Role of fiberoptic endoscopic evaluation of swallowing (FEES) in children with suspected dysphagia

Abstract Objective To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results. Methods This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments. Results Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). Conclusion FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion.

Evaluation of bowel by computed tomography enterography: comparing the water, mannitol and iodinated oral contrast

Background: Despite the small intestine's size and significance, disorders of it are comparatively uncommon and can pose difficulties for diagnosis and treatment. Even with the advent of cutting-edge imaging methods like double balloon endoscopy and capsule endoscopy, diagnostic tests are still unable to accurately evaluate the bowel. Recent innovations, including capsule endoscopy and MRI have emerged as an alternative small bowel imaging techniques that can be performed without ionizing radiations. In this study we have compared Water, mannitol and iodinated oral contrast for assessing intraluminal distension, mucosal fold visualization and mural enhancement. Methods: A total of 150 patients fulfilling the selection criteria were studied. All patients of age group 25 to 70 years were included in the study. Patients with ileostomy, nasogastric tube in-situ and nil by mouth., with suspected intestinal obstruction, patient presenting with acute abdomen and fever were excluded. Results: It was observed that mannitol, homogeneity and mannitol group showed better bowel distension than iodinated contrast and plain water group (p<0.001), iodinated contrast and plain water group. (p<0.001). Mannitol group showed better wall visibility than iodinated contrast and plain water group. (p<0.001). Mannitol is better endo-luminal contrast agent than, iodinated contrast in water and plain water to assess the overall image quality. Conclusions: Computed tomography (CT) enterography using mannitol is excellent technique in better visualization of small bowel loops and thus helped to provide better diagnosis for intestinal abnormalities.

Experience in Peroral Endoscopic Myotomy in a Center in Bogotá, Colombia, Between 2018 and 2022 / Experiencia en miotomía endoscópica peroral en un centro de Bogotá, Colombia, entre 2018 y 2022

Abstract Background: Achalasia is a low-incidence disease, but it significantly affects the life quality of patients. Before 2010, peroral endoscopic myotomy (POEM) was the preferred course of treatment. However, due to its effectiveness and safety, POEM has been widely used since then. Objective: To describe the results of the largest cohort of patients with achalasia-treated with endoscopic surgery-with the poem technique to date in Colombia. Methods: Observational cohort study that included patients treated with peroral endoscopic myotomy in the city of Bogota, Colombia, between 2018 and 2022. Information from medical records was collected and analyzed retrospectively, with subsequent telephone follow-up prospectively. The presurgical and follow-up Eckardt scale was used to establish clinical success. Results: Between 2018 and 2022, 31 patients were intervened, 61% of which were men. The mean age was 47 years. Technical and clinical success was obtained in 97% of cases, with an Eckardt score less than or equal to three, in 93%, at two months of follow-up. Forty-five percent of the procedures were outpatient. The complication rate was 10%. Conclusion: Our study shows that peroral endoscopic myotomy for achalasia management is an effective, low complication rate, and safe technique to perform on an outpatient basis.

Resumen Antecedentes: La acalasia es una enfermedad de baja incidencia, pero que afecta significativamente la calidad de vida de los pacientes. El tratamiento de elección ha sido la miotomía de Heller, pero en 2010 se describió la miotomía endoscópica peroral (POEM) y desde entonces ha tenido amplia difusión por su efectividad y seguridad. Objetivo: Describir los resultados de la cohorte más grande hasta la fecha en Colombia, en pacientes con acalasia tratados con cirugía endoscópica, con la técnica POEM. Métodos: Estudio observacional de cohorte que incluyó pacientes manejados con miotomía endoscópica peroral en la ciudad de Bogotá, Colombia, entre 2018 y 2022. Se recolectó y analizó retrospectivamente la información de las historias clínicas, y prospectivamente el posterior seguimiento telefónico. Se utilizó la escala de Eckardt prequirúrgica y en los seguimientos para establecer el éxito clínico. Resultados: Entre 2018 y 2022 se intervino a 31 pacientes, de los cuales el 61% eran hombres, y la media de edad fue de 47 años. Se obtuvo éxito técnico en el 97% de los casos y éxito clínico, con un puntaje de Eckardt menor o igual a tres, en el 93% a los dos meses de seguimiento. El 45% de los procedimientos fueron ambulatorios y la tasa de complicaciones fue del 10%. Conclusión: Nuestro estudio muestra que la miotomía endoscópica peroral para manejo de acalasia es una técnica efectiva, con baja tasa de complicaciones y segura para realizarse ambulatoriamente.

