Seguridad de la endoscopia y biopsia esofágica en un paciente con esofagitis eosinofílica y enfermedad de Von Willebrand / Safety of esophageal endoscopy and biopsy in a patient with eosinophilic esophagitis and Von Willebrand disease

La esofagitis eosinofílica (EoE) es una enfermedad causada por una respuesta inmune frente a antígenos alimentarios en contacto con la mucosa esofágica; por su parte, la enfermedad de Von Willebrand (EVW) es el trastorno hemorrágico hereditario más común en los seres humanos. La característica central de todos los tipos de EVW, es la presencia de cantidades reducidas o de formas anormales del factor de Von Willebrand (FVW) en el torrente sanguíneo. Debido a que no se han reportado casos previos de EVW tipo 2A asociada a EoE, se describe este caso clínico con el objetivo principal de dar a conocer el hallazgo casual de estas dos patologías, la seguridad de la evaluación por endoscopia de vías digestivas altas y el pronóstico de posibles complicaciones

Eosinophilic esophagitis (EoE) is a disease caused by an immune response against food antigens in contact with the esophageal mucosa; alternatively, Von Willebrand disease (VWD) is the most common inherited bleeding disorder in humans. The central characteristic of all types of VWD is the presence of reduced amounts or abnormal forms of VWF in the bloodstream. Since no previous cases of VWD type 2A associated to EoE have been reported, this clinical case is described with the main objective to present the coincidental finding of these two pathologies, the safety of the evaluation by upper gastrointestinal endoscopy, and the prognosis of possible complications

CARACTERIZAÇÃO DAS ENDOSCOPIAS DIGESTIVAS ALTAS REALIZADAS NO MUNICÍPIO DE MOSSORÓ-RN / CHARACTERIZATION OF HIGH DIGESTIVE ENDOSCOPIES PERFORMED IN THE MUNICIPALITY OF MOSSORÓ-RN

Objetivou-se caracterizar as EDA realizadas na Comunidade de Saúde de Mossoró, RN, no período de 2008 a 2013, definindo a taxa de exames normais e a prevalência dos principais achados sugestivos de patologias digestivas. Trata-se de um estudo transversal e retrospectivo, no qual se analisou 10311 laudos de EDA. As análises estatísticas foram realizadas pelo SPSS (Statistical Package for the Social Sciences, versão 20.0), com nível de confiança95% e um p < 0,05, utilizando-se testes Qui-quadrado. Pelos dados levantados, constatamos que a EDA é um exame prático e seguro, com raríssimas complicações, sendo a agitação e a presença de alimento no estômago as limitações mais comuns. Na análise descritiva geral observou-se que a maioria dos exames foi realizada no gênero feminino, formando mais de 70% da amostra total. A faixa etária predominante, independente do gênero, foi 41 a 60 anos. As patologias frequentes no segmento esofágico foram as Esofagites. No segmento gástrico, a maior frequência de achados foram as Gastrites, que são mais frequentes com o avançar da idade. Na Transição Gastroduodenal, as úlceras de Canal Pilórico são os achados mais descritos, mas observamos também modestos achados de duodenites. No duodeno, os principais achados foram úlceras duodenais, seguidas pelas duodenites e sinais de atrofia. Portanto, as EDA são mais realizadas no gênero feminino, mas apresentam maior percentual de exames normais, sendo a maior frequência de achados encontrada no gênero masculino. Assim, após analisar as 10.311 EDA, é possível prever os achados mais comuns encontrados a EDA.

