal/methods , Catheter Ablation/methods , Middle Aged , Treatment Outcome
11.
Arch. argent. pediatr ; 116(5): 649-654, oct. 2018. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-973666

ABSTRACT

El objetivo de este estudio fue evaluar a los pacientes con fiebre mediterránea familiar (familial Mediterranean fever, FMF) y dolor abdominal crónico resistentes al tratamiento con colchicina. Se incluyó a 48 pacientes diagnosticados en nuestro consultorio de reumatología pediátrica que tenían dolor abdominal a pesar del tratamiento con colchicina. A todos los pacientes se los derivó a un gastroenterólogo pediátrico. Se registraron las características del dolor, tales como aparición, duración y frecuencia; se planificó una endoscopía digestiva para obtener un diagnóstico diferencial. Se determinó la presencia de una mutación del gen MEFV en 46 pacientes. La mediana de la duración del tratamiento fue de 2,8 años. Aproximadamente el 60% de los pacientes tenían dolor abdominal todos los días o de dos a tres veces a la semana; en el 73% de los casos, duró menos de tres horas. A 41 pacientes se les realizó una endoscopía digestiva alta. La gastroduodenitis es un hallazgo frecuente en los pacientes con FMF y dolor abdominal persistente a pesar del tratamiento. Los pacientes con los puntajes más altos de severidad de la enfermedad tenían inflamación digestiva grave.


The aim of the study to evaluate familial mediterranean fever (FMF) patients with chronic abdominal pain unresponsive to colchicine treatment. Forty-eight patients who diagnosed in our Pediatric Rheumatology clinics and suffering from abdominal pain despite colchicine treatment were include. All patients were referred to a pediatric gastroenterologist. The pain characteristics such as onset, duration and frequency were recorded; gastrointestinal (GI) endoscopy was planned for differential diagnosis. MEFV mutation was determined in 46 patients. The median duration of treatment was 2.8 years. Approximately 60% of the patients suffered from abdominal pain every day or 2-3 times a week, in 73% of the cases it lasted less than three hours. Forty-one patients underwent upper GI endoscopy. Gastroduodenitis is a common finding in persisting abdominal pain despite therapy of FMF patients. The patients with the highest disease severity scores had severe inflammation within the entire GI system.


Subject(s)
Humans , Child , Adolescent , Familial Mediterranean Fever/complications , Abdominal Pain/epidemiology , Colchicine/administration & dosage , Chronic Pain/etiology , Familial Mediterranean Fever/drug therapy , Abdominal Pain/etiology , Endoscopy, Gastrointestinal/methods , Duodenitis/diagnosis , Duodenitis/etiology , Chronic Pain/epidemiology , Gastritis/diagnosis , Gastritis/etiology
12.
Arq. gastroenterol ; 55(3): 296-305, July-Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973881

ABSTRACT

ABSTRACT BACKGROUND: Endoscopic antireflux treatments for gastroesophageal reflux disease (GERD) are still evolving, and most of the published studies address symptom relief in the short-term. Objective - We aimed to perform a systematic review and meta-analysis focused on evaluating the efficacy of the different endoscopic procedures. METHODS: Search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane, SciELO, and EMBASE for patients with chronic GERD (>6 months), over 18 years old and available follow up of at least 3 months. The main outcome was to evaluate the efficacy of the different endoscopic treatments compared to sham, pharmacological or surgical treatment. Efficacy was measured by different subjective and objective outcomes. RESULTS: We analyzed data from 16 RCT, totaling 1085 patients. The efficacy of endoscopic treatments compared to sham and proton pump inhibitors (PPIs) treatment showed a significant difference up to 6 months in favor of endoscopy with no heterogeneity (P<0.00001) (I2: 0%). The subgroup analysis showed a statistically significant difference up to 6 months in favor of endoscopy: endoscopy vs PPI (P<0.00001) (I2: 39%). Endoscopy vs sham (P<0.00001) (I2: 0%). Most subjective and objective outcomes were statistically significant in favor of endoscopy up to 6 and 12 months follow up. CONCLUSION: This systematic review and meta-analysis shows a good short-term efficacy in favor of endoscopic procedures when comparing them to a sham and pharmacological or surgical treatment. Data on long-term follow up is lacking and this should be explored in future studies.