Baveno VII Criteria for the Exclusion of Esophageal Varices in a Peruvian Population: Cross-Sectional Study / Criterios de Baveno VII para la exclusión de várices esofágicas en una población peruana: estudio transversal

Abstract Introduction: Esophageal varices represent one of the main complications in patients with liver cirrhosis. The main objective was to determine the diagnostic performance of the new Baveno VII criteria to exclude the presence of esophageal varices in compensated advanced chronic liver disease (cACLD), in an independent Peruvian population. Materials and methods: A cross-sectional study, including patients with cACLD, upper digestive endoscopy, and transient hepatic elastography from January 2017 to December 2019. Results: The mean age was 59.4 (12.9) years, while the mean measurement of liver stiffness was 27.21 (14.6) kPa. The prevalence of esophageal varices was 85.6%; non-alcoholic fatty liver disease (NAFLD) (63.6%) was the most prevalent etiology, followed by viral hepatitis (14.4%). For esophageal varices exclusion, Baveno VII criteria for all etiologies demonstrated adequate sensitivity and negative predictive value (sensitivity: 96.7%; 95% confidence interval [CI]: 92.3%-98.8%; negative predictive value: 76.9%, 95% CI: 56.4% -91%). However, better diagnostic performance was found when applying the Baveno VII criteria without considering NAFLD patients (sensitivity: 98.4%, 95% CI: 79.2% -99.2%; negative predictive value: 90.9%, 95% CI: 79.2% -99.2%). This would prevent 14% of endoscopic studies with a 9% risk of failing to detect esophageal varices. Conclusions: The Baveno VII criteria present good diagnostic performance for the exclusion of esophageal varices, especially in patients with cACLD without NAFLD, in an independent Peruvian population.

Resumen Introducción: Las várices esofágicas representan una de las principales complicaciones en pacientes con cirrosis hepática. El objetivo principal fue determinar el rendimiento diagnóstico de los nuevos criterios de Baveno VII para excluir la presencia de várices esofágicas en la enfermedad hepática crónica compensada (cACLD), en una población peruana independiente. Materiales y métodos: Estudio transversal que incluyó a pacientes con cACLD, endoscopia digestiva alta y elastografía hepática transitoria desde enero de 2017 hasta diciembre de 2019. Resultados: La edad media fue de 59,4 (12,9) años, mientras que la medición media de rigidez hepática fue de 27,21 (14,6) kPa. La prevalencia de várices esofágicas fue del 85,6%; la enfermedad metabólica asociada al hígado graso (MASLD) (63,6%) fue la etiología más prevalente, seguida de la hepatitis viral (14,4%). Para la exclusión de várices esofágicas, los criterios de Baveno VII para todas las etiologías demostraron una sensibilidad y un valor predictivo negativo adecuados (sensibilidad: 96,7%; intervalo de confianza [IC] del 95%: 92,3%-98,8%; valor predictivo negativo: 76,9%, IC 95%: 56,4%-91%). Sin embargo, se encontró un mejor rendimiento diagnóstico al aplicar los criterios de Baveno VII sin considerar a los pacientes con MASLD (sensibilidad: 98,4%, IC 95%: 79,2%-99,2%; valor predictivo negativo: 90,9%, IC 95%: 79,2%-99,2%). Se evitaría el 14% de estudios endoscópicos con un riesgo del 9% de no detectar várices esofágicas. Conclusiones: Los criterios de Baveno VII presentan buen rendimiento diagnóstico para la exclusión de várices esofágicas, especialmente en pacientes con cACLD sin MASLD, en una población peruana independiente.

Extensive Pancreatic Necrosis, Successful Management with Percutaneous Endoscopic Necrosectomy / Necrosis pancreática extensa, manejo exitoso con necrosectomía endoscópica percutánea

Abstract Percutaneous endoscopic necrosectomy is a procedure indicated for managing extensive pancreatic necrosis. Different endoscopic and surgical alternatives have been described for drainage of peripancreatic collections and debridement of necrosis, and minimally invasive approaches have lower complications and mortality rates. We presented the case of a patient with severe pancreatitis associated with pancreatic necrosis extending to both paracolic gutters, who underwent percutaneous endoscopic necrosectomy, after unsuccessful percutaneous and laparoscopic drainage, and a complete resolution of the clinical picture was achieved. Management should consider the clinical condition of the patient, the location of the collections, and the time of evolution of the pancreatitis, and thus choose which intervention will be the most effective, considering also the experience of the medical team and the available resources.

Resumen La necrosectomía endoscópica percutánea es un procedimiento indicado para el manejo de la necrosis pancreática extensa. Se han descrito diferentes alternativas endoscópicas y quirúrgicas para el drenaje de colecciones peripancreáticas y el desbridamiento de la necrosis, y los abordajes mínimamente invasivos tienen menores tasas de complicaciones y mortalidad. Se presenta el caso de un paciente con pancreatitis grave asociada a necrosis pancreática con extensión a ambas goteras parietocólicas, que fue llevado a necrosectomía endoscópica percutánea, luego de drenajes percutáneos y laparoscópicos no exitosos, y se logró una resolución completa del cuadro clínico. Para determinar el manejo, se debe considerar el estado clínico del paciente, la localización de las colecciones y el tiempo de evolución de la pancreatitis, y de este modo elegir qué intervención será la más efectiva, considerando además la experiencia del equipo médico y los recursos disponibles.