This study aimed to characterize the EDA held in Mossoro Health Community, RN, from 2008 to 2013, setting the rate of normal examinations and the prevalence of the main findings suggestive of digestive pathologies. It is a cross-sectional retrospective study, which analyzed 10,311 reports of EDA. Statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 20.0), with a confidence level 95% and p <0.05, using chi-square tests. Raised by the data, we found that EDA is a practical and safe exam, with very few complications, agitation and presence of food in the stomach the most common limitations. In general descriptive analysis it was observed that most of the exams was held in females, forming more than 70% of the total sample. The predominant age group, regardless of gender, was 41-60 years. The frequent pathologies in esophageal segment were Esophagitis. Gastric segment, the highest frequency of findings were Gastritis, which are more common with advancing age. Gastroduodenal in Transition, the Channel Pyloric ulcers are the most described findings, but also observed modest findings of duodenitis. In the duodenum, the main findings were duodenal ulcers, followed by duodenitis and signs of atrophy. Therefore, the EDA are more performed in females, but have a higher percentage of normal results, with the highest frequency of findings found in males. So after analyzing 10,311 EDA, it is possible to predict the most common findings EDA.

Accès d'euphorie au réveil d'une sédation avec le propofol

L'objectif de cette revue était de rapporter les effets hallucinatoires survenus chez un sujet de 30 ans, au réveil d'une sédation au propofol pour endoscopie digestive. Le propofol est un hypnotique intraveineux d'utilisation courante lors des anesthésies pour gestes de courte durée comme les procédures diagnostiques en radiologie et en endoscopie. Le réveil post-anesthésie est qualifié « de très bonne qualité », cependant des effets hallucinatoires et psychodysleptiques ont fait l'objet de quelques écrits dans la littérature. Nous rapportons un cas d'accès d'euphorie post-anesthésique après sédation au propofol pour une endoscopie digestive

Complicaciones de las videocolonoscopias en los primeros once años en un equipo quirúrgico / Adverse events related to colonoscopy on the initial eleven years of a surgical team

Antecedentes: la videocolonoscopia es un procedimiento imprescindible para el diagnóstico y tratamiento de afecciones colorrectales que forma parte de los recursos del cirujano. Posee un índice de complicaciones que pueden ser graves y requieren un adecuado manejo. Objetivo: analizar la experiencia de complicaciones de once años de un equipo quirúrgico realizando videocolonoscopia, con revisión de la bibliografía actual. Material y métodos: análisis retrospectivo consecutivo sobre una base de datos prospectiva. Entre enero de 2005 y diciembre de 2016 se realizaron endoscopias digestivas altas y bajas, diagnósticas y terapéuticas. Se analizan puntualmente las complicaciones de las videocolonoscopias y su manejo por parte del equipo quirúrgico. Resultados: de 3218 videocolonoscopias, 8 pacientes registraron complicaciones (0,2%). Todas fueron perforaciones colónicas resueltas mediante cirugía, con rafia primaria y operación tipo Hartmann. No hubo mortalidad en la serie. Conclusiones: si bien los procedimientos endoscópicos tienen efectos adversos, pueden ser llevados a cabo con estándares de calidad por cirujanos. Es importante que el equipo actuante esté capacitado para la resolución de complicaciones.

Background: colonoscopy is essential for the diagnosis and treatment of colorectal conditions, and is part of the surgeon's resources. Complications associated with the procedure could be severe, and require an appropriate management. Objective: to analyze complications associated with colonoscopies done by a surgical team. Material and method: retrospective analysis on a prospective database. Diagnostic and therapeutic colonoscopies done by a surgical team between January 2005 and December 2016 were included. Complications and management strategies were analyzed. Results: of 3218 colonoscopies, 8 patients presented complications (0.2%). All were colon perforations solved by surgery, with primary closure and a kind of Hartmann's procedure. There was no mortality In this series. Conclusions: although endoscopic procedures may have adverse effects, they can be done under standards of quality by surgeons. It is important that the intervening team be qualified for the solution of complications.

Endoscopic surveillance of extensive esophageal papillomatosis not amenable to endoscopic therapy / Controle endoscópico de papilomatose esofágica extensa sem indicação para tratamento endoscópico

ABSTRACT We present two cases of esophageal papillomatosis, a very rare reported disease leading to dysphagia and did not improve after endoscopic treatment. Both patients refused surgery and they were followed-up for 3 years, but no significant clinical or endoscopic changes were seen.

