[Use of intragastric balloon in 385 obese patients]. / Experiencia en un solo centro de la utilización del balón intragástrico en 385 pacientes obesos.

BACKGROUND: Obesity is associated with systemic co-morbi- dities. Conservative management has a low rate ofsuccess in the short and long term. Therefore, novel endoscopic strate- gies have emerged as alternative therapies to bariatric sur- gery. The intragastric balloon (IGB) is a temporary, effective and safe endoscopic treatment for weight loss. Objectives. 1. To describe changes in body mass index (BMI) in patients who completed treatment with IGB. 2. To describe metabo- lic co-morbidities and psychological features at admission. MATERIAL AND METHODS: Patients with an age equal to or higher than 13 years-old were evaluated by a multidiscipli- nary team and categorized as "suitable" for IGB. The study took place in aprivate center in Buenos Aires, Argentina, bet- ween November 2007 andNovember 2012. The design was interventionist, longitudinal, comparative and retrospective. Interventions were: a) IGB placement was done with the usual technique; b) Nutritional monitoring was performed and a low calorie diet and an exercise plan were indicated. Follow-up was performed monthly. Main outcome measu- rements were: 1) Changes in BMI between baseline and at IGB removal according to diet and exercise compliance, 2) metabolic co-morbidities, 3) psychological traits evaluated wit checklist SCL 90. RESULTS: We included 385 patients, 66% female, mean age 41 years (range 13 to 70 years). A BMI decrease of 5 points (13 kg) was observed in the overall sample and in the 322 patients (83.6%) who completed 6 months (14 kg) (NS). The weight loss was greater in those who were compliant to diet and exercise (P = 0.0001). Most prevalent metabolic co-morbidities and psychological traits were dyslipemia and depression, respectively. CONCLUSIONS: IGB was effective in all patients. Weight loss was greater in patients compliant to diet and exercise.

[Detection of polyps, adenomas, advanced adenomas and adenocarcinomas in patients between 45 and 49 years]. / Detección de pólipos, adenomas, adenomas avanzados y adenocarcinomas de colon en pacientes entre 45 y 49 años.

UNLABELLED: BACKGROUND. Colorectal cancer (CRC) can be prevented. Colonoscopy is the first-line procedure for screening in average risk population. In 2002, Imperiale evaluated people between 40 to 49 years and reported that adenomas and advanced adenomas presented in 8.5% and 3.5% of cases, respectively. Currently, no recommendations for CRC screening in this population have been made. OBJECTIVE: To estimate the prevalence ofpolyps, adenomas, advanced lesions and adenocarcinomas in the 45- to 49-year-old population. METHODS: We included consecutive adults between 45 and 49 years old who performed colonoscopy because of gastrointestinal signs or symptoms. Exclusion criteria were high risk for CRC, incomplete VCC and/or previous evidence of colonic lesions. The study was conducted in a gastroenterology center from Buenos Aires, between September 2010 and October 2011. The design was prospective and cross-sectional. Polyethylene glycol (PEG) lavage solution or phosphates were usedfor cleansing. Colonoscopies were performed under sedation with Olympus equipment. The protocol was approved by the local IRB. 95% confidence intervals (95% CI) were estimated. RESULTS: 814 patients were evaluated and 764 were included, 440 (57%) were women and the average age was 47 years. The global prevalence of polyps was 20% (160 cases, 95% CI 18%-24%). The global prevalence of adenomas was 14% (107 cases, 95% CI 11%-16%). The prevalence of advanced adenomas was 5% (39 cases, 95% CI 4%-7%) and the prevalence of adenocarcinoma was 0.1% (1 case, 95% CI 0%-0.7%). CONCLUSIONS: The prevalence of lesions in this population is lower than that in the average risk population. At the moment we do understand that there is no evidence to recommend CRC screening in 45- to 49-year-old individuals.

[Prevalence of rectosigmoid adenomas and adenocarcinomas in patients younger than 50 years old referred for proctorrhagia]. / Prevalencia de adenomas y adenocarcinomas de recto-sigma en pacientes menores de 50 años que consultan por proctorragia.

BACKGROUND: Rectal bleeding is a sign of colorectal cancer (CRC). Its early diagnosis decreases mortality and improves survival. In young population with no risk factors for the disease, CRC is infrequent. Moreover, benign anorectal disorders are most frequent causes of bleeding and generally, when anal pathology is identified, it is assumed as the origin of the sign. For all these reasons, rectal bleeding sometimes is sub-assessed in young patients. OBJECTIVE: Estimate the prevalence of adenomas and adenocarcinomas in sigmoid and rectum in patients younger than 50 years old referred for proctorrhagia. METHODS: The study design was descriptive, retrospective and cross-sectional. Procedures were performed under sedation and Olympus CF 160 y CF 180 scopes were used. Proctorrhagia was considered as rectal bleeding registered as indication of the procedure. Histology was established according to Vienna classification. Informed consent was signed before the procedures. Colonoscopy reports were reviewed. The study took place in an outpatient clinic in Buenos Aires city, between October 2010 and October 2011. High risk patients for CRC were excluded RESULTS: We included 1,203 from 1,257 reviewed VCC, 49% were female and the median age was 38 years old (range: 18-49 years old). The prevalence of adenomas and adenocarcinomas in sigmoid and rectum was 67% [95% confidence interval (95% CI): 5.4-8.3] and 1.6% (95% CI 1-2.5), respectively. CONCLUSIONS: Adenocarcinomas and adenomas are infrequent in a young population without risk factors for CRC. However, even when benign anal disorders are the most frequent cause for rectal bleeding, miss evaluation of this sign could have a serious impact in almost 10 of 100 individuals.

