ABSTRACT
A wide variety of benign and malignant submucosal lesions may arise from the wall of the large intestine. They can originate in the submucosa or in the muscular propia; furthermore, they can be caused by compression of extrinsic structures.1,2 We report a case of a submucosal mass identified as a fecalith protruding into the cecum.
ABSTRACT
BACKGROUND: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. OBJECTIVE: to assess the safety of esophageal dilation and the factors associated with the development of complications. MATERIALS AND METHODS: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. RESULTS: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. CONCLUSIONS: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.
Subject(s)
Dilatation/adverse effects , Esophageal Stenosis/surgery , Esophagoscopy/adverse effects , Adult , Aged , Aged, 80 and over , Cohort Studies , Esophageal Perforation/etiology , Esophagoscopy/methods , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Predictive Value of Tests , Retrospective Studies , Young AdultABSTRACT
Antecedentes: las dilataciones endoscópicas se consideran el tratamiento de elección para las estenosis esofágicas, sin embargo, no se cuenta en nuestra región con estudios en los que se evalúe la seguridad de este procedimiento. Objetivo: evaluar la seguridad de las dilataciones esofágicas y los factores asociados a las complicaciones. Material y métodos: cohorte retrospectiva. Se incluyeron todos los pacientes referidos para dilatación esofágica entre enero de 2015 y junio de 2017. Se obtuvo la tasa de complicaciones y se determinó la asociación entre la no adherencia a la "regla de los tres" y el desarrollo de complicaciones. Se analizaron otros factores predictivos asociados al desarrollo de complicaciones. Resultados: se incluyeron 164 pacientes en los que se realizaron 474 dilataciones. La etiología más prevalente fue la estenosis de anastomosis quirúrgica. Se presentaron seis complicaciones: tres perforaciones (0,63%), dos sangrados (0,42%) y un episodio de dolor significativo que requirió observación posprocedimiento (0,21%). La dilatación endoscópica esofágica fuera de la "regla de los tres" no se encontró asociada a un mayor riesgo de complicaciones. La dilatación con balón fue el único factor predictivo para el desarrollo de complicaciones. Conclusiones: la dilatación esofágica es un procedimiento seguro. La no adherencia a la "regla de los tres" no parece estar asociada a un mayor riesgo de complicaciones, incluyendo la perforación esofágica
Background: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. Objective: to assess the safety of esophageal dilation and the factors associated with the development of complications. Materials and methods: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. Results: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. Conclusions: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Esophageal Stenosis/surgery , Esophageal Perforation/epidemiology , Dilatation/adverse effects , Iatrogenic Disease/epidemiology , Risk Factors , Postoperative Complications/epidemiology , Deglutition Disorders/etiologyABSTRACT
BACKGROUND: In Peru, there are still no local studies designed for evaluating the performance of clinical guidelines designed to stratify patients according to probability of choledocholithiasis. OBJECTIVES: To evaluate the performance of predictive criteria proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in diagnosis of choledocholithiasis. MATERIALS AND METHODS: A retrospective cohort study conducted in a hospital in Lima (Rebagliati hospital). Were included all patients with suspected choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) between July 2014 and June 2015. Predictors of choledocholithiasis proposed by the ASGE and the diagnostic performance of the risk categories were evaluated. RESULTS: 118 patients met the inclusion criteria. In multivariate analysis, only age >55 years (OR: 3.07 [95: 1.14-8.31], p = 0.027) and the finding of stones in the common bile duct by abdominal ultrasound (OR: 1.68 [95% CI: 1.09-2.59], p = 0.018) were associated with the presence of choledocholithiasis on ERCP. The performance of the high and intermediate risk categories were 75.82% and 70.37% respectively. The performance of the high-risk category improved to 85.90% using a second set of biochemical markers. CONCLUSIONS: The performance of the predictors and risk categories proposed by the ASGE in diagnosis of choledocholithiasis is acceptable in our hospital, according to the proposed standards; however, it must be further improved to prevent the use of diagnostic ERCP.
Subject(s)
Choledocholithiasis/diagnosis , Decision Support Techniques , Health Status Indicators , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Female , Hospitals , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Peru , Practice Guidelines as Topic , Retrospective Studies , Risk Assessment , Sensitivity and SpecificityABSTRACT
Antecedentes: En el Perú no se cuenta con ningún estudio que evalúe el rendimiento de la guía clínica actual orientada a estratificar a los pacientes según probabilidad de presentar coledocolitiasis. Objetivos: Evaluar el rendimiento de los criterios predictivos propuestos por la Sociedad Americana de Endoscopía Gastrointestinal (ASGE) en el diagnóstico de coledocolitiasis. Materiales y métodos: Cohorte retrospectiva realizada en el hospital Rebagliati. Se incluyeron a todos los pacientes con sospecha de coledocolitiasis que contaron con una colangiopancreatografía retrógrada endoscópica (CPRE) entre julio del 2014 y junio del 2015. Se evaluaron los predictores de coledocolitiasis propuestos por la ASGE y el rendimiento diagnóstico de las categorías de riesgo. Resultados: Se incluyeron 118 pacientes que cumplieron con los criterios de inclusión. En el análisis multivariado sólo la edad >55 años (OR:3,07, [IC 95: 1,14-8,31], p=0,027) y el hallazgo de litiasis en la vía biliar común mediante ecografía (OR: 1,68 [IC 95%: 1,09-2,59], p=0,018) se asociaron a la existencia de coledocolitiasis en la CPRE. Los rendimientos de las categorías de riesgo elevado y de riesgo intermedio fueron de 75,82% y 70,37% respectivamente. El rendimiento de la categoría de riesgo elevado mejoró a 85,90% utilizando un segundo set de pruebas de laboratorio control. Conclusiones: El rendimiento de los predictores y las categorías de riesgo propuestos por la ASGE en el diagnóstico de coledocolitiasis es aceptable en nuestro hospital, acorde con los estándares propuestos; sin embargo, creemos que aún debe mejorar para evitar el uso de CPREs diagnósticas.
