Tuberculosis ileocecal: revisión de la literatura a partir de un caso clínico / Ileocecal tuberculosis: literature review from a case report

Tuberculosis (TB) remains a major public health challenge. The true incidence of intestinal TB is unknown, as it can be asymptomatic, and by its nature, often diverts its diagnosis to neoplastic diseases or inflammatory bowel disease. Therefore, we must have a high index of suspicion, not only in high risk populations and immunocompromised patients. Diagnostic tests that certify the pathology, don’t always achieve excellent performance. Endoscopic findings are not always clear in differentiating malignancy, and in some cases, a therapeutic trial may be needed to confirm the disease. We present the case of a patient with chronic diarrhea, consumptive syndrome and without respiratory symptoms at its onset.

La tuberculosis (TBC) sigue siendo un reto importante de salud pública. La verdadera incidencia de TBC intestinal es desconocida, ya que puede ser asintomática, y por su naturaleza a menudo desvía su diagnóstico a patologías neoplásicas o de enfermedad inflamatoria intestinal. Por lo tanto, se debe tener un alto índice de sospecha, no sólo en poblaciones de alto riesgo y en pacientes inmunocomprometidos. Las pruebas diagnósticas que certifiquen la patología no siempre se logran ni tienen un excelente rendimiento. Los hallazgos endoscópicos no siempre son claros para diferenciarla de una neoplasia, y en algunos casos una prueba terapéutica puede ser la confirmación de la enfermedad. Presentamos el caso de un paciente con diarrea crónica, cuadro consuntivo y sin síntomas respiratorios al inicio de su cuadro.

Aspectos relevantes en la realización de la endoscopia digestiva: propuestas basadas en la evidencia. Curso ACHED 2013 / Relevant aspects of digestive endoscopy. Evidence-based suggestions. Chilean Association of Digestive Endoscopy (ACHED), Course 2013

Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called ‘Relevant aspects of digestive endoscopy. Evidence-based suggestions’. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.

La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado “Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia”. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.

Hemorragia por várices esofagogástricas: experiencia con cianoacrilato y polidocanol en 68 pacientes con hemorragia activa / Hemorrhage by esophageal gastric varices: experience with cianoacrylate and polidocanol in 68 patients

Background: Sclerosis, injection of cianoacrylate and rubber band ligation are the most commonly used endoscopic techniques for the treatment of bleeding esophageal varices. Aim: To assess the effectiveness of cianoacrylate and polidocanol in the treatment of bleeding esophageal varices. Patients and methods: Sixty eight patients with active variceal bleeding were studied. Bleeding varices were classified as thin, thick or gastric. Bleeding from thin varices was treated with polidocanol. Bleeding from thick or gastric varices was treated with cianoacrylate. Variceal erradication was done with polidocanol. Results: Bleeding came from thin esophageal varices in 23 percent of patients and endoscopic treatment stopped bleeding in 95 percent of them, from thick esophageal varices in 62 percent and endoscopic treatment was successful in 94 percent of these, and from gastric varices in 12 percent and treatment stopped bleeding in 87 percent of these (in 3 percent bleeding was considered subcardial). Twenty five percent of patients bled again during variceal erradication, 12 percent died due to uncontrollable bleeding and 20 percent died due to liver failure. During variceal erradication 59 percent of patients classified as Child Pugh C, died. Conclusions: Treatment of bleeding esophageal varices with cianoacrylate or polidocanol is effective. Patients classified as Child Pugh C have a bad prognosis