Prevalencia de adenomas y adenocarcinomas de recto-sigma en pacientes menores de 50 años que consultan por proctorragia / [Prevalence of rectosigmoid adenomas and adenocarcinomas in patients younger than 50 years old referred for proctorrhagia].

BACKGROUND: Rectal bleeding is a sign of colorectal cancer (CRC). Its early diagnosis decreases mortality and improves survival. In young population with no risk factors for the disease, CRC is infrequent. Moreover, benign anorectal disorders are most frequent causes of bleeding and generally, when anal pathology is identified, it is assumed as the origin of the sign. For all these reasons, rectal bleeding sometimes is sub-assessed in young patients. OBJECTIVE: Estimate the prevalence of adenomas and adenocarcinomas in sigmoid and rectum in patients younger than 50 years old referred for proctorrhagia. METHODS: The study design was descriptive, retrospective and cross-sectional. Procedures were performed under sedation and Olympus CF 160 y CF 180 scopes were used. Proctorrhagia was considered as rectal bleeding registered as indication of the procedure. Histology was established according to Vienna classification. Informed consent was signed before the procedures. Colonoscopy reports were reviewed. The study took place in an outpatient clinic in Buenos Aires city, between October 2010 and October 2011. High risk patients for CRC were excluded RESULTS: We included 1,203 from 1,257 reviewed VCC, 49

were female and the median age was 38 years old (range: 18-49 years old). The prevalence of adenomas and adenocarcinomas in sigmoid and rectum was 67

CI): 5.4-8.3] and 1.6

CI 1-2.5), respectively. CONCLUSIONS: Adenocarcinomas and adenomas are infrequent in a young population without risk factors for CRC. However, even when benign anal disorders are the most frequent cause for rectal bleeding, miss evaluation of this sign could have a serious impact in almost 10 of 100 individuals.

Prevalencia de adenomas y adenocarcinomas de recto-sigma en pacientes menores de 50 años que consultan por proctorragia. / [Prevalence of rectosigmoid adenomas and adenocarcinomas in patients younger than 50 years old referred for proctorrhagia].

BACKGROUND: Rectal bleeding is a sign of colorectal cancer (CRC). Its early diagnosis decreases mortality and improves survival. In young population with no risk factors for the disease, CRC is infrequent. Moreover, benign anorectal disorders are most frequent causes of bleeding and generally, when anal pathology is identified, it is assumed as the origin of the sign. For all these reasons, rectal bleeding sometimes is sub-assessed in young patients. OBJECTIVE: Estimate the prevalence of adenomas and adenocarcinomas in sigmoid and rectum in patients younger than 50 years old referred for proctorrhagia. METHODS: The study design was descriptive, retrospective and cross-sectional. Procedures were performed under sedation and Olympus CF 160 y CF 180 scopes were used. Proctorrhagia was considered as rectal bleeding registered as indication of the procedure. Histology was established according to Vienna classification. Informed consent was signed before the procedures. Colonoscopy reports were reviewed. The study took place in an outpatient clinic in Buenos Aires city, between October 2010 and October 2011. High risk patients for CRC were excluded RESULTS: We included 1,203 from 1,257 reviewed VCC, 49

were female and the median age was 38 years old (range: 18-49 years old). The prevalence of adenomas and adenocarcinomas in sigmoid and rectum was 67

[95

confidence interval (95

CI): 5.4-8.3] and 1.6

(95

CI 1-2.5), respectively. CONCLUSIONS: Adenocarcinomas and adenomas are infrequent in a young population without risk factors for CRC. However, even when benign anal disorders are the most frequent cause for rectal bleeding, miss evaluation of this sign could have a serious impact in almost 10 of 100 individuals.

[Adherence of physicians to colorectal cancer screening: which is their compliance to this strategy?]. / Adherencia de la población médica a los programas de rastreo de cáncer colorrectal: ¿Cuál es el cumplimiento de esta medida preventiva entre los profesionales?

BACKGROUND: Colorectal cancer (CRC) screening is strongly recommended as early diagnosis improves survival and reduces mortality. However, the adherence in general population is about 50% and even lower among physicians. OBJECTIVE: 1) To estimate the percentage of physicians that had done a screening test. 2) To estimate the frequency of tests used by these professionals. METHODS: We conducted an anonymous survey among 269 physicians, 50-year-old or more, from four hospitals and four scientific conventions in 2008. This validated survey included specialty, family history, compliance to screening, clinical features at screening, age, tests used reasons for having or not done the tests and results. RESULTS: Twenty-four hundred and two data surveys were included (response rate 90%). Average age was 58+6 years. Specialties were Internal Medicine (72%), Surgery (18%) and others (9%). One hundred physicians had a test done [41% (IC95% 35-47)]. The most used test was colonoscopy [70% (IC 95% 60-78)], followed by barium enema [10% (IC 95% 5-18)]. From screened physicians, 36% had family history of CRC, 63% did not and 1% was unaware of this antecedent. Physicians referred the following reasons for not being compliant: personal decision, fear of the procedure, insufficient knowledge of guidelines and lack of time. CONCLUSIONS: The compliance of physicians to CRC screening is suboptimal. New strategies should be implemented to achieve changes in health habits of physicians and compliance to preventive strategies.