Background: In Peru, there are still no local studies designed for evaluating the performance of clinical guidelines designed to stratify patients according to probability of choledocholithiasis. Objectives: To evaluate the performance of predictive criteria proposed by the American Society for Gastrointestinal Endoscopy (ASGE) in diagnosis of choledocholithiasis. Materials and methods: A retrospective cohort study conducted in a hospital in Lima (Rebagliati hospital). Were included all patients with suspected choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) between July 2014 and June 2015. Predictors of choledocholithiasis proposed by the ASGE and the diagnostic performance of the risk categories were evaluated. Results: 118 patients met the inclusion criteria. In multivariate analysis, only age >55 years (OR: 3.07 [95: 1.14-8.31], p = 0.027) and the finding of stones in the common bile duct by abdominal ultrasound (OR: 1.68 [95% CI: 1.09-2.59], p = 0.018) were associated with the presence of choledocholithiasis on ERCP. The performance of the high and intermediate risk categories were 75.82% and 70.37% respectively. The performance of the high-risk category improved to 85.90% using a second set of biochemical markers. Conclusions: The performance of the predictors and risk categories proposed by the ASGE in diagnosis of choledocholithiasis is acceptable in our hospital, according to the proposed standards; however, it must be further improved to prevent the use of diagnostic ERCP.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Health Status Indicators , Decision Support Techniques , Choledocholithiasis/diagnosis , Peru , Logistic Models , Multivariate Analysis , Retrospective Studies , Sensitivity and Specificity , Cholangiopancreatography, Endoscopic Retrograde , Practice Guidelines as Topic , Risk Assessment , HospitalsABSTRACT
OBJECTIVE: The present study was designed to determine the histological effect of Lepidium meyenii "Maca" on the gastric mucosa in patients with functional dyspepsia. MATERIAL AND METHODS: This study consists of a clinical case series, in which the effect of Maca on the gastric histopathology of 29 Peruvian patients diagnosed with functional dyspepsia was examined. The presence of H. pylori, as well as the degree and depth of the gastric mucosa inflammation was evaluated from biopsies obtained before and after the treatment based solely of Maca 3 grams per day for four weeks. RESULTS: Average values of the degree and depth of mucosal inflammation before and after the treatment were compared showing no statistical difference among the samples. Sixteen patients were infected with H. pylori, and they remained infected after the treatment with Maca. CONCLUSIONS: A four week long treatment with Maca does not produce significant changes on gastric mucosa of patients with functional dyspepsia, neither on H. pylori eradication.
Subject(s)
Dyspepsia/pathology , Gastric Mucosa/drug effects , Gastric Mucosa/pathology , Lepidium , Plant Preparations/pharmacology , Adolescent , Adult , Aged , Dyspepsia/microbiology , Female , Gastric Mucosa/microbiology , Helicobacter pylori/isolation & purification , Humans , Male , Middle Aged , Young AdultABSTRACT
Objetivo: Determinar el efecto que tiene Lepidium meyenii Maca en la histología de la mucosa gástrica en pacientes con dispepsia funcional. Material y métodos: Serie de casos realizado en el Hospital Nacional Cayetano Heredia en la que se evaluó el efecto de la Maca administrada por cuatro semanas 3 gramos por día en la histopatología gástrica de pacientes con diagnóstico clínico y endoscópico de dispepsia funcional. Se evaluó el grado y la profundidad de la inflamación en la lámina propia y el efecto sobre la presencia de H. pylori (en aquellos que tenían la infección), a través de biopsias obtenidas antes y después del tratamiento. Resultados: Se reclutaron 29 pacientes con dispepsia funcional entre el 2010 y 2012. Las biopsias antes y después del tratamiento, revisadas por un solo patólogo, no demostraron cambios significativos en los parámetros histológicos, ni tuvo efecto en la erradicación del H. pylori. Conclusiones: La Maca no produce cambios significativos en la mucosa gástrica ni tiene efecto en la erradicación del H. pylori al ser brindada por cuatro semanas a pacientes con dispepsia funcional.
Objective: The present study was designed to determine the histological effect of Lepidium meyenii Maca on the gastric mucosa in patients with functional dyspepsia. Material and methods: This study consists of a clinical case series, in which the effect of Maca on the gastric histopathology of 29 Peruvian patients diagnosed with functional dyspepsia was examined. The presence of H. pylori, as well as the degree and depth of the gastric mucosa inflammation was evaluated from biopsies obtained before and after the treatment based solely of Maca 3 grams per day for four weeks. Results: Average values of the degree and depth of mucosal inflammation before and after the treatment were compared showing no statistical difference among the samples. Sixteen patients were infected with H. pylori, and they remained infected after the treatment with Maca. Conclusions: A four week long treatment with Maca does not produce significant changes on gastric mucosa of patients with functional dyspepsia, neither on H. pylori eradication.