RESUMO CONTEXTO: Os tratamentos endoscópicos para a doença do refluxo gastroesofágico (DRGE) ainda estão em evolução e a maioria dos estudos publicados abordam o alívio dos sintomas em curto prazo. OBJETIVO: Pretendemos realizar uma revisão sistemática e meta-análise focada na avaliação da eficácia dos diferentes procedimentos endoscópicos. MÉTODOS: A pesquisa foi restrita a ensaios clínicos randomizados em MedLine, Cochrane, SciELO e EMBASE para pacientes com DRGE crônica (>6 meses), com mais de 18 anos e acompanhamento disponível por pelo menos 3 meses. O principal desfecho foi avaliar a eficácia dos diferentes tratamentos endoscópicos em comparação com o tratamento sham, farmacológico ou cirúrgico. A eficácia foi medida por diferentes resultados subjetivos e objetivos. RESULTADOS: Analisamos dados de 16 ensaios clínicos randomizados, totalizando 1085 pacientes. A eficácia dos tratamentos endoscópicos em comparação com o tratamento com sham e inibidores da bomba de prótons mostrou uma diferença significativa até 6 meses a favor da endoscopia sem heterogeneidade (P<0,00001) (I2: 0%). A análise do subgrupo mostrou diferença estatisticamente significativa até 6 meses a favor da endoscopia: endoscopia vs inibidores da bomba de prótons (P<0,00001) (I2: 39%). Endoscopia vs sham (P<0,00001) (I2: 0%). A maioria dos resultados subjetivos e objetivos foram estatisticamente significativos em favor da endoscopia até 6 e 12 meses de acompanhamento. CONCLUSÃO: Esta revisão sistemática e meta-análise mostrou uma boa eficácia a curto prazo em favor dos procedimentos endoscópicos ao compará-los a tratamento sham, farmacológico ou cirúrgico. Não existem dados sobre o acompanhamento a longo prazo e isso deve ser explorado em estudos futuros.


Subject(s)
Humans , Gastroesophageal Reflux/surgery , Gastroesophageal Reflux/drug therapy , Endoscopy, Gastrointestinal/methods , Placebos , Time Factors , Randomized Controlled Trials as Topic , Chronic Disease , Treatment Outcome , Proton Pump Inhibitors/therapeutic use
13.
Arq. gastroenterol ; 55(2): 170-174, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-950518

ABSTRACT

ABSTRACT BACKGROUND: Schistosomiasis is an endemic health problem affecting about four million people. The hepatosplenic form of the disease is characterized by periportal hepatic fibrosis, pre-sinusoidal portal hypertension and splenomegaly. Liver function is preserved, being varices bleeding the main complication of the disease. The surgical treatment used in the majority of centers for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Most authors reported better results with the association of surgical and postoperative endoscopic treatment. OBJECTIVE: The aim of this study was to compare the intra operative portal pressure decrease and esophageal varices behavior and rebleeding rates in patients submitted to surgical and postoperative endoscopic treatment after long-term follow-up. METHODS: A retrospective study of 36 patients with schistosomiasis with, at least, one previous bleeding from esophageal varices rupture submitted to esophagogastric devascularization and splenectomy, added to endoscopic varices postoperative treatment was performed. Patients were stratified according to the intra operative portal pressure decrease in two groups: reduction below and above 30%. Long-term varices presence, size and bleeding recurrence were evaluated. RESULTS: Regarding varices behavior, no significant influence was observed in both groups of portal pressure fall. Regarding bleeding recurrence, despite three times more frequent in the group with lower portal pressure fall, no significant difference was observed. All patients were submitted to postoperative endoscopic treatment. CONCLUSION: Esophageal varices banding, rather than portal pressure decrease, seems to be the main responsible factor for good results after combination of two therapies (surgery and endoscopy) for patients with portal hypertension due to schistosomiasis; further studies are necessary to confirm this hypothesis.