RESUMO Apresentamos dois casos de papilomatose esofágica, lesão raramente relatada, que pode levar à disfagia, e que não teve melhora após tratamento endoscópico. Ambos os pacientes recusaram cirurgia e foram acompanhados por até 3 anos, sem alterações clínicas ou endoscópicas importantes.

Análise epidemiológica de pacientes submetidos à endoscopia digestiva alta em uma unidade de saúde de curta permanência / Epidemiological analysis of patients submitted to high digestive endoscopy in a short-stay health unit

Introdução e objetivos: a Endoscopia Digestiva Alta (EDA) representa o método de endoscopia mais usado, e geralmente é realizada sob sedação consciente. Dentre os efeitos adversos (EA) deste exame, os eventos cardiorrespiratórios são os que implicam maior importância, representando cerca de 60% do total, estando relacionados a fatores predisponentes dos pacientes, tais como obesidade, idade e doenças pulmonares prévias. Assim, considerando-se a relevância dos fatores de risco (FR) relacionados ao paciente e seus possíveis efeitos na morbimortalidade geral do procedimento, objetiva-se com o presente trabalho epidemiológico traçar o perfil do paciente que se submete à EDA no Brasil. Métodos: o estudo é transversal com amostragem aleatória de 974 pacientes submetidos à EDA eletiva. O questionário foi aplicado entre janeiro de 2013 e junho de 2013. Resultados: a média de idade foi de 40,88 anos, sendo 11,50% acima dos 60 anos. A média do IMC foi de 26,21kg/m², com 53,18% dos entrevistados apresentando sobrepeso ou obesidade. As morbidades encontradas incluíram hipertensão arterial sistêmica (N=152); outras doenças cardíacas (N=35); doenças respiratórias (N=599); diabetes mellitus (N=43); doença tireoidiana (N=68). Os principais medicamentos utilizados foram os benzodiazepínicos (4,93%) ou outros neuropsiquiátricos, somando 11,59%. O uso de álcool foi relatado por 37,39% e 5,54% eram tabagistas. Apenas 19,40% dos pacientes não apresentavam alguma enfermidade coexistente ou FR. Conclusão: considerando-se a endoscopia e a sedação envolvida, a atenção às variações demográficas e epidemiológicas populacionais assume especial importância, visto que estão diretamente relacionadas ao aumento da probabilidade de ocorrência de EA cardiorrespiratórios durante e após o procedimento. As conclusões deste trabalho devem ser entendidas à luz de seu local de realização, que é uma unidade ambulatorial.

Background: the Upper Gastrointestinal Endoscopy (UGE) represents the most common endoscopic modality and it is usually made with conscious sedation. Among the adverse events of this procedure, the cardiovascular events are the most relevant, comprising around 60% of overall events. It is known that some adverse events are related to patient's risk factors, such as obesity, age and pulmonary disease. Thus, considering the importance of risk factors and their impact in the morbimortality related to the procedure, the aim of this study is to know the epidemiological profile of the patients that need an endoscopy in Brazil. Methods: it is a sectional study with an aleatory sample of 974 patients that was submitted to an elective UGE in the period of January of 2013 and June of 2013. A questionnaire was applied to each individual. Results: the average age of the study was 40.88 years old, with 11.50% being over 60 years old. The body mass index (BMI) average was 26.21 kg/m² among which 53.18% of the interviewed could be classified as overweight or obese. The morbidities founded were high blood pressure (N=152); other cardiac diseases (N=35); respiratory diseases (N=599); diabetes mellitus (N=43); thyroid diseases (N=68). The most used drugs were benzodiazepines (4.93%) or other psychiatric drugs, comprising 11.59%. The use of alcohol was mentioned by 37.39% and 5.54% were smokers. Only 19.40% amongst the patients did not mention any comorbidity or risk factor to the procedure. Conclusion: considering the endoscopy and the sedation involved in the procedure, knowing the demographic and epidemiological differences between populations are of special importance, since they are related to the cardiorespiratory adverse events that can occur during and after an UGE. The conclusions of this study should be interpreted taking into account that it was made in an ambulatory unity.

