Diagnostic accuracy of the faecal immunochemical test for colorectal cancer in symptomatic patients: comparison with NICE and SIGN referral criteria.

AIM: The diagnostic accuracy of the faecal immunochemical test (FIT) at a 100 ng/ml threshold for colorectal cancer (CRC) was compared with National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) referral criteria. METHOD: A multicentre, prospective, blind study of diagnostic tests was carried out in two Spanish health areas. In 787 symptomatic patients referred for a diagnostic colonoscopy, we determined whether patients met NICE and SIGN referral criteria. All patients performed one FIT determination (OCsensor(™) ). The sensitivity and specificity for CRC detection were determined with McNemar's test. The diagnostic odds ratio as well as the number needed to scope (NNS) to detect a CRC were calculated. RESULTS: We detected CRC in 97 (12.3%) patients; 241 (30.6%) had an FIT ≥ 100 ng/ml and 300 (38.1%) and 473 (60.1%) met NICE and SIGN referral criteria. The FIT had a higher sensitivity for CRC detection than NICE criteria (87.6%, 61.9%; P < 0.001) and SIGN criteria (82.5%; P = 0.4). The specificity of FIT was also higher than NICE and SIGN criteria (77.4%, 65.2%, 42.7%; P < 0.001). The odds ratios of FIT, NICE and SIGN criteria for the diagnosis of CRC were 24.24 (95% CI 12.91-45.53), 3.04 (95% CI 1.96-4.71) and 3.51 (95% CI 2.03-6.06). The NNS to detect a CRC in individuals with an FIT ≥ 100 ng/ml was 2.83 (95% CI 2.4-3.41) and in individuals who met NICE and SIGN criteria it was 5 (95% CI 3.98-6.37) and 5.95 (95% CI 4.85-7.35). CONCLUSION: Our study suggests that FIT is more accurate for the detection of CRC than the current NICE and SIGN referral criteria in symptomatic patients referred for colonoscopy.

Factors associated with complete endoscopic resection of an invasive adenocarcinoma in a colorectal adenoma.

BACKGROUND AND OBJECTIVE: endoscopic polypectomy may allow curative resection of invasive adenocarcinoma on colorectal adenoma. Our goal was to determine the factors associated with complete endoscopic resection of invasive adenocarcinoma. METHODS: retrospective observational study. We included 151 patients with invasive adenocarcinoma on adenomas endoscopically resected between 1999 and 2009. We determined those variables independently related to incomplete resection by a logistic regression. Relation was expressed as Odds Ratio (OR) and its 95% confidence interval (95% CI). RESULTS: patients were predominantly male (66.2%) and their mean age was 68.03 ± 10.65 years. Colonoscopy was completein 84% of the patients and 60.3% had synchronous adenomas. Invasive adenocarcinoma was mainly located in distal colon (90.7%) and morphology was pedunculated in 75.5%. The endoscopic averagesize was 22.61 ± 10.86 mm. Submucosal injection was required in 32.5%. Finally, the resection was in one piece in 73.5% and incomplete in 8.6% of the adenocarcinomas. Factors independently associated with incomplete endoscopic resection were size (mm) (OR 1.08, 95% CI 1.03-1.14, p = 0.002), sessile or flat morphology (OR 8.78, 95% CI 2.24-34.38, p = 0.002) and incomplete colonoscopy (OR 4.73, 95% CI 1.15-19.34, p = 0.03). CONCLUSIONS: endoscopic polypectomy allows complete resection of 91.4% of invasive adenocarcinomas on colorrectal adenoma in our series. Factors associated with incomplete resection were the size of the lesion, sessile or flat morphology and incomplete colonoscopy.

Immunohistochemical alterations in invasive adenocarcinoma in endoscopically resected adenoma and factors associated with risk of residual or recurrent disease.

