Diagnóstico y tratamiento de las várices esófago gástricas en Chile: realidad nacional / Management of bleeding esophageal varices in public and private institutions in Chile

Background: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. Aim: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. Material and methods: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cides with more than 100,000 inhabitants. Results: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutionis that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutionis that had an emergency room. Rubber band ligation was available in 16 public (52 percent) and in all private institutions. Cyanoacrylate injections were done in 10 public (32 percent) and 11 (65 percent) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41 percent) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65 percent) and all private institutions. Primary prophylaxis was done in 18 public (58 percent) and 14 private (82 percent) institutions. Secondary prophylaxis was carried out in 26 public (84 percent) and 16 private (94 percent) institutions. Conclusions: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.

Ligadura elástica complementada de esclerosis en el tratamiento de várices esofágicas: experiencia en la hemorragia activa y en el tratamiento electivo / Endoscopic ligation plus sclerotherapy in the treatment of bleeding esophageal varices

Background: Endoscopic ligation is the treatment of choice for bleeding esophageal varices. The usefulness of additional sclerotherapy is not clear. Aim: To assess the effectiveness of ligation followed by sclerotherapy in the treatment of variceal bleeding. Patients and methods: Forty eight patients with variceal bleeding admitted for emergency treatment and 73 patients admitted for elective treatment were studied. Varices were ligated until a significant reduction in size was achieved. Eradication was completed with the injection of 1 per cent polidocanol. Results: In 34 of 48 patients admitted for emergency treatment, the site of variceal rupture was identified. In all these subjects, and in 13 of 14 patients in whom the rupture site was not identified, hemorrhage was stopped with the procedure. Varices were eradicated in 108 of the 121 patients. Hemorrhage recidivated in 12.5 per cent of patients admitted for emergency treatment, in a period of 14 months of follow up and in 9.6 per cent of those admitted for elective treatment, in a period of 16 months follow up. Mortality was 14, 18 and 57 per cent among patients classified as Child Pugh A, B or C, respectively. Conclusions: Endoscopic ligation is effective in the treatment of variceal bleeding. Adding sclerotherapy, variceal eradication is achieved in a high percentage of patients. Survival depends on hepatic function

Prótesis esofágica: inserción endoscópica: experiencia preliminar / Esophageal prosthesis: endoscopical implant: preliminary experience

Presentamos nuestra experiencia inicial en el tratamiento paliativo de la estenosis esofágica maligna mediante inserción endoscópica de una prótesis. Las dilataciones se efectuaron con bujías de Savary-Gilliard y la inserción bajo orientación radiológica, deslizando la prótesis sobre una bujía de 11 mm o sobre un endoscopio fino. El procedimiento fue exitoso en 12 de 14 pacientes. Los dos fracasos correspondieron a lesiones cardiales avanzadas y tortuosas. No hubo mortalidad ni complicaciones graves. En el seguimiento se presentó un caso de reflujo gastroesofágico severo, dos de obstrucción por alimento y uno de crecimiento tumoral sobre la prótesis. Aunque el promedio de sobrevida fue de sólo 4,3 meses, hubo una notable mejoría en la calidad de vida. Este procedimiento por ser simple y seguro representa una excelente alternativa a la instalación quirúrgica de prótesis

Diagnóstico y tratamiento del pólipo juvenil del colon / Diagnosis and treatment of juvenile polyp of colon

Entre 1984 y 1989 hemos efectuado 75 colonoscopías en 66 niños con rectorragia, 5 de ellos con anemia severa secundaria, cuya edad fluctuaba entre 2 y 16 años (promedio 6,6). La mayoría de estos procedimientos se realizaron en forma ambulatoria (87%), bajo premedicación con sedantes orales, y en compañia de un familiar cercano. En todos los casos se examinó hasta el ángulo esplénico del colon. En 40 niños encontramos pólipos únicos y en 7 pacientes más de uno. Todos los pólipos fueron resecados endoscópicamente mediante asa de alambre y electrocirugía durante el mismo procedimiento. No hubo complicaciones graves ni mortalidad. Concluimos que en niños con rectorragia persistente debe efectuarse la colonoscopía corta por la alta probabilidad de encontrar un pólipo juvenil y de tratarlo mediante un procedimiento simple, seguro y bien tolerado que es la polipectomía endoscópica