Perforación durante la endoscopia ¿qué hacer, qué no hacer? / Perforation in endoscopy. what to do, what not to do?

Iatrogenic perforation during endoscopy is associated to significant morbidity and mortality, and presents a high incidence due to the increasing number of endoscopic procedures and the frequency of complex therapeutic procedures. Evidence available to decide which is the best strategy to manage patients with iatroenic perforation is scarce, mainly due to rare occurrence of this complication. The European Society of Gastroenterology (ESGE) published their “Position Statement on Diagnosis and management of iatrogenic endoscopic perforations” including recommendations for developing a strategy for the prevention and management of iatrogenic perforations in the gastrointestinal tract. Among the multiple recommendations, the following have shown a reduction in the morbi-mortality rate: implementing a written protocol on the management of these complications; including information on their location, and initial endoscopic management; carrying out a CT if signs or symptoms are present; attempting endoscopic closure, depending on the type of perforation, its size and endoscopic expertise; change to CO2 insufflation; derivation of luminal contents and decompression of pneumoperitoneum or pneumothorax; and finally, considering additional management based on successful closure of the perforation and on the patient’s clinical condition, as well as early surgical resolution if no endoscopic closure is performed or if the procedure fails in patients with poor clinical condition.

La perforación iatrogénica durante los procedimientos endoscópicos se asocia a significativa morbilidad y mortalidad y presenta una incidencia creciente por el alto número exploraciones endoscópicas y la realización cada vez más frecuente de procedimientos terapéuticos complejos. La evidencia disponible para decidir cuál es la mejor estrategia para manejar a los pacientes con una perforación iatrogénica es escasa, principalmente debido a lo inhabitual de esta complicación. La Sociedad Europea de Endoscopia Gastrointestinal (ESGE) publicó su “Declaración de Posición de Diagnóstico y Manejo de Perforaciones Endoscópicas Iatrogénicas” en la que formula diversas recomendaciones para desarrollar una estrategia de prevención y manejo de perforaciones iatrogénicas del tubo digestivo. Dentro de las principales recomendaciones, las siguientes han demostrado una reducción en la morbimortalidad: implementar un protocolo escrito sobre el manejo de estas complicaciones; incluir en el informe datos sobre su tamaño, localización y manejo endoscópico inicial; la realización de una tomografía computada ante síntomas o signos sugerentes; intentar el cierre endoscópico, dependiendo del tipo de perforación, su tamaño y la experiencia endoscópica disponible; el cambio a insuflación con CO2; la derivación del contenido luminal y la descompresión del neumoperitoneo o neumotórax a tensión; y finalmente, basar el manejo adicional en el éxito estimado del cierre y en la condición clínica del paciente, considerando la resolución quirúrgica precoz en caso de no realizar un cierre endoscópico o falla de éste y/o en pacientes con deterioro clínico.

Complications after intestinal resection in Crohn's disease: laparoscopic versus conventional approach / Complicações após ressecções intestinais na doença de Crohn: há diferenças entre as vias convencional e videolaparoscópica?

