Cáncer gástrico: algunas consideraciones sobre factores de riesgo y Helicobacter pylori / Gastric cancer: some considerations on risk factors and Helicobacter

RESUMEN La Organización Mundial de la Salud señala que el cáncer gástrico es una neoplasia frecuente en el mundo contemporáneo. Constituye la segunda causa de muerte en el hombre y la tercera en las mujeres. Numerosos son los factores de riesgo que se asocian con la aparición del cáncer gástrico, en determinadas regiones del mundo. El descubrimiento del Helicobacter pylori y la asociación con las enfermedades gastroduodenales ha revolucionado los aspectos fisiopatológicos y terapéuticos hasta el punto de considerar la bacteria como agente precursor del cáncer gástrico. Por tal motivo se realizó una revisión de los factores de riesgo y el papel del Helicobacter pylori en la formación de la neoplasia gástrica, con el objetivo de aportar conocimientos relacionados con el cáncer gástrico y su prevención (AU).

ABSTRACT The World Health Organization points out that gastric cancer is a frequent neoplasia in the contemporary world. It is the second cause of death in men and the third one in women. There are several risk factors associated to the development of gastric cancer in specific regions of the world. The discovery of Helicobacter pylori and its association to gastro duodenal diseases has renewed the physiopathological and therapeutic aspects up to the point of considering the bacteria as precursor agent of gastric cancer. For that cause, it was carried out a review of the risk factors and the role of Helicobacter pylori in the formation of gastric neoplasia, with the objective of giving out knowledge related to gastric cancer and its prevention (AU).

Curva de aprendizaje en disección endoscópica de la submucosa en un hospital universitario latinoamericano / Learning curve in the endoscopic submucosal dissection at a Latin American university hospital

Introduction: The endoscopic submucosal dissection (ESD) is a technique used in the treatment of early gastric cancer that was developed in Japan in the early 90's. When compared with mucosectomy it shows clear benefits, as lower local recurrence with the resection of lesions greater than 2 cm, yet with larger number of complications, especially bleeding and perforation. There is little experience with ESD in the West, because of the low incidence of early gastric cancer and the lack of screening programs; ESD reports are scarce in Colombia. Objective: To report the experience with the endoscopic dissection of the gastric submucosa in the period between March 2012 and January 2014 at Hospital de San José, Bogotá, Colombia. Methods: ESD was performed in eight patients (four men and four women) that fulfilled the Vienna criteria for this procedure. Results: Eight ESD were performed, three in the body and five in the antrum, with a mean size of 3.4 cm; complications included bleeding in one patient and perforation in one patient. En bloc resection was achieved in all eight cases with R0 (margins free of tumor) in seven patients. Conclusion: Gastric ESD is a complex technique and infrequent technique in our evironment. The procedure was performed in a safe manner with acceptable complication rates and achieving en bloc resection in all patients.

Introduction: The endoscopic submucosal dissection (ESD) is a technique used in the treatment of early gastric cancer that was developed in Japan in the early 90's. When compared with mucosectomy it shows clear benefits, as lower local recurrence with the resection of lesions greater than 2 cm, yet with larger number of complications, especially bleeding and perforation. There is little experience with ESD in the West, because of the low incidence of early gastric cancer and the lack of screening programs; ESD reports are scarce in Colombia. Objective: To report the experience with the endoscopic dissection of the gastric submucosa in the period between March 2012 and January 2014 at Hospital de San José, Bogotá, Colombia. Methods: ESD was performed in eight patients (four men and four women) that fulfilled the Vienna criteria for this procedure. Results: Eight ESD were performed, three in the body and five in the antrum, with a mean size of 3.4 cm; complications included bleeding in one patient and perforation in one patient. En bloc resection was achieved in all eight cases with R0 (margins free of tumor) in seven patients. Conclusion: Gastric ESD is a complex technique and infrequent technique in our evironment. The procedure was performed in a safe manner with acceptable complication rates and achieving en bloc resection in all patients.