RESUMO CONTEXTO: A esquistossomose é um problema de saúde pública endêmico, afetando cerca de quatro milhões de pessoas. A forma hepato-esplênica da doença é caracterizada por fibrose peri-portal, hipertensão pré-sinusoidal e esplenomegalia. A função hepática está preservada, sendo o sangramento por varizes a principal complicação da afecção. O tratamento cirúrgico usado pela maioria dos serviços para prevenção do ressangramento é a desconexão ázigo-portal e esplenectomia. Muitos autores reportaram melhores resultados com a associação do tratamento cirúrgico e o tratamento endoscópico pós-operatório. OBJETIVO: O objetivo deste estudo foi comparar a queda da pressão portal intraoperatória com o comportamento das varizes esofagianas e as taxas de ressangramento em pacientes submetidos a tratamento cirúrgico e endoscópico pós-operatório após seguimento de longo prazo. MÉTODOS: Foi realizado um estudo retrospectivo de 36 pacientes esquistossomóticos com pelo menos um episódio de sangramento prévio por ruptura de varizes esofagianas, submetidos a desconexão ázigo-portal e esplenectomia, associada a tratamento endoscópico pós-operatório das varizes. Os pacientes foram divididos de acordo com a queda da pressão portal intraoperatória em dois grupos: redução menor e maior que 30%. Foram avaliadas a presença de tamanho das varizes a longo prazo e a recorrência do sangramento. RESULTADOS: Levando-se em conta o comportamento das varizes, não foi observada influência significativa em ambos os grupos de queda de pressão portal. Com relação ao ressangramento das varizes, embora três vezes mais frequente no grupo com menor queda de pressão portal, não foi observada diferença estatística. Todos pacientes foram submetidos a tratamento endoscópico pós-operatório. CONCLUSÃO: A ligadura elástica das varizes esofagianas, mais do que a queda da pressão portal, parece ser o principal fator responsável pelos bons resultados após a combinação das duas terapias (cirúrgica e endoscópica) para pacientes com hipertensão portal devido à esquistossomose. Estudos futuros serão necessário para confirmar esta hipótese.


Subject(s)
Humans , Male , Female , Adult , Schistosomiasis/surgery , Splenectomy , Esophageal and Gastric Varices/surgery , Endoscopy, Gastrointestinal/methods , Portal Pressure/physiology , Gastrointestinal Hemorrhage/etiology , Hypertension, Portal/etiology , Postoperative Complications/etiology , Postoperative Period , Recurrence , Vascular Surgical Procedures , Esophageal and Gastric Varices/complications , Retrospective Studies , Follow-Up Studies , Preoperative Period , Gastrointestinal Hemorrhage/prevention & control , Hypertension, Portal/surgery , Middle Aged
14.
Arq. gastroenterol ; 55(1): 46-49, Apr.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-888245

ABSTRACT

ABSTRACT BACKGROUND: - Conventional esophagogastroduodenoscopy is the best method for evaluation of the upper gastrointestinal tract, but it has limitations for the identification of the major duodenal papilla, even after the use of the straightening maneuver. Side-viewing duodenoscope is recommended for optimal examination of major duodenal papilla in patients at high risk for lesions in this region. OBJECTIVE: To evaluate the use of the biopsy forceps during conventional esophagogastroduodenoscopy as an additional tool to the straightening maneuver, in the evaluation of the major duodenal papilla. METHODS: A total of 671 patients were studied between 2013 and 2015, with active major duodenal papilla search in three endoscope steps: not straightened, straightened and use of the biopsy forceps after straightening. In all of them it was recorded whether: major duodenal papilla was fully visualized (position A), partially visualized (position B) or not visualized (position C). If major duodenal papilla was not fully visualized, patients continued to the next step. RESULTS: A total of 341 were female (50.8%) with mean age of 49 years. Of the 671 patients, 324 (48.3%) major duodenal papilla was identified in position A, 112 (16.7%) in position B and 235 (35%) in position C. In the 347 patients who underwent the straightening maneuver, position A was found in 186 (53.6%), position B in 51 (14.7%) and position C in 110 (31.7%). Of the 161 remaining patients and after biopsy forceps use, position A was seen in 94 (58.4%), position B in 14 (8.7%) and position C in 53 (32.9%). The overall rate of complete visualization of major duodenal papilla was 90%. CONCLUSION: The use of the biopsy forceps significantly increased the total major duodenal papilla visualization rate by 14%, reaching 604/671 (90%) of the patients (P<0.01) and it can be easily incorporated into the routine endoscopic examination of the upper gastrointestinal tract.