BACKGROUND: significant advances in medical therapy for Crohn's disease (CD) occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series. METHODS: this was a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD) referral center, treated between January 2008 and June 2012 with laparoscopic approach (LA) or conventional approach (CA). VARIABLES ANALYZED: age at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LA or CA), and complication rates and characteristics were compared. Statistical analysis was performed with Mann-Whitney test (quantitative variables) and chi-square test (qualitative variables), with p < 0.05 considered significant. RESULTS: a total of 46 patients (25 men) were included (16 submitted to LA), with mean age of 38.1 (± 12.7) years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CA group (p = 0.029). The most common procedure performed was ileocolic resection on both groups (56.7% of the CA and 75% of the LA patients - p = 0.566). Overall, total complications (surgical and medical, including minor and major issues) occurred in 60% (18/30) of the CA group and 12.5% (2/16) of the LA group (p = 0.002). Wound infection was the most frequent complication (10/30 on CA and 1/16 on the LA groups). There were 3 deaths in the CA group. Specific analysis of each complication did not demonstrate any difference between the groups regarding abdominal sepsis, urinary tract infections, pneumonia, readmission, reoperations and deaths (p = 0.074). CONCLUSIONS: there was a higher complication rate in patients operated with CA as compared to LA. This was probably due to patient selection for the laparoscopic approach, with severe cases, mostly due to fistulizing abdominal CD, being operated mainly by open surgery. LA tends to be the recommended approach in most cases of non-complicated CD. (AU)

INTRODUÇÃO: avanços significativos no tratamento medicamentoso da doença de Crohn (DC) ocorreram nos últimos 12 anos, principalmente após a introdução da terapia anti-TNF. A cirurgia laparoscópica colorretal representa um dos maiores progressos no tratamento cirúrgico minimamente invasivo da DC, bem como no manejo de outras afecções. Existe uma tendência a menores taxas de complicações com as ressecções intestinais laparoscópicas quando comparadas a cirurgia convencional. O objetivo deste estudo foi analisar e comparar as taxas de complicações após ressecções intestinais na DC entre as duas vias de acesso em uma série de casos brasileira. MÉTODO: estudo retrospectivo longitudinal, incluindo pacientes com DC submetidos a ressecções intestinais em um centro de referência brasileiro em doença inflamatória intestinal (DII), tratados entre janeiro de 2008 e junho de 2012, com cirurgia laparoscópica (CL) ou cirurgia convencional (CC). As variáveis analisadas foram: idade no momento da cirurgia, gênero, classificação de Montreal, tabagismo, medicações concomitantes, tipo de cirurgia, via de acesso, presença e tipo de complicação em até 30 dias do procedimento. Readmissão, reoperações e mortalidade também foram avaliadas. Os pacientes foram alocados em dois grupos de acordo com a via de acesso (CL ou CC), sendo as taxas de complicações comparadas entre si. Análise estatística foi realizada pelos testes de Mann-Whitney (variáveis quantitativas) e chi-quadrado (qualitativas), com p<0.05 considerado significativo. RESULTADOS: No total, 46 pacientes (25 homens) foram incluídos (16 operados por CL), com média de idade de 38,1 (± 12,7) anos. Os grupos foram considerados homogêneos em relação à idade, gênero, localização da doença, DC perianal e medicações concomitantes. Houve predomínio da forma fistulizante no grupo de cirurgias abertas (p = 0.029). O procedimento mais realizado foi a ileocolectomia direita em ambos os grupos (56,7% na CC e 75% na CL - p = 0.566). No total, complicações pós-operatórias (cirúrgicas e clínicas) ocorreram em 60% (18/30) dos casos após CC e 12,5% (2/16) após a CL (p = 0.002). Infecção da ferida operatória foi a complicação mais frequente (10/30 na CC e 1/16 na CL). Ocorreram 3 óbitos no grupo da CC. Em análise individualizada das complicações, não houve diferença entre os grupos em relação a sepse abdominal, infecções urinárias, pneumonia, reinternações, reoperações e óbitos (p=0.074). CONCLUSÕES: houve maior taxa de complicações nos pacientes operados por CC comparado a CL. A seleção de casos para cirurgia laparoscópica provavelmente contribuiu para este resultado, havendo uma tendência a utilização da cirurgia convencional nos casos mais graves, geralmente com DC abdominal fistulizante. A CL parece ser a via de acesso recomendada na maioria dos casos de DC não-complicada. (AU)

