ABSTRACT
Colorectal cancer (CRC) is one of the most common causes of cancer mortality in the world. Serrated lesions are responsible for 10 to 20% of all CRCs. Serrated polyps, particularly sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA), have a subtle appearance and proximal location, and therefore have a high miss rate. The objective of this review was to evaluate the available evidence on the use of various endoscopic interventions for improving serrated lesion detection rate, thus reducing CRC related mortality.
Subject(s)
Colonoscopy , Polyps , HumansABSTRACT
El cáncer colorrectal (CCR) es una de las causas más frecuentes de mortalidad por cáncer en el mundo. Las lesiones serradas son responsables de 10 a 20% de todos los CCR. Los pólipos serrados, en particular los adenomas serrados sésiles (ASS) y adenomas serrados tradicionales (AST), tienen una apariencia sutil y localización proximal, y por ello presentan una alta tasa de lesiones perdidas. El objetivo de la presente revisión fue evaluar la evidencia disponible sobre el uso de diversas intervenciones endoscópicas para mejorar la tasa de detección de las lesiones serradas, para de esta forma, disminuir la mortalidad relacionada al CCR.
Colorectal cancer (CRC) is one of the most common causes of cancer mortality in the world. Serrated lesions are responsible for 10 to 20% of all CRCs. Serrated polyps, particularly sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA), have a subtle appearance and proximal location, and therefore have a high miss rate. The objective of this review was to evaluate the available evidence on the use of various endoscopic interventions for improving serrated lesion detection rate, thus reducing CRC related mortality.
ABSTRACT
INTRODUCTION: Colonoscopy is the standard method for the evaluation of the colon. A suitable intestinal cleaning is critical for the effectiveness and security of the procedure, but unfortunately there is a high proportion of suboptimal bowel preparation. OBJECTIVE: To identify factors related to suboptimal bowel preparation. METHODS: We performed an analytic, observational, cross-sectional and prospective study. We included all outpatients scheduled for colonoscopy in the Peruvian-Japanese Health Center between January and July 2012. We excluded patients with a complete or partial colonic resection. In patients with two or more colonoscopies during the study interval, only the first procedure was considered. Aronchick scale was used in assessment of bowel cleaning. The variables studied with relationship to bowel preparation were: age, sex, grade ofeducation, body mass index, time of examination, history (diabetes mellitus, stroke, cirrhosis, use of antidepressants/anxiolytics, number of bowel movements per week, abdominal surgery, personal history of previous colonoscopy, polyps and colon cancer, family history of colon cancer), received purgative, additional laxative, indication for colonoscopy and adverse effects of the preparation. Statistical analysis was made with SPSS v.160. For the categorical variables we used chi square test or Fisher exact test, whereas for continuous variables the Mann Whitney test was used. The variables significantly associated with suboptimal preparation in the univariated analysis were included in a multivariate analysis using logistic regression. RESULTS: We included 841 patients. The bowel preparation was suboptimal in 438 patients (52.1%). The univariate analysis showed that the factors related to suboptimal preparation were age (P = 0.023) and body mass index ≥ 30 kg/m2 (P = 0.021). The multivariate analysis confirmed that age ≥ 70 years old (P = 0.001) and body mass index ≥ 30 kg/m2 (P = 0.010) were the variables related to suboptimal bowel preparation. CONCLUSIONS: Age greater than 70 years old and obesity are factors related to suboptimal bowel preparation.
Subject(s)
Cathartics/administration & dosage , Colonoscopy/standards , Patient Compliance , Polyethylene Glycols/administration & dosage , Adult , Aged , Colonoscopy/methods , Colorectal Neoplasms/diagnosis , Cross-Sectional Studies , Educational Status , Female , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Therapeutic IrrigationABSTRACT
Determinar los factores relacionados con resangrado dentro de los 5 días y mortalidad dentro de las 6 semanas de un episodio de hemorragia variceal en los pacientes cirróticos. Material y métodos: Estudio observacional, descriptivo, correlacional, retrospectivo. Fueron incluidos en el estudio los pacientes cirróticos que ingresaron al Hospital Hipólito Unanue, en Lima, Perú, entre enero del 2006 y febrero del 2012 con sospecha de hemorragia variceal. Fueron excluidos pacientes con sangrado de origen no variceal, o que no tenían los datos en la historia clínica para calcular el puntaje de Child Pugh, el Modelo para enfermedades terminales del hígado (MELD), o el informe endoscópico detallando la fuente de sangrado y la presencia de várices esofágicas y/o gástricas. Resultados: Fueron incluidos 63 pacientes, de los cuales 35 (55,6%) eran varones. La mediana de edad fue de 64 años. 26 de ellos (41,3%) eran Child Pugh C, en tanto que la mediana del puntaje MELD fue 9. El análisis multivariado encontró que el puntaje Child Pugh se relacionó con mortalidad dentro de las 6 semanas (p=0,003), mientras que la presencia de sangrado activo durante la endoscopía (p=0,012) y el valor de creatinina (p=0,012) se relacionaron con resangrado dentro de los 5 días. Conclusiones: El puntaje Child Pugh se relacionó con el riesgo de mortalidad dentro de las 6 semanas en pacientes cirróticos con hemorragia variceal. El sangrado activo durante la endoscopía y el valor de creatinina se relacionaron con el riesgo de resangrado dentro de los 5 días...