Gastric Polyposis in Familial Adenomatous Polyposis: A Case Report. An Approach for the Endoscopist / Poliposis gástrica en la poliposis adenomatosa familiar: a propósito de un caso. Un enfoque para el endoscopista

Abstract Familial adenomatous polyposis (FAP) is an autosomal dominant inheritance syndrome. Although the main manifestation of this disease is the presence of numerous colon adenomas, upper gastrointestinal tract involvement also occurs. A report of a young patient with gastric polyposis (more than 100 polyps) was presented. There was a brief updated review of the topic focused on endoscopic findings, including updated suggestions on gastric polyps in FAP management and monitoring.

Resumen La poliposis adenomatosa familiar (PAF) es un síndrome hereditario autosómico dominante. Aunque la principal manifestación de esta enfermedad es la presencia de numerosos adenomas de colon, también ocurre afectación del tracto gastrointestinal superior. Se presenta un reporte de una paciente joven con una poliposis gástrica (más de 100 pólipos). Se realiza una breve revisión actualizada del tema enfocada en los hallazgos endoscópicos, así como sugerencias actualizadas en el manejo y seguimiento de los pólipos gástricos en la PAF.

Positive association of serum IgG4 levels with modified marsh classification system in children with gluten enteropathy: a single centre experience

Background: Celiac disease or gluten enteropathy is an immune-mediated systemic disorder elicited by gluten and related prolamines in genetically susceptible individuals and is characterized by the presence of gluten enteropathy, celiac disease-specific antibodies, HLA-DQ2/DQ8 haplotypes. IgG4-related diseases is an increasingly recognized immune-mediated condition in autoimmune disorders such as primary sclerosing cholangitis, autoimmune hepatitis, and autoimmune thyroiditis, characterized by tissue fibrosclerosis and infiltration by IgG4-positive plasma cells and increased serum IgG4 concentrations.Methods: A total of 33 children with newly diagnosed celiac disease and 31 control subjects were included in this study. All suspected celiac disease children underwent duodenal biopsy and were diagnosed based on Marsh grading. Serum IgG4 level estimations were performed using an enzyme-linked immune sorbet assay method with a cut-off of 135 mg/dl for diagnosis.Results: A significant positive association between serum IgG4 levels and Marsh classification was found, the higher the levels of IgG4 in serum, the higher the grade on Marsh staging. Mean serum IgG4 levels in Marsh 3a was 126.32 mg/dl, in 3b was 171.35 mg/dl and in 3c was 209.24 mg/dl (p value=0.004)Conclusions: With increasing serum IgG4 levels, increased severity of damage was seen on biopsy specimens based on higher Marsh grade. To the best of found knowledge, this is the first study to establish the relation between IgG4 and mucosal damage in children with celiac disease.

Study endoscopic and colonoscopy findings in children under 16 years of age with gastrointestinal bleeding from 2018 to 2021

Background: One of the most common reasons for Children to visit clinics is gastrointestinal issues in which endoscopic studies are used occasionally to investigate it’s etiology more accurately. GI bleeding eventhough uncommon in children, can be life threatening. The aim of this study was to study endoscopic and colonoscopic findings in children with GI bleeding. Methods: This descriptive analytical study was done on 73 children under 16 years in Ardabil with the diagnosis of gastrointestinal bleeding. A checklist including demographic and treatment information of patients like severity of bleeding, bleeding type (melena, hematochezia, occult blood), laboratory results (hemoglobin, hematocrit) and clinical findings (abdominal pain, nausea and vomiting, ETC), endoscopic and colonoscopic results were collected and then analyzed by statistical methods in SPSS version 21. Results: Total 38 cases (52.1%) were gone under upper endoscopy and 35 cases (47/9%) were gone under colonoscopy. The most common indications for upper endoscopy was GI bleeding (76.3%) and the most common involved anatomical part was lower portion of esophagus (44.7%). The most common indication for colonoscopy was recurrent abdominal pain (62.9%). Pathologic cases were often seen in sigmoid, rectum and anus (52/8%). The most common colonoscopic findings were nodular hyperplasia (25/7%) and solitary nodule (20%). Conclusions: Results of study showed that, the frequency of endoscopic evaluation has been significantly lower in female children. According to the most common indications for upper and lower endoscopy, it is important to consider the frequency pattern of indications for endoscopic study.

Visión general de las várices gástricas y su tratamiento / Overview of gastric varices and their treatment

Las várices gástricas (VG) son un complejo de colaterales vasculares entre la circulación portal y sistémica, condición que se desarrolla como resultado de la presión elevada en el sistema venoso portal. Se encuentran en el 20 % de los pacientes con cirrosis, y son menos frecuentes que las várices esofágicas. Según la clasificación de Sarin, las VG se dividen en cuatro tipos según su ubicación en el estómago y su relación con las várices esofágicas (GOV1, GOV2, IGV1 e IGV2). Entender su hemodinámica con respecto a las rutas de drenaje de las VG es importante para guiar su tratamiento.