RESUMO CONTEXTO: Esofagogastroduodenoscopia convencional é o melhor método para avaliação do trato gastrointestinal superior, mas apresenta limitações para identificação da papila duodenal maior, mesmo após emprego da manobra de retificação. Exame completo da papila duodenal maior está indicado para pacientes de alto risco para adenocarcinoma da papila duodenal maior. OBJETIVO: Avaliar a utilização da pinça de biópsia durante esofagogastroduodenoscopia convencional como ferramenta adicional à manobra de retificação na avaliação da papila duodenal maior. MÉTODOS: Foram estudados 671 pacientes entre 2013-2015 com busca ativa da papila duodenal maior em três etapas: endoscópio não retificado, endoscópio retificado e uso da pinça de biópsia após retificação. Em todas se registrou: se a papila duodenal maior foi totalmente visualizada (posição A), se parcialmente visualizada (posição B) ou se não visualizada (posição C). Caso a papila duodenal maior não tenha sido completamente visualizada, o paciente foi direcionado para a etapa seguinte. RESULTADOS: Um total de 341 era do sexo feminino (50,8%) com idade média de 49 anos. Dos 671 pacientes, em 324 (48,3%) a papila duodenal maior foi identificada na posição A, 112 (16,7%) em posição B e, 235 (35%) em posição C. Dos 347 pacientes submetidos à manobra de retificação, posição A foi encontrada em 186 (53,6%), posição B em 51 (14,7%) e posição C em 110 (31,7%). Dos 161 pacientes restantes que utilizaram a pinça de biópsia, posição A foi vista em 94 (58,4%), posição B em 14 (8,7%) e posição C em 53 (32,9%). A taxa acumulativa de visualização completa da papila duodenal maior foi de 90%. CONCLUSÃO: O uso da pinça de biópsia aumentou a taxa de visualização completa da papila duodenal maior em 14%, alcançando 604/671 (90%) dos pacientes (P<0,01) avaliados e pode ser facilmente incorporada aos exames endoscópicos de rotina do trato gastrointestinal superior.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Ampulla of Vater/diagnostic imaging , Endoscopy, Gastrointestinal/instrumentation , Common Bile Duct Diseases/diagnostic imaging , Biopsy/instrumentation , Cross-Sectional Studies , Endoscopy, Gastrointestinal/methods , Duodenoscopy/instrumentation , Duodenoscopy/methods , Gastrointestinal Diseases , Middle Aged
16.
Clinics ; 73: e513, 2018. tab, graf
Article in English | LILACS | ID: biblio-974926

ABSTRACT

OBJECTIVES: The current study was designed to assess the clinical predictors of hypoxemia and to develop a multivariable, predictive model for hypoxemia during routine gastrointestinal endoscopy. METHODS: In total, 308 patients were enrolled in the analysis. Demographic data, concurrent chronic disease information, anesthetic dose and Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores were collected and analyzed statistically. RESULTS: Multivariate logistic regression indicated that age (OR: 1.04; 95%CI 1.01-1.08), body mass index (BMI) (OR: 1.12; 95%CI: 1.02-1.21) and habitual snoring (OR: 3.71; 95%CI: 1.62-8.48) were independently associated with hypoxemia. A logistic regression function (LR model) was developed to predict hypoxemia considering the parameters of -7.73+0.04 age (years), +0.11 BMI, and +1.31 habitual snoring (yes or no). The area under the receiver operating characteristic (ROC) curve for the LR model was 0.76. CONCLUSIONS: The LR model, consisting of age, BMI and habitual snoring, was a useful predictor of hypoxemia during routine sedation for gastrointestinal endoscopy.