To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. Material and methods: Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. Results: We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. Conclusions: The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding...
Subject(s)
Humans , Male , Aged , Liver Cirrhosis/mortality , Risk Factors , Gastrointestinal Hemorrhage , Gastrointestinal Hemorrhage/mortality , Epidemiology, Descriptive , Observational Study , Retrospective Studies , PeruABSTRACT
OBJECTIVES: To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. MATERIAL AND METHODS: Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. RESULTS: We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. CONCLUSIONS: The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding.
Subject(s)
Esophageal and Gastric Varices/complications , Esophageal and Gastric Varices/mortality , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/mortality , Liver Cirrhosis/complications , Liver Cirrhosis/mortality , Acute Disease , Aged , Female , Hospitals , Humans , Male , Middle Aged , Peru , Recurrence , Retrospective Studies , Risk Factors , Time FactorsABSTRACT
INTRODUCCIÓN: La investigación biomédica en el Perú es limitada. Entre los factores implicados en este problema tenemos el reducido gasto per-cápita en investigación, los esfuerzos dispersos y la escasa comunicación entre la investigación y las actividades sociales y productivas. OBJETIVOS: Determinar los factores personales, laborales y académicos relacionados con la producción científica de los médicos gastroenterólogos que laboran en la provincia de Lima. MATERIAL Y MÉTODOS: Estudio correlacional, observacional, comparativo, transversal y retrospectivo que se realizó entre marzo de 2007 y abril de 2008. Se elaboró un cuestionario conteniendo las variables de investigación, el cual previamente fue sometido a juicio de expertos y a una prueba piloto, para posteriormente ser aplicado auto administrado a los gastroenterólogos. Usando análisis bivariado y multivariado, se identificaron los factores relacionados con la producción científica. RESULTADOS: 58 gastroenterólogos encuestados (32,4 por ciento) tenían "producción científica". El análisis bivariado encontró como factores relacionado con la producción científica: carga docente, tipo de búsqueda bibliográfica, grado de comprensión de un artículo original, facilidades para la investigación en la institución laboral, suscripción a revista científica, pertenecer a sociedad médica y el número de empleos. El análisis multivariado encontró a los factores antes mencionados excepto docencia y suscripción a revista científica. CONCLUSIONES: Un tercio de los gastroenterólogos encuestados (32,4 por ciento) desarrolló actividad científica, y de acuerdo al análisis multivariado los factores relacionados fueron: personales: pertenecer a sociedad científica; laborales: facilidades para la investigación en el centro laboral y número de empleos; y académicos: tipo de búsqueda bibliográfica y grado de comprensión de un artículo original.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Scientific and Technical Activities , Health Research Evaluation , Gastroenterology , Retrospective Studies , Cross-Sectional Studies , Observational Studies as TopicABSTRACT
Presentamos la historia clínica de una paciente de 70 años, con dolor abdominal crónico (más de 12 meses), náusea, vómitos y baja de peso. En el examen abdominal no se detectaron alteraciones significativas. La ecografía abdominal y la TAC abdominal mostraron una imagen quística de 170x121mm que aparentó ser dependiente de cuerpo y cola de páncreas. En la intervención quirúrgica se encontró una tumoración con extensa necrosis que englobaba en su totalidad al bazo, y se extendía de manera infiltrante al estómago (cuerpo y fondo) y páncreas. El estudio histológico e inmunohistoquímico indicó la presencia de una Linfoma no Hodkin tipo B primario de bazo (difuso de células grandes). La evolución post-quirúrgica y oncológica fue satisfactoria.
We present the clinical history of a 70-year-old woman, with chronic abdominal pain (most of 12 month), nausea, vomiting and low weight. In the abdominal examination not did detect significant alteration. The abdominal ultrasound and TAC scanning did show a cystic imagen of 170 x 121 mm that did apparent to be dependent of body and tail of pancreas. In the surgical intervention was encountered a tumoration with necrosis wide that wrap up in their overall at spleen, and was extend of infiltrant hand at stomach (body and fundus) and spleen. The histologic and inmunohistoquimic studies did indicate the presence of a primary splenic type B non-Hodgkins lymphoma (diffuse of large cell). The post-surgical and oncologic evolution was satisfactory.