AIM: We determined the pattern of immunohistochemical expression in invasive adenocarcinoma in endoscopically resected adenoma, its relationship with the risk of residual or recurrent disease and the related factors. METHOD: We included individuals with malignant polyps resected endoscopically in the period 1999-2009. Clinical and endoscopic data were collected. All histological specimens were re-analysed. CD44, matrix metalloproteinase 9 (MMP-9), vascular endothelial growth factor-ß (VEGF-ß), ß-catenin, laminin and cyclooxygenase 2 (COX-2) expression were determined by immunohistochemistry. A multivariate logistic regression was performed to determine variables independently associated with the risk of residual or recurrent disease. RESULTS: One-hundred and fifty-one malignant polyps (114 pedunculated; mean size ± SD=22.61 ± 10.86 mm) were resected endoscopically. Resection was fragmented and incomplete in 26.5% and 8.6% of patients, respectively. Surgical resection was performed on 71 (47%) patients. After a median follow-up of 44 months, residual (n=12) or recurrent (n=6) disease was detected in 17 patients. Conventional histology showed that 32.1% met high-risk histological criteria. Immunohistochemical expression was positive for CD44, MMP-9, VEGF-ß, ß-catenin, laminin and COX-2 in 63.3%, 25.3%, 45%, 38.8%, 79% and 34.5% of specimens, respectively, with no differences between both groups. Variables associated with residual or recurrent disease in the univariate analysis were: nonpedunculated morphology (P=0.07); fragmented (P<0.001) or incomplete resection (P<0.001); margin infiltration (P=0.04); and histological high-risk lesion (P=0.003). Finally, incomplete resection (OR=12.16, 95% CI=3.15-46.98; P<0.001) and histological high risk (OR=4.73, 95% CI=1.33-16.74; P=0.002) were independently associated with the risk of residual or recurrent disease. CONCLUSION: Immunohistochemistry could not predict residual or recurrent disease. Only incomplete excision and histological high risk did so. The factors independently associated were histological high-risk lesion and incomplete resection.

Risk factors associated with Helicobacter pylori infection. A population-based study conducted in the province of Ourense.

OBJECTIVES: to identify the relationship between Helicobacter pylori infection and various factors that have been described in other studies in the general adult population in the province of Ourense. MATERIAL AND METHODS: three hundred and eighty-three participants were enrolled in a study on the prevalence of Helicobacter pylori infection. All participants filled in a questionnaire under supervision, and the data obtained were examined by means of a univariate analysis. The odds ratio corresponding to each variable studied was calculated with their corresponding 95% confidence intervals. Furthermore, a multivariate analysis was performed. RESULTS: the univariate analysis revealed an association between infection and: age, place of residence during childhood, current social status based on the head of the family s profession, current blue collar/white collar profession of the head of the family, sharing a bedroom during childhood, type of drinking water, and contact with animals during childhood. No association was found with respect to the presence of dyspeptic symptoms. The multivariate analysis disclosed that only age is an independent risk factor associated with infection. CONCLUSION: age has been identified as the only independent risk factor associated with Helicobacter pylori infection in this population-based study. The univariate analysis has detected other factors. No association has been identified with respect to dyspeptic symptoms.

Prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense.

OBJECTIVES: to determine the prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense. MATERIAL AND METHODS: a cross-sectional study was carried out with a randomly selected populational sample. The diagnosis of Helicobacter pylori infection was reached using the 13C-urea breath test. RESULTS: three hundred and eighty-three subjects were studied, with a prevalence rate of 69.1% (95% CI: 61.7-75.1%); 69.8% (95% CI: 63.2-76.6%) in males and 68.4% (95% CI: 61.5-75.4%) in females (difference not statistically significant). Prevalence increases with age up to a maximum of 88.4% in the 45-54 years age group, and decreases thereafter to a rate of 57.1% in individuals over the age of 84 years. CONCLUSION: this study reveals that the prevalence rate of Helicobacter pylori infection is high in the general adult population of the province of Ourense. It increases with age until it peaks in the group of middle-aged individuals and is similar in both sexes.

Factores de riesgo asociados a la infección por Helicobacter pylori. Un estudio de base poblacional en la provincia de Ourense / Risk factors associated with Helicobacter pylori infection. A population-based study conducted in the province of Ourense

Objetivos: identificar en la población general adulta de la provinciade Ourense, la relación entre la infección por Helicobacterpylori y diversos factores que se han descrito en otros estudios.Material y métodos: se han incluido los 383 participantesen un estudio de prevalencia de la infección por Helicobacter pylori.Todos han completado un cuestionario bajo supervisión y losdatos se han examinado mediante análisis univariante. Se han calculadolas odds ratio correspondientes a cada variable estudiada,con sus intervalos de confianza al 95%. Además, se ha efectuadoun análisis multivariante.Resultados: el análisis univariante demuestra asociación dela infección con: edad, lugar de residencia en la infancia, clasesocial actual por la profesión del cabeza de familia, profesiónno manual/manual del cabeza de familia actual, compartir dormitorioen la infancia, tipo de agua de consumo y el contactocon animales en la infancia. No se ha encontrado asociacióncon la presencia de síntomas dispépticos. El análisis multivarianteha mostrado que solamente la edad es un factor de riesgoindependiente asociado a la infección.Conclusión: en este estudio de base poblacional la edad es elúnico factor de riesgo independiente que se ha identificado asociadoa la infección por Helicobacter pylori. En el análisis univariantese han identificado otros factores. No se demuestra asociacióncon síntomas dispépticos