Gastric varices (GV) are a complex of vascular collaterals between portal and systemic circulation, a condition that develops as a result of elevated pressure in the portal venous system. They are found in 20% of patients with cirrhosis, and are less common than esophageal varices. According to the Sarin classification, GV are divided into four types based on their location in the stomach and their relationship with esophageal varices (GOV1, GOV2, IGV1, and IGV2). Understanding their hemodynamics with respect to GV drainage routes is important to guide their treatment.

Esophageal diverticulum: a case report

Esophagic diverticulum抯 are a rare entity. The prevalence in the world population is reported to be less than 1%. They are generally diagnosed incidentally, have a higher peak of prevalence in the fifth decade of life, affecting men and women equally. The most common esophageal diverticula are epiphrenic and the main symptom is usually dysphagia. A case of a 74-year-old female with diagnosis of epiphrenic esophageal diverticulum is reported, which is treated with conservative management. The objective of this study was to describe a clinical case of esophageal diverticulum, as well as its etiology, clinical presentation, and therapeutic conduct. The screening of these patients must be focused on what the literature indicates, symptomatic patients with long-term evolution, the treatment will be surgical and with minimally invasive techniques so clinical evolution will be more favorable, reducing possible complications.

Infección por Helicobacter pylori y factores asociados en adultos de la sierra norte del Perú / Helicobacter pylori infection and associated factors in adults from the northern highlands of Peru

INTRODUCCIÓN: Helicobacter pylori afecta a más de 50% de la población mundial, siendo más prevalente en poblaciones de nivel socioeconómico bajo; esta bacteria constituye la principal causa de cáncer gástrico a nivel global. OBJETIVO: Determinar la frecuencia y los factores asociados a la infección por H. pylori en personas adultas que viven en el centro histórico de la ciudad de Cajamarca, en el norte del Perú. MATERIAL Y MÉTODO: Estudio descriptivo que incluyó 124 personas encuestadas mediante un cuestionario y evaluadas mediante endoscopía y cultivo de biopsia gástrica. Una biopsia por persona fue sometida a prueba de ureasa y los cultivos se confirmaron por reacción de polimerasa en cadena (RPC). RESULTADOS: La frecuencia de infección fue de 60,5 % (IC 95% 51,3 - 69,2). El análisis univariado demostró asociación significativa entre la infección y la edad (p = 0,002), y entre la infección y el antecedente de patología gástrica (p = 0,015). El análisis multivariado reveló dos factores asociados: edad (OR = 0,94; IC95% 0,90-0,97) y antecedente de infección por H. pylori (OR = 0,23; IC95% 0,08 - 0,67). CONCLUSIONES: Existe alta frecuencia de infección por H. pylori en esta población; la edad y el antecedente de infección constituyen factores asociados que deben evaluarse con mayor profundidad.

BACKGROUND: Helicobacter pylori affects more than 50% of the world's population, being more prevalent in populations of low socioeconomic status. H. pylori is the main cause of gastric cancer globally. AIM: To establish the frequency and factors associated with H. pylori infection in adults living in the historic center of Cajamarca City, in northern Peru. METHODS: This was a descriptive study that included 124 individuals surveyed through a questionnaire and evaluated through endoscopy and gastric biopsy culture. One biopsy per person underwent the urease test, and the cultures were confirmed by PCR. RESULTS: The frequency of infection was 60.5% (95% CI 51.3 - 69.2). In the univariate analysis, there was a significant association between the infection and age (p = 0.002), and between the infection and a history of gastric pathology (p = 0.015). The multivariate analysis revealed two associated factors: age (OR = 0.94; 95% CI 0.90 - 0.97), and history of H. pylori infection (OR = 0.23; 95% CI 0.08 - 0.67). CONCLUSIONS: There is a high frequency of H. pylori infection in this population, and the age and history of H. pylori infection are factors that should be further evaluated.

Resección laparoscópica de quiste de duplicación gástrica asistida por endoscopia / Laparoscopic resection of gastric duplication cyst assisted by endoscopy

Introducción. Las duplicaciones gástricas son entidades congénitas poco frecuentes que se diagnostican principalmente en las etapas tempranas de la vida, y rara vez en pacientes adultos. El objetivo de este artículo fue presentar el caso de un adulto con esta patología, tratado exitosamente mediante cirugía. Caso clínico. Mujer de 26 años de edad con epigastralgia crónica refractaria a manejo médico, a quien durante endoscopia digestiva superior se le identificó una lesión quística sugestiva de tumor estromal gastrointestinal, confirmada por ultrasonido endoscópico. Resultados. Se realizó una resección quirúrgica laparoscópica asistida por endoscopia, con buena evolución postoperatoria. El estudio anatomo-patológico informó la presencia de un quiste de duplicación gástrica. Conclusiones. A pesar de las ayudas diagnósticas disponibles en la actualidad, esta patología representa un reto diagnóstico importante que, en muchas ocasiones solo puede ser confirmado mediante el estudio anatomo-patológico. En paciente asintomático, continúa la controversia entre observarlo o llevarlo a cirugía, por el riesgo de malignidad. Actualmente, el manejo de las duplicaciones gástricas en adultos se considera eminentemente quirúrgico. Las resecciones laparoscópicas y el uso de endoscopia intraoperatoria permiten garantizar la resección completa de la lesión, preservando la mayor cantidad de tejido sano adyacente y previniendo estenosis o deformidades gástricas que afecten su adecuado funcionamiento.

