EUS-guided tissue samples for the diagnosis of patients with a thickened gastric wall and prior negative endoscopic biopsies.

AIM: Evaluate the diagnostic yield of biopsies obtained by EUS guidance in patients with gastric wall thickening and prior negative endoscopic biopsies. MATERIAL AND METHODS: Data collected from October 2008 to January 2016 were analyzed in a retrospective manner. All included patients had undergone at least one endoscopy with a negative biopsy and showed evidence of gastric wall thickening by tomography, confirmed by endoscopy. All patients gave their written informed consent before the procedure. Demographics and baseline characteristics, including age, sex, number of previous endoscopies, and histopathological diagnosis were recorded. Follow-up data were obtained from a review of the electronic medical records. RESULT: In total, 22 patients with previous negative endoscopic biopsies and gastric wall thickening were included. Using EUSFNA/FNB, the diagnosis was made in the first procedure in 19/22 (86.30%) cases, while in 1/22 (4.5%) patients the diagnosis was made in the second EUS-FNA. A total of 18 (81.82%) patients with EUS-FNA were assessed using a standard Echo-tip, while the remaining four (18.18%) patients underwent EUS-FNB and using a ProCore needle. All patients with a final diagnosis of malignancy had a thickened gastric wall with impaired gastric distension and a loss of wall structure determined by EUS. Of patients with a benign final diagnosis, all (n=8) showed a thickened gastric wall by EUS but with preservation of the deep layers. CONCLUSION: EUS-FNA/FNB is necessary in patients with a thickened gastric wall and prior negative biopsy on endoscopy. The procedure is safe and has a good diagnostic.

Barrett's esophagus: Ten years of experience at a tertiary care hospital center in Mexico. / Esófago de Barrett: experiencia de 10 años en un centro de tercer nivel en México.

INTRODUCTION: The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. AIM: To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. MATERIAL AND METHODS: The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. RESULTS: Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. CONCLUSIONS: The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer.

[Optimization of the tagged urea test for the detection of H. pylori in patients with dyspepsia]. / Optimización de la prueba de la urea marcada para la detección de H. pylori en pacientes con dispepsia.

Helicobacter pylori (Hp) has been associated to gastritis, peptic ulcer, gastric cancer, and other gastrointestinal disorders. The 14C-urea breath test (UBT) has been proposed as a simple and noninvasive method for its detection, and has recently been implemented in our institution. To optimize our resources, we performed a sensitivity analysis to determine the minimal sampling and duration of testing required, and to establish objective criteria for its interpretation. With this purpose, endoscopy, antral biopsy and UBT were performed in 104 dyspeptic patients. For the UBT, a basal breath sample was taken before the administration of 10 microCi of 14C-urea and followed by sequential breath sampling at 5, 15, 30 and 60 minutes. Considering histologic findings as the gold standard, receiver operating characteristic (ROC) curves were constructed for the following three 14CO2 excretion strategies: excretion by sample, maximum excretion, and cumulative excretion. Hp was detected in 74 (71%) of the patients, and its presence coincided with significantly higher 14CO2 excretion than in the Hp negative (p < 0.001). The three excretion strategies were comparable in terms of diagnostic accuracy, but the most efficient results were given by the 15 minute sample. With a cut-off point of > or = 1.7%, the sensitivity and specificity of this sample was > or = 83%, the positive and negative predictive values were 93% and 68%, and the accuracy was 84%. We conclude that UBT can be completed with a single breath sampling at 15 min, and its results objectively interpreted as positive if the 14CO2 excretion is > or = 1.7%.

[Usefulness of the 14C-urea marked test in the detection of Helicobacter pylori in patients with dyspepsia]. / Utilidad de la prueba de urea marcada con 14C en la detección de Helicobacter pylori en pacientes con dispepsia.

This study was undertaken to evaluate the usefulness of the urea test (UT) in the detection of Helicobacter pylori (HP) in dyspeptic patients. The UT was done in 105 patients with dyspepsia who underwent endoscopy and biopsy. Hematoxylin-eosin and Warthin Starry tissue stains were performed for HP detection, and the resulting microscopic findings were considered as the gold standard. The sensitivity, specificity, and positive and negative predictive values of the UT were of 95%, 63%, 85% and 83% when compared to the hematoxylin-eosin stain-related findings, and 99%, 79%, 93% and 96% when compared to those related to the Warthin Starry stain. We conclude that the UT is a simple, non-invasive and useful diagnostic alternative to detect HP in patients with dyspepsia.

[Emergency endoscopic sclerosis in esophageal varices]. / Esclerosis endoscópica de urgencia en várices esofágicas.

In 52 patients we performed endoscopic sclerotherapy during active bleeding with good results in stopping hemorrhage in 93%. Most patients were Child "C" (66%) and postnecrotic cirrhosis was the commonest etiology (50%). Major complications were pleural effusion (2%) and mediastinal inflammation (2%), no mortality was found directly by this method. Conclusions are that endoscopic sclerosis of variceal hemorrhage have a special role in stopping bleeding but has no effect in one year survival.

[Esophageal candidiasis in AIDS. Clinical, endoscopic, and histopathologic analysis of 19 cases]. / Candidiasis esofágica en SIDA. Análisis clínico, endoscópico e histopatológico en 19 casos.

From May 1988 to December 1989, fiberoptic endoscopy of the upper digestive tract was performed in 53 patients with AIDS. In 19 cases a presumptive diagnosis of candida esophagitis was made: 13 were men and six women; the median age was 38.9 years. The Kodsi grading scale was used to evaluate the extent of the fungal colonization. In five patients no symptoms were found, eight did not show oral candidiasis; dysphagia in seven cases and odynophagia in five cases were the main esophageal complaints. Eleven cases showed pan-esophagitis, but three cases showed only the distal portion involvement. Grade II lesions were observed in ten patients, and four had grades I or III. No correlation was found between the symptoms and the grade score. Direct brushing cytology of the esophageal lesions corroborated the endoscopic diagnosis. Association with other opportunistic infections were detected only in one case. Our findings corroborates the usefulness of the fiberoptic esophageal endoscopy to improve the diagnosis of AIDS-related esophageal candidiasis in patients without symptoms or oral lesions.

[Gastric polyps. Experience at the department of endoscopy of the Salvador Zubirán National Institute of Nutrition]. / Pólipos gástricos. Experiencia en el Departamento de Endoscopia del Instituto Nacional de la Nutrición Salvador Zubirán.

During 1981-1989 we seen 54 patients with gastric polyps in the Instituto Nacional de la Nutrición SZ, Endoscopy Dept., México City. We found 100 polyps among 15,974 upper endoscopy studies (0.33%), being multiple in 22 patients with an overall of 68 polyps. Females had a predominance of 2:1 with prevalence from the 5th to 8th decades. All were asymptomatic in regard to polyps. Its main locations were in antrum (46%) and corpus (39%). They measured an average of 8 mm with a range from 5 to 25. Only three adenomatous polyps shows dysplastic changes, two with moderate dysplasia and one, bigger than 20 mm, had severe dysplasia (carcinoma in situ). Histological findings were: Inflammatory (chronic gastritis) 30%, adenomatous 22%, hyperplastic 17% and hamartomatous 13%. In seven patients we seen recurrence at follow up.