Chronic Kidney Disease, Hemodynamic Instability, and Endoscopic High-Risk Appearance Are Associated with 30-Day Rebleeding in Patients with Non-Variceal Upper Gastrointestinal Bleeding

The results of studies that evaluated predictive factors for rebleeding in non-variceal upper gastrointestinal bleeding are inconsistent. The aim of this study was to investigate predictive factors for 30-day rebleeding in these patients. A consecutive 312 patients presenting symptoms and signs of gastrointestinal bleeding were enrolled in this prospective, observational study. Clinical and demographic characteristics and endoscopic findings were evaluated for potential factors associated with 30-day rebleeding using logistic regression analysis. Overall, 176 patients were included (male, 80.1%; mean age, 59.7+/-16.0 yr). Rebleeding within 7 and 30 days occurred in 21 (11.9%) and 27 (15.3%) patients, respectively. We found that chronic kidney disease (CKD) (OR, 10.29; 95% CI, 2.84-37.33; P100 beats/min) during the admission (OR, 3.79; 95% CI, 1.25-11.49; P=0.019), and Forrest classes I, IIa, and IIb (OR, 6.14; 95% CI, 1.36-27.66; P=0.018) were significant independent predictive factors for 30-day rebleeding. However, neither Rockall nor Blatchford scores showed statistically significant relationships with 30-day rebleeding in a multivariate analysis. CKD, hemodynamic instability during hospitalization, and an endoscopic high-risk appearance are significantly independent predictors of 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. These factors may be useful for clinical management of such patients.

Diagnostic Yield of Tissue Sampling Using a Bite-On-Bite Technique for Incidental Subepithelial Lesions

BACKGROUND/AIMS: Techniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique. METHODS: One hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion. RESULTS: The bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109). CONCLUSIONS: The bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.

Neumomediastino Espontáneo: reporte de un caso y revisión de la literatura / Spontaneous pneumomediastinum: report of a case and literature review

El neumomediastino espontáneo es un trastorno infrecuente que, por lo general, ocurre en personas jóvenes sin un factor o una enfermedad evidente precipitante. El término espontáneo se refiere a la ausencia de trauma u otros procesos patológicos identificables que expliquen el origen del neumomediastino. Se presenta el caso de un paciente masculino de 29 años de edad, ingresado en el Hospital Escuela, quien luego de presentar crisis convulsivas secundarias a síndrome de abstinencia inicia con dolor torácico,disnea y crepitación subcutánea; la radiografía de tórax reveló enfisema subcutáneo y aire libre en la cavidad torácica, se realizó varios exámenes entre ellos una TAC de tórax que confirmó el hallazgo. Se concluyó que presentó neumomediastino espontáneo. La evolución fue satisfactoria.

Utilização prévia de antiinflamatórios não-esteróides por pacientes encaminhados para endoscopia em um hospital universitário brasileiro / Use of nonsteroidal anti-inflammatory drugs by patients before undergoing to endoscopy in a Brazilian university hospital

O estudo teve como objetivo descrever o padrão de uso de antiinflamatórios não-esteróides (AINE) por pacientes encaminhados para endoscopia digestiva alta no Hospital das Clínicas/UFMG, Belo Horizonte/MG. Trata-se de um estudo transversal de uma amostra de 533 pacientes com idade igual ou superior a 17 anos, com endoscopia previamente marcada. Os dados foram coletados por meio de questionário padronizado. As variáveis estudadas foram relativas aos antiinflamatórios não-esteróidese ao seu modo de uso. Cerca de 34% dos entrevistados relatou uso de AINE no período de um mês anterior à endoscopia. Os AINE mais utilizados foram o ácido acetilsalicílico e o diclofenaco e o uso caracterizou-se, principalmente, pela forma esporádica e por período inferior a sete dias. Entre os AINE que foram utilizados por período prolongado, foram mais frequentes o uso em dose diária elevada e o uso de mais de uma especialidade. Evidenciou-se um cenário de utilização inadequada destes medicamentos entre os pacientes estudados, caracterizado pelo uso de especialidades desaconselhadas, uso de AINE em indicações inadequadas, uso de associações medicamentos as questionáveis e uso desnecessário de especialidades dispendiosas em detrimento daquelas seguras e mais acessíveis. Os resultados apontam para a necessidade de estudos adicionais, a fim de maior aprofundamento no conhecimento dessa questão no Brasil.