Introduction. Gastric duplications are rare congenital entities that are diagnosed primarily in early life, and rarely in adult patients. The objective of this article was to present the case of an adult with this pathology, successfully treated by surgery. Clinical case. A 26-year-old woman with chronic epigastralgia refractory to medical management, who during upper digestive endoscopy was identified with a cystic lesion suggestive of gastro-intestinal stromal tumor, confirmed by endoscopic ultrasound. Results. A laparoscopic surgical resection assisted by endoscopy was performed, with good postoperative evolution. The anatomopathological study reported the presence of a gastric duplication cyst. Conclusions. Despite the diagnostic adjuncts currently available, this pathology represents an important diagnostic challenge that, in many cases, can only be confirmed through pathology. In asymptomatic patients, the controversy continues between observing them or taking them to surgery due to the risk of malignancy. Currently, the management of gastric duplications in adults is considered eminently surgical. Laparoscopic resections and the use of intraoperative endoscopy ensure complete resection of the lesion, preserving the greatest amount of adjacent healthy tissue and preventing gastric stenosis or deformities that affect its proper functioning.

Experiencia con sonda luminal funcional endoluminal (EndoFLIP) en Hospital Universitario San Ignacio, Bogotá, Colombia / Experience with endoluminal functional luminal probe (EndoFLIP) at San Ignacio University Hospital, Bogota, Colombia

RESUMEN Introducción: La EndoFLIP (por sus siglas en inglés: sonda luminal funcional endoluminal) es un sistema que mide en tiempo real el índice de la distensibilidad de la unión esofagogástrica y el peristaltismo esofágico secundario, basándose en el principio de planimetría de impedancia. Aunque esta tecnología es relativamente nueva y su utilidad diagnóstica aún se encuentra en evaluación, cada vez se reconoce más su uso en la práctica clínica, fundamentalmente en aquellos pacientes donde no hay un diagnóstico manométrico conclusivo de un trastorno motor esofágico, principalmente obstrucción al tracto de salida y acalasia. Objetivo: El objetivo del presente estudio es describir la experiencia con la EndoFLIP en el Hospital Universitario San Ignacio en Bogotá, Colombia. Materiales y métodos: Estudio observacional descriptivo tipo serie de casos, donde se incluyeron pacientes mayores de 18 años a quienes se les realizó EndoFLIP en el Hospital Universitario San Ignacio desde el año 2021 hasta el 2022, bien sea de forma intrahospitalaria como ambulatoria, con indicación clara de realización del estudio, previamente discutida en Junta multidisciplinaria de Gastroenterología. Resultados: Se incluyeron un total de 27 pacientes en el estudio con promedio de 55,6 años de edad, de los cuales 20 eran mujeres (74%) y 7 hombres (26%). La indicación más frecuente del estudio fue diagnóstico no conclusivo de obstrucción al tracto de salida identificado en manometría esofágica de alta resolución de acuerdo a los criterios de la clasificación de Chicago 4.0 (14 pacientes), seguido de esófago hipercontráctil (4 pacientes) y motilidad esofágica inefectiva (3 pacientes). Al evaluar la respuesta contráctil, se encontró que 9 pacientes con diagnóstico no conclusivo de obstrucción al tracto de salida tenían respuesta normal, 3 ausente y una alterada; y en los pacientes con diagnóstico no conclusivo de acalasia uno de ellos tenía respuesta contráctil limítrofe y dos ausente. La totalidad de los pacientes con diagnóstico previo de contractilidad ausente, tenían respuesta contráctil igualmente ausente en la EndoFLIP. Conclusiones: La imagen luminal funcional endoluminal es una técnica que evalúa las propiedades biomecánicas como la distensibilidad, volumen, presión e inclusive diámetros de regiones esfinterianas como la unión esofagogástrica, píloro y ano. Se ha destacado su utilidad para varias indicaciones, siendo las más importantes los diagnósticos manométricamente no conclusivos de trastornos motores esofágicos como la acalasia y la obstrucción del tracto de salida, patologías que tienen un impacto importante en la calidad de vida de los pacientes y cuyo diagnóstico es esencial para poder brindar la mejor opción terapéutica.

