RESUMO
Barretts esophagus is considered an acquired pre-malignant condition for esophageal adenocarcinoma, and its risk increases with the degree of dysplasia. Its presence therefore requires endoscopic surveillance or eradication. Historically patients with high-grade dysplasia and intramucosal esophageal adenocarcinoma were routinely treated with esophagectomy, considered the definitive therapy and therapeutic gold standard, 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 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 Barretts patients with low-grade dysplasia the recommendation of most international guides remains endoscopic surveillance, however given the good results of endoscopic ablation, this concept has changed towards the therapeutic approach. In the absence of dysplasia endoscopic therapy is not recommended but endoscopic surveillance. In the present article we will review the endoscopic therapeutic alternatives to Barretts esophagus, its scientific basis and how they have evolved in recent times.
El esófago de Barrett se considera una condición adquirida pre-maligna para adenocarcinoma esofágico, cuyo riesgo aumenta según el grado de displasia. Su presencia obliga, por lo tanto, a la vigilancia endoscópica o erradicación. Históricamente pacientes con displasia de alto grado y adenocarcinoma esofágico intramucoso eran rutinariamente tratados con esofagectomía, considerada terapia definitiva y patrón de oro terapéutico, pero con una morbimortalidad considerable. Esto ha llevado al desarrollo de nuevas alternativas de tratamientos menos invasivos como el endoscópico, tanto para la lesión displásica como para el remanente de mucosa metaplásica. Las alternativas terapéuticas más utilizadas son la crioterapia, ablación por radiofrecuencia, la 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, este concepto ha ido cambiando hacia tomar esta conducta terapéutica. En caso de ausencia de displasia no se recomienda la terapia endoscópica de regla sino la vigilancia endoscópica. En el siguiente artículo revisaremos las alternativas terapéuticas endoscópicas frente al esófago de Barrett, su sustento científico y cómo han evolucionado en el último tiempo.
Assuntos
Humanos , Esôfago de Barrett/terapia , Ablação por Cateter , Crioterapia , EsofagoscopiaRESUMO
Background: Electrical burns are associated with complications and may aggravate burned patients. Aim: To evaluate the effect of electrical burns in mortality and length of stay in a critical care unit for burn patients. Material and Methods: Retrospective analysis of medical records of 182 patients aged 15 to 90 years, admitted to an intensive care unit for burn patients. The length of stay and mortality of 14 patients that suffered electric burns was compared with the features of 168 patients with other type of burns. Results: Patients with electrical burns were younger, had a lower percentage of total body surface burnt and had a lower frequency of inhalatory injuries than their counterparts with other type of burns. Mortality rate among patients with electric or other types of burns was similar (three and 49 patients, respectively). Intensive care unit stay was also similar. A multivariate analysis showed that high voltage electric burns were an independent risk factor for death with an odds ratio of 12 (95 percent confidence intervals 1.8-79.4). Conclusions: High voltage electric burns are an independent risk factor for death among burn patients.