Objectives: to identify the relationship between Helicobacterpylori infection and various factors that have been described inother studies in the general adult population in the province ofOurense.Material and methods: three hundred and eighty-three participantswere enrolled in a study on the prevalence of Helicobacterpylori infection. All participants filled in a questionnaire undersupervision, and the data obtained were examined by means of aunivariate analysis. The odds ratio corresponding to each variablestudied was calculated with their corresponding 95% confidenceintervals. Furthermore, a multivariate analysis was performed.Results: the univariate analysis revealed an association betweeninfection and: age, place of residence during childhood,current social status based on the head of the family’s profession,current blue collar/white collar profession of the head of the family,sharing a bedroom during childhood, type of drinking water,and contact with animals during childhood. No association wasfound with respect to the presence of dyspeptic symptoms. Themultivariate analysis disclosed that only age is an independent riskfactor associated with infection.Conclusion: age has been identified as the only independentrisk factor associated with Helicobacter pylori infection in thispopulation-based study. The univariate analysis has detected otherfactors. No association has been identified with respect to dyspepticsymptoms

Prevalencia de la infección por Helicobacter pylori en la población general adulta de la provincia de Ourense / Prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense

Objetivos: conocer la prevalencia de la infección por Helicobacterpylori en la población general adulta de la provincia deOurense.Material y métodos: se ha realizado un estudio transversalcon una muestra poblacional seleccionada al azar. El diagnósticode la infección por Helicobacter pylori se ha realizado mediantela prueba de aliento con 13C-urea.Resultados: se han estudiado 383 sujetos, obteniéndoseuna prevalencia del 69,1% (IC 95%: 61,7-75,1%), del 69,8%(IC 95%: 63,2-76,6%) en hombres y del 68,4% (IC 95%:61,5-75,4%) en mujeres, diferencia no significativa. La prevalenciaaumenta en relación con la edad, hasta un máximo del88,4% en el grupo de 45-54 años, y decrece en los grupos siguienteshasta alcanzar el 57,1% en los individuos de más de84 años.Conclusión: este estudio muestra que la prevalencia de la infecciónpor Helicobacter pylori es elevada en la población generaladulta de la provincia de Ourense. Aumenta con la edad hastaalcanzar un máximo en el grupo de edad media, y es similar enambos sexos

Objectives: to determine the prevalence of Helicobacter pyloriinfection in the general adult population of the province ofOurense.Material and methods: a cross-sectional study was carriedout with a randomly selected populational sample. The diagnosisof Helicobacter pylori infection was reached using the 13C-ureabreath test.Results: three hundred and eighty-three subjects were studied,with a prevalence rate of 69.1% (95% CI: 61.7-75.1%);69.8% (95% CI: 63.2-76.6%) in males and 68.4% (95% CI:61.5-75.4%) in females (difference not statistically significant).Prevalence increases with age up to a maximum of 88.4% in the45-54 years age group, and decreases thereafter to a rate of57.1% in individuals over the age of 84 years.Conclusion: this study reveals that the prevalence rate of Helicobacterpylori infection is high in the general adult populationof the province of Ourense. It increases with age until it peaks inthe group of middle-aged individuals and is similar in both sexes

¿Quién debe responsabilizarse de la realización de las técnicas de sedación en endoscopia digestiva? Réplica / Who should be responsible for sedation techniques in digestive endoscopy? Reply

No disponible

¿Quién debe responsabilizarse de la realización de las técnicas de sedación en endoscopia digestiva? Nuestro punto de vista / Who should be responsible for sedation techniques in digestive endoscopy? Our point of view

No disponible

Sedation at endoscopic units in Galicia: results of the "Sociedad Gallega de Patología Digestiva" inquiry.

