Evaluation of the serrated lesions detection rate and its role as a colonoscopy quality criteria

Objectives: To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods: This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by themedical team. All polyps identified were removed and sent to the same pathologist for analysis. Results: A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions: The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams. (AU)

Comparative analysis of late results of cervical esophagogastric anastomosis by manual and mechanical suture in patients submitted to esophageal mucosectomy through advanced megaesophagus / Análise comparativa dos resultados em longo prazo da anastomose esofagogástrica cervical pela sutura manual e mecânica em pacientes submetidos à mucosectomia esofágica por megaesôfago avançado

ABSTRACT Background: Among the anastomoses of the gastrointestinal tract, those of the esophagus are of special interest due to several anatomical or even general peculiarities. Aim: Evaluate retrospectively the results comparing mechanical vs. manual suture at cervical esophagogastric anastomosis in megaesophagus treatment. Methods: Were included 92 patients diagnosed with advanced megaesophagus with clinical conditions to undergo the surgery. All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. In order to make this anastomosis, the patients were divided into two groups: group A (n=53) with circular mechanical suture, lateral end; group B (n=39) with manual suture in two sides, lateral end. In the postoperative period, an early evaluation was performed, analyzing local and systemic complications and late (average 5.6 y) analyzing deglutition. Results: Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%) in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6 (15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the patients presented the criteria 4 and 5 from SAEED, expressing effective swallowing mechanisms without showing significant differences among the groups. Conclusion: Cervical esophagogastric anastomosis by means of mechanical suture is more proper than the manual with lower incidence of local complications and, in the long-term evaluation, regular deglutition was acquired in both suture techniques in equal quality.

RESUMO Racional: Das anastomoses do trato gastrointestinal, as do esôfago têm especial interesse devido às varias peculiaridades anatômicas e mesmo sistêmicas. Objetivo: Avaliar retrospectivamente os resultados comparando a sutura mecânica e manual na anastomose esofagogástrica cervical no tratamento do megaesôfago. Métodos: Foram estudados 92 pacientes com diagnóstico de megaesôfago avançado com condições clínicas de serem submetidos à operação. Todos foram submetidos à mucosectomia esofágica, sendo realizada anastomose do coto esofágico com o tubo gástrico no nível cervical. Para a realização desta anastomose, foram divididos em dois grupos: grupo A (n=53) com sutura mecânica circular terminolateral; grupo B (n=39) com sutura manual em dois planos terminolateral. No período pós-operatório foi realizada avaliação precoce, com análise das complicações locais e sistêmicas, e tardia (média 5,6 anos) com análise da deglutição. Resultados: Avaliação precoce: a) deiscência da anastomose esofagogástrica, n=5 (9,4%) no grupo A vs. n=9 (23,0%) no grupo B (p=0.0418); b) estenose da anastomose esofagogástrica n=8 (15,1%) no grupo A vs. n=15 (38,4%) no grupo B (p=0.0105); c) infecção pulmonar n=5 (9,4%) no grupo A vs. n=3 (7,6%) no grupo B (p=1.000); d) derrame pleural n=5 (9,4%) no grupo A vs. n=6 (15,4%) no grupo B (p<0.518). A avaliação tardia demonstrou que 86,4 a 96,0% dos pacientes apresentaram critérios 4 e 5 de SAEED, demonstrando deglutição efetiva e sem diferença significante entre os grupos. Conclusão: A anastomose esofagogástrica pela sutura mecânica é mais adequada que a manual com pequena incidência de complicações locais e, na avaliação em longo prazo, a deglutição demonstrou ser adequada em ambos os grupos e com qualidade semelhante.