Subject(s)
Humans , Male , Female , Middle Aged , Conscious Sedation/adverse effects , Endoscopy, Gastrointestinal/adverse effects , Hypoxia/etiology , Predictive Value of Tests , Prospective Studies , ROC Curve , Endoscopy, Gastrointestinal/methods , Models, Theoretical
17.
Arq. gastroenterol ; 54(1): 16-20, Jan.-Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-838825

ABSTRACT

ABSTRACT BACKGROUND Small bowel bleeding is a leading indication for small bowel capsule endoscopy. The Suspected Blood Indicator (SBI) is a software feature directed to automatically detect bleeding lesions during small bowel capsule endoscopy. OBJECTIVE We aimed to assess SBI diagnostic accuracy for small bowel haemorrhage or potentially bleeding lesions during small bowel capsule endoscopy for small bowel bleeding. Methods - Single-centre retrospective study including 281 consecutive small bowel capsule endoscopy performed for small bowel bleeding during 6 years. The investigators marked lesions with high bleeding potential (P2), such as angioectasias, ulcers and tumours, as well as active bleeding during regular small bowel capsule endoscopy viewing with PillCam SB2(r). All small bowel capsule endoscopy were independently reviewed by another central reader using SBI. RESULTS Among the 281 patients, 29 (10.3%) presented with active haemorrhage while 81 (28.9%) presented with a P2 lesion. The most frequently observed P2 lesions were angioectasias (52), ulcers (15), polyps (7) and ulcerated neoplasias (7). SBI showed a 96.6% (28/29) sensitivity for active small bowel bleeding, with a 97.7% negative predictive value. Regarding P2 lesions, the SBI displayed an overall sensitivity of 39.5%, being highest for ulcerated neoplasias (100%), but significantly lower for angioectasias (38.5%) or ulcers (20.0%). CONCLUSION Although SBI sensitivity for the automatic detection of potentially bleeding lesions was low, it effectively detected active small bowel bleeding with very high sensitivity and negative predictive value.


RESUMO CONTEXTO A hemorragia do intestino delgado é uma das principais indicações para a realização de enteroscopia por cápsula. A ferramenta "Suspected Blood Indicator (SBI)", incluída no software de leitura da enteroscopia por cápsula, tem como objetivo a deteção automática de hemorragia e de lesões potentialmente hemorrágicas. OBJETIVO Pretendemos avaliar a acuidade diagnóstica do SBI para a deteção de hemorragia ou lesões potencialmente hemorrágicas durante a enteroscopia por cápsula no contexto de hemorragia do intestino delgado. MÉTODOS Estudo retrospectivo incluindo 281 enteroscopia por cápsula (PillCam SB2(r)) consecutivas realizadas por hemorragia do intestino delgado durante 6 anos. Os investigadores registaram lesões com potential hemorrágico elevado (P2), como angiectasias, úlceras e neoplasias, assim como hemorragia activa. Todos os exames foram revistos independentemente por outro investigador, utilizando o SBI. RESULTADOS Dos 281 doentes, 29 (10,3%) apresentaram hemorragia ativa, enquanto 81 (28,9%) apresentaram uma lesão P2. As lesões P2 mais frequentes foram angiectasias (52), úlceras (15), póipos (7) e neoplasias ulceradas (7). O SBI demonstrou uma sensibilidade de 96,6% (28/29) para hemorragia activa, com um valor preditivo negativo de 97,7%. Para as lesões P2, a sensibilidade global foi de 39%: 100% para neoplasias ulceradas, 38,5% para angiectasias e 20% para úlceras. CONCLUSÃO Apesar da sensibilidade do SBI para lesões potencialmente hemorrágicas do instestino delgado ser baixa, permitiu a deteção de hemorragia activa com uma muito elevada sensibilidade e excelente valor preditivo negativo.


