Consenso chileno de diagnóstico y manejo de neoplasias quísticas pancreáticas. Club de páncreas Chile-SCHGE / Chilean consensus on diagnosis and management of pancreatic cystic neoplasms

Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.

Cirugía endoscópica transgástrica: experiencia inicial en modelos animales / Transgastric endoscopic surgery: initial experience in animal model

Natural orifice transluminal endoscopic surgery (notes), is a novel approach to the peritoneal cavity, that has been used for both diagnostic and surgical procedures. Aims: to evaluated the safety and feasibility of per-oral transgastric route for peritoneal approach and for several basic surgical techniques in a porcine experimental model. Material and methods: five pigs entered in the study. Under general anesthesia , a conventional endoscope was passed into the stomach, the gastric wall was punctured by mean of a sphincterotome and the size of the gastric incision was increased with a cholecystectomy and intestinal loops mobilization were attempted. Gastric incision closure was performed with endoloops. Results: a good observation of the peritoneal cavity was achieved. Liver samples were obtained in all procedures as well as mobilization of small intestinal loops. Cholecystectomy was possible in only three cases. Conclusion: transgastric approach to the peritoneal cavity seems to be a potential alternative to the classical laparotomy and laparoscopic technique.

La cirugía endoscópica transluminal por orificios naturales (NOTES) es un nuevo abordaje a la cavidad peritoneal que ha sido utilizada ya sea como procedimiento diagnóstico o quirúrgico. Objetivos: Evaluar la seguridad y factibilidad de la ruta per-oral transgástrica para el acceso a la cavidad peritoneal , y para la realización de técnicas quirúrgicas básicas en un modelo experimental porcino. Material y métodos: Se utilizaron cinco cerdos. Bajo anestesia general mediante un endoscopio convencional se accedió al estómago y se puncionó la pared gástrica mediante un papilótomo. La abertura se amplió ya sea con papilótomo o con balón. Se exploró la cavidad peritoneal y se intentó realizar: biopsias hepáticas en todos los procedimientos, lo mismo ocurrió con la movilización de asas intestinales. La colecistectomía fue posible en sólo tres ocasiones. Conclusión: el abordaje transgástrico de la cavidad peritoneal pareciera ser una potencial alternativa a la laparotomía clásica y laparoscópica.