AIM: To evaluate the human and material resources available for sedation, and the usual manner of handling them at endoscopic units in Galicia. METHODS: A prospective and descriptive study based on the performance, distribution, and analysis of a clinical practice inquiry. We requested information about endoscopies performed, available means for sedation, sedation monitoring, and level of sedation used in each procedure. RESULTS: Our inquiry was answered by twenty endoscopic units (thirteen were in public hospitals, and eleven performed complex procedures). Of these units, 80% had a pulse oximeter, 42% had continuous electrocardiography, 40% had a defibrillator, and 45% had a recovery area. The drug most commonly used in gastroscopies was midazolam (76%), and the combination midazolam-meperidine was most frequent in both colonoscopies (72%) and ERCPs (60%). An anesthesiologist was usually available for certain procedures in 15% of units, and as an exception in 65%. Of those inquired, 35% wished to have a full-time anesthesiologist in the unit, 25% wished to have an anesthetist only for certain procedures, and 35% on an exceptional basis. Finally, endoscopists considered that 83% of therapeutical gastroscopies, 87% of therapeutical colonoscopies, 98% of ERCPs, 95% of enteroscopies, and 98% of echoendoscopies deserved sedation. CONCLUSIONS: Although endoscopists consider that endoscopic procedures should benefit from sedation in a high proportion, the available resources to safely monitor patients are inadequate in some units.

Sedación en las Unidades de Endoscopia de Galicia. Resultados de la encuesta de la Sociedad Gallega de Patología Digestiva / Sedation at Endoscopic Units in Galicia: results of the “Sociedad Gallega de Patología Digestiva” inquiry

Objetivo: evaluar los medios materiales y humanos disponiblespara la sedación y el modo habitual de manejarla en las unidadesde endoscopia de Galicia.Métodos: estudio prospectivo, descriptivo, basado en la realización,distribución y análisis de una encuesta sobre práctica clínica.Se solicitó información sobre las exploraciones realizadas, losmedios disponibles para la sedación, el modo de controlarla y elnivel de sedación usado y deseable en cada exploración.Resultados: la encuesta fue respondida por veinte unidades deendoscopia (trece de titularidad pública y once realizaban exploracionesde alta complejidad). El 80% de las unidades estaban dotadasde pulsioximetría, el 42% de monitorización electrocardiográfica, el40% de defibrilador y finalmente, el 45% de sala de recuperación.El fármaco más utilizado en las gastroscopias fue el midazolam(76%) siendo la asociación midazolam-meperidina la sedación másutilizada en las colonoscopias (72%) y la CPRE (60%). El anestesistaestaba disponible para determinadas exploraciones de forma habitualen el 15%, y de forma excepcional en el 65% de las unidades.El 35% de los encuestados desearía tener un anestesista en la unidada tiempo completo, el 25% sólo para exploraciones determinadasy el 35% sólo para casos excepcionales. Finalmente, los encuestadosconsideran que es necesario algún grado de sedación en el83% de las gastroscopias terapéuticas, en el 87% de las colonoscopiasterapéuticas, en el 98% de las CPRE, en el 95% de las enteroscopiasy en el 98% de las ecoendoscopias.Conclusiones: aunque los endoscopistas consideran que losprocedimientos endoscópicos deben ser sedados en una proporciónelevada, en algunas unidades los medios disponibles paramonitorizar con seguridad a los pacientes son insuficientes

Aim: to evaluate the human and material resources availablefor sedation, and the usual manner of handling them at endoscopicunits in Galicia.Methods: a prospective and descriptive study based on theperformance, distribution, and analysis of a clinical practice inquiry.We requested information about endoscopies performed,available means for sedation, sedation monitoring, and level of sedationused in each procedure.Results: our inquiry was answered by twenty endoscopic units(thirteen were in public hospitals, and eleven performed complexprocedures). Of these units, 80% had a pulse oximeter, 42% hadcontinuous electrocardiography, 40% had a defibrillator, and 45%had a recovery area. The drug most commonly used in gastroscopieswas midazolam (76%), and the combination midazolammeperidinewas most frequent in both colonoscopies (72%) andERCPs (60%). An anesthesiologist was usually available for certainprocedures in 15% of units, and as an exception in 65%. Of thoseinquired, 35% wished to have a full-time anesthesiologist in theunit, 25% wished to have an anesthetist only for certain procedures,and 35% on an exceptional basis. Finally, endoscopistsconsidered that 83% of therapeutical gastroscopies, 87% of therapeuticalcolonoscopies, 98% of ERCPs, 95% of enteroscopies,and 98% of echoendoscopies deserved sedation.Conclusions: although endoscopists consider that endoscopicprocedures should benefit from sedation in a high proportion,the available resources to safely monitor patients are inadequatein some units