Subject(s)
Humans , Male , Female , Adult , Endoscopy, Gastrointestinal/methods , Capsule Endoscopy , Gastrointestinal Hemorrhage/diagnostic imaging , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Gastrointestinal Hemorrhage/etiology
18.
Gastroenterol. latinoam ; 28(supl.1): S16-S20, 2017. ilus
Article in Spanish | LILACS | ID: biblio-1120139

ABSTRACT

Barrett's esophagus has a risk of developing esophageal adenocarcinoma and it increases when dysplasia is present. For this reason, its diagnosis requires endoscopic surveillance or eradication if dysplasia or cancer appears. In the past, high-grade dysplasia and intramucosal esophageal adenocarcinoma were routinely treated with esophagectomy, but with considerable morbidity and mortality. This has led to the development of new alternatives as less invasive endoscopic treatments for both dysplastic lesion and total eradication of the remaining metaplastic mucosa. The most commonly used treatment options include cryotherapy, radiofrequency ablation, endoscopic resection (mucosal resection or endoscopic submucosal dissection) or a combination of these (multimodal endoscopic eradication). For patients with low-grade dysplasia still some international guides suggest keeping endoscopic follow up; however, considering the good results of endoscopic ablation and new evidence about the course of this disease, this concept has changed towards the therapeutic approach. For Barrett´s esophagus without any complication, endoscopic therapy is not recommended, but endoscopic surveillance. In this article we will review the endoscopic therapeutic alternatives to Barrett's esophagus, its scientific basis and how they have evolved in recent times.


El Esófago de Barrett es una lesión adquirida que tiene riesgo de desarrollar adenocarcinoma esofágico. Su presencia obliga, por lo tanto, a la vigilancia endoscópica y erradicación cuando aparece displasia sobre este epitelio, pues aumenta la probabilidad de progresar a cáncer. Antes de la aparición de la terapia endoscópica estos casos con displasia de alto grado y adenocarcinoma esofágico independiente de su estadío, eran sometidos a una esofagectomía. Sin embargo, esta intervención se asocia a una morbimortalidad importante. De esta manera, los avances en la cirugía endoscópica también han sido traspasados al manejo del Esófago de Barrett con displasia o cáncer intramucoso, que incluyen en estos casos la erradicación del epitelio columnar en su totalidad. Las alternativas terapéuticas más utilizadas son la crioterapia, ablación por radiofrecuencia, resección endoscópica (mucosectomía o disección submucosa endoscópica) o una combinación de éstas (erradicación endoscópica multimodal). Para pacientes portadores de Barrett con displasia de bajo grado, la recomendación de la mayoría de las guías internacionales sigue siendo la vigilancia endoscópica. Sin embargo, dado los buenos resultados de la ablación endoscópica y nuevas evidencias respecto al curso de esta patología, este concepto ha ido cambiando hacia tomar una conducta terapéutica. En caso de ausencia de displasia no se recomienda la terapia endoscópica de regla sino la vigilancia endoscópica. En el presente artículo revisaremos las alternativas terapéuticas endoscópicas frente al esófago de Barrett, su sustento científico y cómo han evolucionado en el último tiempo.


