Seguridad de la resección con asa fría de lesiones colorrectales no polipoideas (0-IIa y 0-IIb) de hasta 20 mm / [Safety and efficacy of cold snare resection of non-polypoid colorectal lesions (0-IIa and 0-IIb)].

BACKGROUND: Cold polypectomy is a widely used technique for removing small polyps. Little evidence is available regarding its use for removing non-polypoid colorectal lesions (NPCRL). OBJECTIVE: The main aim of this study was to assess the safety of cold snare resection of NPCRL up to 20 mm. METHODS: This was a prospective cohort study carried out from January 2009 to January 2012. Consecutive patients scheduled for colonoscopy who had at least one NPCRL were recruited. Patients undergoing antiaggregation or anticoagulation treatment were excluded. NPCRL of up to 20 mm were removed by means of a cold snare, with or without piecemeal technique. To evaluate the safety of the procedure, the measured outcomes were bleeding and perforation rates. Statistical measures as percentages with their respective confidence intervals of 95

were estimated and the level of significance was set at alpha = 0.03. The calculated interval was unilateral, because the experimental rate was 0

, and was built based on the binomial distribution. Statistix (SX9.0) was used. RESULTS: A total of 171 NPCRL were removed from 124 patients. The mean size of the lesions was 9.22 +/- 4.7 mm (range: 4 to 20 mm). The mean age of patients was 55 +/- 11 years (range: 25 to 81 years) and 56

of them were women. No immediate or delayed complications were recorded. CONCLUSIONS: Cold snare resection could be used to remove LNPCR (0-IIa and 0-IIb) measuring up to 20 mm, without immediate or delayed complications.

Histoplasmosis gastrointestinal: una presentación atipica / [Gastrointestinal histoplasmosis: an atypical presentation].

Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum. It is an endemic disease in the American continent. It is spread hematogenously and any organ can be affected. It is more frequent in immunodeficient patients and the most common opportunist mycosis associated with HIV Exclusive gastrointestinal involvement is rare and invariably mortal without treatment. It is considered to be impossible to diagnose the disease based on the macroscopic aspect of lesions. We report a 43-year-old male in apparent good health status who was admitted with intermittent proctorrhagia of one year of evolution associated to burning proctalgia, without any further symptoms. A videocolonoscopy (VCC) with proctologic exam was conducted The patient was warned about the potential orificial origin of the bleeding and the importance of screening for colorectal neoplasia. The proctologic exam revealed internal congestive hemorrhoids. VCC showed during the routine exploration of the terminal ileon lesions both in that level and rectum, although of a different morphology. The colon had normal endoscopic appearance. Biopsies of both lesions identified Histoplasma. Later studies diagnosed HIV/AIDS and the patient was referred to the infectology department to complete diagnostic tests and begin treatment of both diseases. In conclusion, we present an atypical case of this mycosis because of its exclusive gastrointestinal allocation, in anasymptomatic patient, in apparent good health, with unknown HIV/AIDS, who was admitted because of a proctorrhagia of orificial origin. Endoscopic biopsies of lesions of different morphologies, located in the terminal ileon and rectum, allowed the diagnosis of this disease, that had no clinical expression. This casual endoscopic diagnosis enabled to change the life expectancy of the patient. We consider that the described endoscopic lesions in rectum are of a particular morphology and can rarely be found in other pathologies. The diffusion of these images could warn other endoscopists of these phenomena.