Pólipos gástricos epiteliales. Estudio retrospectivo 1995-2000 / Gastric epithelial polyps. A retrospective study 1995-2000

Objetivo. Analizar las características endoscópicas e histológicas de todos los pólipos gástricos epiteliales diagnosticados por endoscopia en nuestro servicio durante un período de 5 años y evaluar la utilidad del seguimiento endoscópico tras la polipectomía. Pacientes y métodos. Entre enero de 1995 y enero de 2000 hemos realizado 5.314 endoscopias altas en el servicio de Aparato Digestivo del Hospital Santa María Madre. Se han detectado 64 pólipos gástricos epiteliales en 18 pacientes, 10 hombres y 8 mujeres, cuya edad media ha sido de 61,7 años. Resultados. Sesenta y tres pólipos fueron extirpados mediante polipectomía endoscópica y uno fue biopsiado debido a su tamaño (5 cm), 30 (46,87 por ciento) fueron hiperplásicos, 24 (37,5 por ciento) presentaron una histología normal, 8 (12,5 por ciento) fueron adenomas y 2 (3,12 por ciento) adenocarcinomas polipoideos. El 56,2 por ciento medía menos de 6 mm y solamente el 6,2 por ciento medía más de 11 mm. Ningún paciente presentó adenocarcinoma gástrico acompañante. Ocurrió una complicación tras la polipectomía y una hemorragia tratada con éxito mediante la inyección local de adrenalina. Durante el seguimiento no hemos detectado ningún caso de cáncer y han recurrido 2 pólipos en 2 de los 8 pacientes con adenoma. Conclusiones. Los pólipos gástricos epiteliales son infrecuentes (0,33 por ciento de las gastroscopias), la mayoría (93,75 por ciento) mide menos de 1 cm y pueden ser extirpados endoscópicamente con seguridad. En nuestra serie, el tipo histológico más frecuente es el hiperplásico (43,75 por ciento), representando el adenocarcinoma polipoideo el 3,12 por ciento de los casos, uno de menos de 6 mm. Tras la polipectomía, el seguimiento endoscópico es obligado, principalmente para el adenoma (AU)

[Gastric epithelial polyps. A retrospective study 1995-2000]. / Pólipos gástricos epiteliales. Estudio retrospectivo 1995-2000.

OBJECTIVE: The analysis of the endoscopic and histological characteristics of all the gastric epithelial polyps diagnosed through endoscopy in our service during a period of 5 years, and the evaluation of the usefulness of the endoscopic monitoring after polypectomy. PATIENTS AND METHODS: Between January 1995 and January 2000 5,314 high digestive system endoscopies were carried out in the Gastroenterology Service of the Santa María Madre Hospital. Sixty-four gastric epithelial polyps were detected in 18 patients (10 men and 8 women) with a median age of 61.7 years. RESULTS: Sixty-three polyps were removed through endoscopic polypectomy, and one was biopsied because of its size (5 cm), 30 (46.87%) were hyperplastic polyps, 24 (37.5%) presented normal histological characteristics, 8 (12.5%) were adenomas and 2 (3.12%) were polypoid adenocarcinomas. 56.2% measured less than 6 mm and only 6.2% measured more than 11 mm. No patient presented simultaenous gastric adenocarcinoma. Only one complication was observed after the polypectomy, a hemorrhage that was treated successfully with local injection of adrenaline. During the follow-up no case of cancer was detected and the recurrence of the polyp was observed in 2/8 patients with adenoma. CONCLUSIONS: Gastric epithelial polyps are infrequent (0.33% gastroscopies); most of them (93.75%) measure less than 1 cm and they can be removed through endoscopy with safety. In our series, the most frequent histological type was the hyperplastic polyp (43.75%); polypoid adenocarcinoma constituted 3.12% of the cases, one of them with less than 6 mm. Endoscopic follow-up is considered absolutely essential after the polypectomy, especially in adenomatous polyps.

Ganglioneuromatous polyposis of the colon associated with adenocarcinoma and primary hyperparathyroidism.