The objective of this study was to describe the pattern of use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients referred for upper endoscopy at the Teaching Hospital of the Federal University of Minas Gerais, Belo Horizonte, Brazil. This cross-sectional survey included 533 patients, aged 17 or older, whose endoscopies had been previously scheduled. A standardized questionnaire was used to collect the data, which related to the nonsteroidal anti-inflammatory drugs taken and the way in which they were used. Almost 34% of the interviewed subjects reported having taken NSAIDs during the month prior to the endoscopy. The NSAIDs used most were acetylsalicylic acid and diclofenac and their pattern of use was characterized, in the main, by sporadic use over a period of less than seven days. Among the NSAIDs taken for long periods of time (> 30 dias), a commonly observed pattern was high daily doses and more than one kind of drug. The general picture that emerged was of inappropriate use of these medicines among the studied patients, typically the use of non-recommended types of drug, inappropriate use of NSAIDs for certain conditions, use of questionable drug combinations and the unnecessary use of expensive drugs despite the availability of safer and cheaper alternatives. The results point to the need to carry out more research, to improve our understanding of this question in Brazil.

Resultados obtenidos con el tratamiento quirúrgico en el cáncer esofágico / Results obtained from the surgical treatment of esophageal cancer

Con el objetivo de conocer la morbilidad y mortalidad que con esta terapéutica se ofrece a los pacientes ingresados en el Hospital Clinicoquirúrgico "Hermanos Ameijeiras", se realizó un estudio descriptivo, prospectivo, se calcularon medias, porcentajes y prueba de correlación de Pearson. Se estudiaron 71 personas con cáncer esofágico, durante los últimos 7 años, 49 (69 por ciento) con indicación quirúrgica y 22 sin ella. Del primer grupo 37 fueron hombres y 12 mujeres con una media de 56 años. 43 fueron resecables, 21 por técnica de McKeown. En el 100 (por ciento) se usó estómago y realizó yeyunostomía. En los últimos 7 casos no se realizó proceder de drenaje gástrico. Hubo 7 accidentes (16,3 (por ciento) y 22 complicados (51,2 (por ciento), principalmente por fístula cervical (16). La mortalidad fue de 14 (por ciento), asociada a sepsis y mayores de 60 años. Para mejorar estos resultados debemos mejorar la técnica de esofagogastrostomía cervical, evitar la sepsis y evaluar los riesgos en mayores de 60 años(AU)

To find out morbidity and mortality of this therapy that is provided to the patients admitted to "Hermanos Ameijeiras" clinical and surgical hospital, a prospective, descriptive study was conducted in which means and percentages were estimated and Pearson´s correlation test was applied. Seventy one persons with esophageal cancer were studied for the last 7 years, 49 (69 percent) with surgical prescription and 22 without surgical prescription. Of the 49, 37 were males and 12 females averaging 56 years of age. Forty three were resectable cancers, 21 operated on by McKeown technique. Stomach was used and jejunostomy performed in 100 percent of cases. In the last 7 cases, no gastric drainage procedure was applied. There were 7 accidents (16,3 percent) and 22 complicated patients (51.2 percent), mainly due to cervical fistula (16). The mortality rate was 14 percent associated with sepsis and age over 60 years. To improve these outcomes, we should better the cervical esophagogastrostomy technique, avoid sepsis and evaluate the risk of this procedure in over 60 years-old people(AU)

Cuidados de enfermería en la detección del helicobacter pylori en pacientes operados de estómago / Nursing care in the detection of Helicobacter pylori in patients with stomach surgery