ABSTRACT Introduction: The EndoFLIP (for its acronym in English: endoluminal functional luminal probe) is a system that measures in real time the compliance index of the gastroesophageal junction and secondary esophageal peristalsis, based on the principle of impedance planimetry. Although this technology is relatively new and its diagnostic usefulness is still being evaluated, its use in clinical practice is increasingly recognized, fundamentally in those patients where there is no conclusive manometric diagnosis of esophageal motor pathology, mainly esophagogastric junction outflow obstruction and achalasia. Objective: The aim of the present study is to describe the experience with EndoFLIP at the San Ignacio University Hospital in Bogotá, Colombia. Material and methods: Descriptive observational case series study, which included patients over 18 years of age who had undergone EndoFLIP at the San Ignacio University Hospital from 2021 to 2022, either in-hospital or outpatient, with a clear indication of performance of the study, previously discussed in the multidisciplinary Gastroenterology Board. Results: A total of 27 patients with an average age of 55 years were included in the study, of which 20 were women (74%) and 7 men (26%). The most frequent indication of the study was an inconclusive diagnosis of outflow tract obstruction identified in high-resolution esophageal manometry according to Chicago 4.0 criteria (14 patients), followed by hypercontractile esophagus (4 patients) and ineffective esophageal motility (3 patients). When evaluating the contractile response, it was found that 9 patients with an inconclusive diagnosis of outflow tract obstruction had a normal response, 3 absent and one altered; and in the patients with an inconclusive diagnosis of achalasia, one of them had a borderline contractile response and two had no response. All patients with a previous diagnosis of absent contractility had an equally absent contractile response in EndoFLIP. Conclusion: Endoluminal functional luminal imaging is a technique that evaluates biomechanical properties such as distensibility, volume, pressure and even diameters of sphincter regions such as the gastroesophageal junction, pylorus and anus. Its usefulness has been highlighted for several indications, the most important being manometrically inconclusive diagnoses of esophageal motor disorders such as achalasia and outflow tract obstruction, pathologies that have a significant impact on the quality of life of patients and whose diagnosis is essential to be able to provide the best treatment option.

Efficacy of routine second-look endoscopy after endoscopic hemostasis in patients with acute peptic ulcer bleeding: systematic review and meta-analysis / Eficacia de la endoscopia control de rutina después de la hemostasia endoscópica en pacientes con hemorragia por úlcera péptica aguda: revisión sistemática y meta-análisis

ABSTRACT Objective: To evaluate the efficacy of scheduled second-look endoscopy in patients with acute peptic ulcer bleeding (PUB). Materials and methods: We systematically search in four databases for randomized controlled trials (RCTs) that evaluated the usefulness of scheduled second-look endoscopy vs. single endoscopy in patients with PUB. Our primary outcome was rebleeding. Secondary outcomes were surgery, mortality, and the number of units of blood transfused (NUBT). All meta-analyses were performed using a randomeffects model. Pooled risk ratio (RR) and mean difference (MD), with their 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively. The risk of bias was assessed using the Cochrane RoB 2.0 tool, and the quality of evidence (QoE) was rated with the GRADE approach. Results: Eight full-text RCTs and two RCT abstracts were included (n=1513). We did not find differences in rebleeding (RR, 0.78; 95% CI, 0.531.14, moderate QoE), surgery (RR, 0.58; 95% CI, 0.29-1.15, moderate QoE), mortality (RR, 0.89; 95% CI, 0.46-1.71, moderate QoE) or NUBT (MD, -0.01 units; 95% CI, -0.3 to 0.28, low QoE) between second-look and single endoscopy. Sensitivity analyses had similar results to the main analyses. Conclusions: Routine second-look endoscopy was not more efficacious than single endoscopy in patients with PUB.

RESUMEN Objetivo: Evaluar la eficacia de la endoscopia de revisión programada en pacientes con hemorragia por úlcera péptica aguda (UPA). Materiales y métodos: Buscamos de forma sistemática en cuatro bases de datos ensayos controlados aleatorios (ECA) que evaluaran la utilidad de la endoscopia de control programada versus la endoscopia única en pacientes con UPA. Nuestro outcome primario fue el resangrado. Los outcomes secundarios fueron la necesidad de cirugía, la mortalidad y el número de unidades de sangre transfundidas (NUST). Todos los meta-análisis se realizaron mediante un modelo de efectos aleatorios. Se calcularon el riesgo relativo (RR) combinado y la diferencia de medias (DM), con sus intervalos de confianza (IC) del 95% para los resultados categóricos y continuos, respectivamente. El riesgo de sesgo se evaluó mediante la herramienta Cochrane RoB 2.0 y la calidad de la evidencia (QoE) se calificó con el enfoque GRADE. Resultados: Se incluyeron ocho ECA de texto completo y dos resúmenes de ECA (n = 1513). No encontramos diferencias en resangrado (RR, 0,78; IC 95%, 0,53-1,14, QoE moderada), cirugía (RR, 0,58; IC 95%, 0,291,15, QoE moderada), mortalidad (RR, 0,89; 95% IC, 0,46-1,71, QoE moderada) o NUST (DM, -0,01 unidades; IC del 95%, -0,3 a 0,28, QoE baja) entre la segunda revisión y la endoscopia única. Los análisis de sensibilidad tuvieron resultados similares a los análisis principales. Conclusiones: La endoscopia de control de rutina no fue más eficaz que la endoscopia única en pacientes con UPA.