A rare case of ganglioneuromatous polyposis of the colon found in association with mucinous adenocarcinoma and primary hyperparathyroidism caused by a parathyroid adenoma in a 77-year-old woman is described. We discuss the clinical implications of this finding and review the literature.

A prospective trial of self-expanding metal coated stents in the palliation of malignant dysphagia.

OBJECTIVE: To analyze the use of self-expanding metal coated esophageal stents a palliative therapy of malignant dysphagia. METHOD: We performed a one year prospective study placing 12 stents in 10 patients with malignant dysphagia. RESULTS: The insertion mean time was lower than 25 min, and most of our patients (70%) reported a good tolerance. Dysphagia score improved immediately and it lasted until death with no occlusions. Complications appeared early, 17% at the time of placement, with one patient having a life-threatening complication. The probability for these patients not to develop any complications after the three first weeks will be about 60%. CONCLUSIONS: Self-expanding metal coated esophageal stents provide a fast and lasting relief in malignant dysphagia, with a good tolerance.

[Comparative study of the efficacy and tolerance of 2 types of colon cleansing]. / Estudio comparativo de la eficacia y tolerancia de dos tipos de limpieza colónica.

OBJECTIVE: To examine if (hypothesis): orally administered colon cleansing with 3 liters of balanced electrolyte/polyethylene glycol solution is superior to the standard method of bowel preparation with senna laxatives and sodium phosphate enemas. STUDY FACTORS: 1st) Quality of colon cleansing estimated by the attending endoscopist. 2nd) Patient tolerance. DESIGN: prospective randomized trial, blind to the endoscopist, comparing two methods of bowel preparation: group A received 3 L of the balanced electrolyte/polyethylene glycol solution the night before the procedure and group B was instructed to ingest 75 ml of a senna laxative the day before the colonoscopy and sodium phosphate enemas per rectum b.i.d. starting 2 days before the examination and again the morning of the procedure. Assessing criteria: 1st) Questionnaire filled by the attending endoscopist immediately after the completion of the colonoscopy. 2nd) Questionnaire filled by the patient the day after the procedure. INCLUSION CRITERIA: all the patients addressed to our Unit for colonoscopy (18 patients refused to participate). EXCLUSION CRITERIA: severe cardiovascular disease, decompensated diabetes mellitus and severe disease or neurological derangement that prevented collaboration (35 patients). Two hundred and sixteen patients were initially included, 110 in group A and 106 in group B; in 39 patients (18 in group A and 21 in group B) colonoscopy could not be completed for causes others than bowel preparation and were excluded for further evaluation by the endoscopist, thus, quality of bowel preparation was evaluated in 92 patients in group A and in 85 patients in group B; 83 patients (43 in group A and 40 in group B) did not answer the questionnaire, or did it incorrectly, thus, tolerance was evaluated in 67 patients in group A and in 66 patients in group B. RESULTS: In 2 patients in group A (2.2%) and in 9 patients in group B (10.6%) colonoscopy could not be completed because of solid stool (p = 0.045). Mucosal visualization was better in group A than in group B (p = 0.0108). A total of 11.9% of the patients in group A and 25.8% of the patients in group B found the preparation hard or very hard to tolerate (p = 0.0001), patients in this latter group presented more frequently abdominal cramps (p = 0.0004), and distress (p < 0.00001), and dizziness (p = 0.0031). Bad tolerance in group B was primarily due to the rectal enemas (p < 0.0001). CONCLUSIONS: Bowel preparation for colonoscopy with 3 L of orally administer balanced electrolyte/polyethylene glycol solution (PEG) results in a better colon cleansing and is better tolerated than the classical preparation consisting in oral purge and rectal enemas.

[Ganglioneuroma of the duodenum]. / Ganglioneuroma del duodeno.

Ganglioneuroma is an exceptional benign tumour of the duodenum and only three cases have been described previously. We report the case of a 71-year-old male in whom this pathology was incidentally discovered, as it usually happens with this type of tumour. Within rare duodenal nonepithelial tumours, gangliocytic paraganglioma is a fairly well defined entity characterized by a proliferation of neurons, Schwann cells, and endocrine-like epithelial cells. Ganglioneuroma lacks this last type of cells and represents and even rarer finding within tumoral pathology of the duodenum. The histopathogenesis of this tumor is discussed and there are theories that defend an hamartomatous origin against a neoplastic nature.