En los pacientes operados de estómago el reflujo biliar reduce la incidencia de Helicobacter pylori, ya que crea condiciones desfavorables para su supervivencia, lo cual es más evidente en aquellos casos operados con la técnica Billroth I y II o con vagotomías con piloroplastia. De 55 pacientes gastrectomizados estudiados de forma experimental, no ciego y aleatorio, se detectó en 30 de ellos la presencia de Helicobacter pylori mediante métodos invasivos empleados, lo que demuestra una incidencia elevada de 55 (por ciento), al compararla con los datos reportados en la literatura médica internacional. Los 30 pacientes fueron adultos de uno y otro sexos, con diagnóstico de gastritis crónica alcalina por reflujo duodenogástrico; en resecados de estómago (Billroth I, II) mediante endoscopia superior y con H.pylori positivo. La infección por H. pylori fue más frecuente en enfermos del sexo masculino y en edades comprendidas entre los 46 y 60 años. Se describen los cuidados de enfermería en la realización de la endoscopia y en las diferentes investigaciones efectuadas para la detección del H. pylori. Se hace énfasis en la importancia de la labor de enfermería para garantizar el éxito del diagnóstico de esta infección(AU)

In patients with stomach surgery, the biliary reflux reduces the incidence of Helicobacter Pylori since it creates unfavorable conditions for the survival of this bacteria. This is more evident in those cases operated on with Billroth I and II o with vagotomies with pyloroplasty. Of 55 patients with stomach surgeries included in an experimental non-blind and random study, helicobacter pylory was found in 30 of them by using invasive methods., which showed a high incidence of 55 percent after a comparison with the international medical literature data. These 30 patients were adults of both sexes diagnosed with chronic alkaline gastritis due to duodenal-gastric reflux, gastric-resected (Billroth I,II) through upper endoscopy and H.pylory-positive. H.pylori infection was more frequent in male patients aged 46-60 years. Nursing care in endoscopy and in the various research methods for detecting H.pylori was described. Emphasis was made on the importance of the nurses'work to ensure successful diagnosis of this infection(AU)

Fibrovideo endoscopía de la vía biliar / Endoscopy biliary procedure

Se presentan 45 pacientes en los que se realizó endoscopía de la vía biliar. La vía utilizada fue: laparotómica en 35, laparoscópica en 4, transfistular en 3 y transhepática en otros 3. El tiempo de exploración promedio fue de 17,7 minutos y no hubo accidentes o complicaciones relacionadas con el método. En el 27 por ciento de los casos se modificó el diagnóstico inicial. En el 45 por ciento de los casos de litiasis coledociana, demostró persistencia de litiasis luego de la exploración instrumental. Por la mejor evaluación biliar, se realizaron 10 coledocorrafias primarias y 7 abordajes transcísticos. La principal ventaja de la endoscopía biliar es su efectividad para reducir a los niveles mínimos la incidencia de litiasis residual postoperatoria. Es un procedimiento versátil que puede realizarse por varios accesos a la vía biliar y permite definir el tratamiento en forma más racional

Uso de midazolam para sedaçäo em endoscopia digestiva alta: estudo comparativo näo encoberto entre as vias intravenosa e sublingual / Use of midazolan for sedation in upper digestive endoscopy: comparative study between intravenous and sublingual route

Os autores compararam a efetividade do midazolam sublingual com o midazolam intravenoso como pré-medicaçao em EDA, envolvendo 80 pacientes divididos em dois grupos. O grau de sedaçao, cooperaçao durante o procedimento e o grau de amnésia após o exame foram comparados, bem como os efeitos na PA, FC e FR, que foram similares para as duas vias de administraçao, com exceçao da amnésia anterógrada, que foi mais efetiva no grupo intravenoso. Concluem que o uso de midazolam sublingual tem efetividade semelhante ao intravenoso, porém com custo menos elevado, determinando maior praticidade na execuçao do procedimento.