Consenso de endoscopia en enfermedad inflamatoria intestinal de la Organización Panamericana de Crohn y Colitis (PANCCO) y la Sociedad Interamericana de endoscopia (SIED) / Pan American Crohn's and Colitis Organization (PANCCO) and the Interamerican Society of Endoscopy (SIED) consensus on endoscopy in inflammatory bowel disease

resumen está disponible en el texto completo

ABSTRACT Introduction: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications. Materials and methods: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement. Results: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD. Conclusions: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.

Endoscopic decompression as management of uncomplicated sigmoid volvulus: case report and literature review

Sigmoid volvulus is a cause of intestinal obstruction explained by the twist of the sigmoid over its mesentery. The colon is at risk of ischaemia due to alterations in the irrigation due to rotation of the mesentery and risk of perforation. Surgical management is suggested in complicated cases, but endoscopic management with decompression and detorsion may be suggested in the case of uncomplicated sigmoid volvulus, with risk of recurrence. We present the case of a 49-year-old male with a diagnosis of uncomplicated sigmoid volvulus resolved by decompression with rigid proctosigmoidoscopy and medical management with remission of intestinal occlusion, without surgical intervention. A case and review of the current literature are presented.

Role of histopathological and microbiological investigations for a definitive diagnosis of benign sinonasal masses: a tertiary care institute study

Background: This research aimed to study the clinical presentation of various sino nasal masses (SNM), to study the importance of Histopathological and microbiological investigations in making diagnosis of SNM and to study the correlation between clinical, radiological, histopathological, and microbiological findings of SNM. Methods: In the present study 50 patients attending the ENT outpatient department with clinical evidence of nasal mass were selected based on inclusion and exclusion criteria. Patients were examined clinically and radiologically followed by surgical intervention. Histopathological and microbiological examination was done to make a definitive diagnosis. Results: Majority of cases were from 21-40 years age group (66%) with male preponderance. Nasal obstruction was most common symptom 45 (90%) followed by nasal discharge 43(86%). On histopathology highest incidence was of inflammatory polyps 22 (44%) followed by allergic polyps 14(28%) and non-invasive fungal sinusitis (NIFS) 11 (22%) respectively. Microscopically in KOH, fungal elements, yeast and hyphae were seen in total 11 (22%) cases and with SDA, Aspergillus niger was seen in 7 (14%) cases, Candida albicans in 3 (6%) and both in 1 (2%) case. Correlation of provisional diagnosis with HPE was found to be highly significant. Conclusions: It was observed that histopathological and microbiological examination is irreplaceable as both are the 揋OLD STANDARD� for making a definitive diagnosis.

Stomach Cancer and Postendoscopy Colorectal Cancer: Parallel Lives / Cáncer gástrico y cáncer colorrectal posendoscopia: vidas paralelas

Abstract Background and objectives: The rates of (interval) stomach cancer (SC) or postendoscopy (PECRC) or postcolonoscopy (PCCRC) colorectal cancer (CRC) have been little studied in our setting. Data from overseas studies reported PECRC and PCCRC rates of 7-26%. We aim to determine and compare local PECRC and PCCRC rates and characteristics. Patients and methods: With data from three quaternary-care cancer centers, we ambispectively identified patients diagnosed with SC and CRC between 2012 and 2021, in whom a history of endoscopies or colonoscopies in the previous three years was investigated. Cancers diagnosed between 6 and 36 months after an endoscopic study reported as normal were defined as interval cancers. This study compares the clinical, endoscopic, and survival characteristics of both PECRC and PCCRC cohorts. Results: Of 828 patients diagnosed with SC, 66 had PECRC (rate: 7.3%), while in 919 patients with CRC, 68 had PCCRC (rate: 6.9%). There were no significant differences in age or sex, although males predominated (2:1) in the PECRC (0.09). The finding of premalignant lesions was similar in both groups (p = 0.260). The anatomical location was shown to be more proximal (right colon) in the PCCRC than in the PECRC (cardia/fundus) (p = 0.002). Gastric neoplasms were more poorly differentiated (58%) than colon neoplasms (26%) (p = 0.001). There were no differences in early cancers, but tumor status was more advanced in PECRC (p < 0.01). The Kaplan-Meier showed a worse survival for PCCRC than for detected CRC, with no differences in SC and PECRC, suggesting poor survival. Conclusions: The rate of interval cancers is 7.3% and 6.9%, and differences were found between PECRC and PCCRC, proximal locations of the lesions, degree of differentiation, tumor status, and poor survival for the PCCRC. Establishing measures to achieve the World Endoscopy Organization's goal of <5% is necessary.