Subject(s)
Humans , Barrett Esophagus/surgery , Barrett Esophagus/therapy , Endoscopy, Gastrointestinal/methods , Cryotherapy/methods , Endoscopic Mucosal Resection/methods , Radiofrequency Ablation/methods , Barrett Esophagus/prevention & control , Esophageal Neoplasms/prevention & control
20.
Rev. cuba. med. mil ; 45(3): 312-320, jul.-set. 2016. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-960545

ABSTRACT

Introducción: la reducción de la mortalidad en pacientes con hemorragia digestiva alta está dada no solo por la terapéutica endoscópica, sino por el adecuado manejo clínico que incluye reposición de volumen y transfusión sanguínea si es requerida; por lo que es necesaria la evaluación de la utilidad de parámetros pronósticos en la estratificación del riesgo de necesidad de hemotransfusión. Objetivo: evaluar la utilidad del Índice de Rockall en la estratificación del riesgo de necesidad de hemotransfusión en pacientes con hemorragia digestiva alta no varicosa. Métodos: estudio longitudinal, descriptivo y prospectivo desde diciembre de 2011 hasta junio de 2012. Fueron incluidos los pacientes admitidos en el Cuerpo de Guardia del Hospital Militar Central Carlos J. Finlay, con evidencia clínica de hemorragia digestiva alta, a quienes se les realizó una endoscopia dentro de las 24 horas siguientes al ingreso. Se evaluaron parámetros clínicos (edad, comorbilidad y estado hemodinámico), endoscópicos (hallazgos, estigmas de sangrado) y la necesidad de hemotransfusión. Se relacionaron pacientes transfundidos con las diferentes variables incluidas en la Escala de Rockall para determinar factores de riesgo de necesidad de hemotransfusión. Resultados: se estudiaron 89 pacientes, con predominio del sexo masculino (n= 64; 71,91 por ciento), la edad promedio fue de 63,58 años. Se identificaron como factores de riesgo de necesidad transfusional, la comorbilidad, el estado hemodinámico y la presencia de estigmas de sangrado activo o reciente. Del total de pacientes 26 por ciento de los casos (n= 23) tenía un Índice de Rockall alto. Dicho Índice tuvo pobre capacidad predictiva para la necesidad transfusional (área bajo la curva de COR de 0,682; p= 0,00). Conclusión: el índice de Rockall fue útil en la estratificación de riesgo de necesidad de hemotransfusión, lo que puede tenerse en cuenta para una adecuada selección del paciente con hemorragia digestiva alta no varicosa que requiera una terapia transfusional(AU)


Introduction: Reducing mortality in patients with upper gastrointestinal bleeding is due not only to endoscopic therapy but also to clinical care, including volume replacement and blood transfusion if required. So it is necessary to evaluate the utility of prognostic parameters on the stratification of the risk of need for blood transfusion. Objective: Evaluate the utility of Rockall index on the stratification of the risk of need for blood transfusion in patients with upper gastrointestinal bleeding episode of non varicosa origin. Methods: A longitudinal, descriptive and prospective study was carried out from December 2011 to June 2012. Patients admitted to the hospital emergency room, with clinical evidence of upper gastrointestinal bleeding, who underwent an endoscopy within 24 hours after admission. Clinical parameters (age, comorbidity, and hemodynamic status), endoscopic (findings, stigmata of bleeding) and need for blood transfusion were assessed. Transfused patients and different variables included in the Rockall index were listed to determine risk factors when transfusion need. Results: 89 patients were studied with a predominance of males (n= 64, 71.91 percent), mean age 63, 58 years. Comorbidity, hemodynamic state and the presence of stigmata of active or recent bleeding (RR= 8.31 IC: 0.73-1.27; RR= 2.43 IC: 0.22-1.78 y RR= 5.05 IC: 0.62-1.38 respectively. p=0.00) were identified as risk factors for transfusion need. 26 percent of cases (n= 23) had a high index Rockall. This index had predictive poor capacity of transfusion need (area under the ROC curve of 0.682; p= 0.020). Conclusion: Rockall index was useful to identify patients at increased risk of transfusion need, it can be used for the adequate selection of patients with non- varicosa gastrointestinal bleeding that need transfusional therapy(AU)


Subject(s)
Humans , Male , Aged , Blood Transfusion/methods , Endoscopy, Gastrointestinal/methods , Gastrointestinal Hemorrhage/diagnosis , Epidemiology, Descriptive , Prospective Studies , Risk Factors , Longitudinal Studies
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