Resumen Antecedentes y objetivos: Las tasas de cáncer gástrico (CG) o cáncer colorrectal (CCR) posendoscopia (CGPE) o poscolonoscopia (CCRPC) (de intervalo) han sido poco estudiadas en nuestro medio. Los datos de estudios en el exterior informaron tasas de CGPE y CCRPC de 7%-26%. Nuestro objetivo fue determinar y comparar las tasas y características del CGPE y CCRPC locales. Pacientes y métodos: Con datos de tres centros oncológicos de cuarto nivel se identificaron, de forma ambispectiva, pacientes diagnosticados con CG y CCR entre 2012 y 2021, en quienes se investigó el antecedente de endoscopias o colonoscopias en los tres años previos. Los cánceres diagnosticados entre 6 y 36 meses después de un estudio endoscópico reportado como normal se definieron como cánceres de intervalo. En este estudio se comparan las características clínicas, endoscópicas y de sobrevida entre ambas cohortes de cánceres posendoscopia y poscolonoscopia. Resultados: De 828 pacientes diagnosticados con CG, 66 tuvieron CGPE (tasa: 7,3%), mientras que en 919 pacientes con CCR, 68 pacientes presentaron CCRPC (tasa: 6,9%). No hubo diferencias significativas en la edad o el sexo, aunque predominó el masculino (2:1) en el CGPE (0,09). El hallazgo de lesiones premalignas fue similar en ambos grupos (p = 0,260). La ubicación anatómica mostró ser más proximal (colon derecho) en el CCRPC que en el CGPE (cardias/fondo) (p = 0,002). Las neoplasias gástricas fueron más mal diferenciadas (58%) que las de colon (26%) (p = 0,001). No hubo diferencias en los cánceres tempranos, pero el estado tumoral fue más avanzado en el CGPE (p < 0,01). El Kaplan-Meier mostró una peor sobrevida para el CCRPC que para el CCR detectado, sin diferencias en el CG y el CGPE, que mostraron una pobre sobrevida. Conclusiones: La tasa de cánceres de intervalo es de 7,3% y 6,9%, y se encontraron diferencias entre los CGPE y el CCRPC, ubicaciones proximales de las lesiones, grado de diferenciación, estado del tumor y una pobre sobrevida para el CCRPC. Se hace necesario establecer medidas para lograr la meta de la Organización Mundial de Endoscopia de <5%.

Endoscopic Ultrasound-guided Hepaticogastrostomy, Experience in Colombia: Case Series / Hepaticogastrostomía guíada por ultrasonido endoscópico, experiencia en Colombia: serie de casos

Abstract The primary tool for malignant biliary obstruction is decompression of the bile duct, using endoscopic retrograde cholangiopancreatography (ERCP) with stenting, which is satisfactory in many cases; still, the actual challenge arises when it is impossible to cannulate the ampulla of Vater due to neoplastic involvement at that level. Although percutaneous transhepatic biliary drainage (PTBD) is an option, it has high morbidity, which directly impacts the patient's quality of life by having an external device added to a malignant pathology. With the arrival of endoscopic ultrasound (EUS), new methods have been reported, such as EUS-guided hepaticogastrostomy (EUS-HGS), which is performed through a natural orifice (NOTES) and positively impacts the outcome of these patients. Below is an example of our experience with the first three cases in Colombia.

Resumen La principal herramienta para la obstrucción biliar maligna es la descompresión de la vía biliar, mediante la colangiopancreatografía retrógrada endoscópica (CPRE) con colocación de stent, la cual en un gran porcentaje de los casos es satisfactoria; sin embargo, el verdadero reto se presenta cuando es imposible canular la papila de váter por compromiso neoplásico a ese nivel. Aunque el drenaje biliar transhepático percutáneo (PTBD) es una opción, representa una gran morbilidad, que repercute directamente en la calidad de vida del paciente al tener un dispositivo externo sumado a una patología maligna. Con la llegada de la ultrasonografía endoscópica (USE), existen nuevos métodos reportados como la hepaticogastrostomía guiada por EUS (EUS-HGS), la cual se realiza por un orificio natural (NOTES) e impacta positivamente en el desenlace de estos pacientes. A continuación, se ejemplifica nuestra experiencia con los primeros 3 casos en Colombia.

Estudio de la vía aérea superior frente a apneas obstructivas del sueño persistentes en pediatría / An approach to the upper airway evaluation in pediatric persistent obstructive sleep apnea

El síndrome de apneas obstructivas del sueño (SAOS) en pediatría constituye un trastorno asociado a múltiples consecuencias en el espectro cognitivo y comportamental. El principal factor de riesgo asociado es la hipertrofia amigdalina y las vegetaciones adenoideas. La adenoamigdalectomía es el tratamiento de primera línea. La incidencia del SAOS persistente varía entre un 15 % y un 75 % según las comorbilidades. Este se presenta como un desafío a la hora de tratarlo; requiere un abordaje integral para su diagnóstico y tratamiento adecuado. El objetivo de esta revisión bibliográfica es proponer un abordaje diagnóstico y terapéutico para el SAOS persistente.

In pediatrics, obstructive sleep apnea syndrome (OSAS) is a disorder associated with multiple consequences at the cognitive and behavioral level. The main associated risk factor is the presence of tonsillar hypertrophy and adenoids. An adenotonsillectomy is the first-line treatment. The incidence of persistent OSAS varies from 15% to 75%, depending on comorbidities. This is a challenge in terms of management; it requires a comprehensive approach for an adequate diagnosis and treatment. The objective of this bibliographic review is to propose a diagnostic and therapeutic approach for persistent OSAS.