THE ESOPHAGEAL, GASTRIC, AND COLORECTAL TUMORS AND THE ESOPHAGOGASTRODUODENOSCOPIES AND COLONOSCOPIES BY THE BRAZILIAN UNIFIED HEALTH SYSTEM: WHAT IS THE IMPORTANCE?

AIM: Esophagogastroduodenoscopies and colonoscopies are the main diagnostic examinations for esophageal, stomach, and colorectal tumors. This study aimed to evaluate the estimates of the incidence of esophageal, stomach, and colorectal cancer; population growth; and esophagogastroduodenoscopies and colonoscopies performed by the Unified Health System (SUS), from 2010 to 2018, in the five regions of the country, and to analyze the relationship between these values. RESULTS: The colorectal tumor had a significant elevation, while the esophageal and gastric maintained the incidences. In the five regions, there was a significant increase in the number of colonoscopies; however, this increase did not follow the increase in the population in the North and Northeast regions. There was no significant increase in the number of esophagogastroduodenoscopies in the North, Northeast, Midwest, and South regions, and in the North region there was a decrease. In the Northeast region, there was a decreasing number, and in the South and Midwest regions, the number of examinations remained stable in the period. The Southeast region recorded an increase in the number of examinations following the population growth. CONCLUSION: The current number of esophagogastroduodenoscopies and colonoscopies performed by the SUS did not follow the population growth, in order to attend the population and diagnose esophageal, stomach, and colorectal tumors. Therefore, the country needs to have adequate and strategic planning on how it will meet the demand for these tests and serve the population well, incorporating new technologies.

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus.

BACKGROUND: Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial. METHODS: Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital. RESULTS: Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m2. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months. CONCLUSIONS: Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.

Megaduodenum associated with gastric strongyloidiasis.

Gastric strongyloidiasis and megaduodenum are rare diseases. Gastrointestinal (GI) strongyloidiasis has many clinical features. One of them is megaduodenum. We describe a case of a 32-years-old man who has come to us from an endemic area for Strongyloides stercoralis. He had had megaduodenum diagnosed in his childhood. We submitted him to two surgeries. He has recovered just after the second surgery, a Roux-en-Y partial gastrectomy. After that, his follow-up was uneventful and the patient has gained 10kg in weight. Histopathology confirmed gastric strongyloidiasis. In conclusion, if patients arrive from an endemic area of S. stercoralis and if they present GI symptoms or a previous diagnosis of megaduodenum, they must be considered for a histological evaluation for gastric strongyloidiasis.

Neoadjuvant chemoradiotherapy and surgery compared with surgery alone in squamous cell carcinoma of the esophagus.

CONTEXT: Despite progress in recent years in methods of diagnosis and surgical treatment of esophageal cancer, there is still controversy about the benefits from neoadjuvant chemoradiotherapy. OBJECTIVE: To analise the survival of patients submitted to esophagectomy for squamous cell carcinoma of the esophagus with or without neoadjuvant chemoradiotherapy. METHOD: A retrospective, non-randomized study conducted using the medical charts of patients operated for squamous cell carcinoma of the esophagus at the School of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil between 1979 and 2006. The Kaplan-Meier analysis was used to calculate survival curves and the log-rank test to compare data in each group. The significance level was settled as 5%. RESULTS: A total of 123 patients were evaluated in this study, divided into three groups: I-26 (21.2%) patients submitted to esophagectomy alone; II-81 (65.8%) patients submitted to neoadjuvant radiotherapy plus esophagectomy and III-16 (13%) patients submitted to neoadjuvant chemoradiotherapy plus esophagectomy. A statistically significant survival was recorded between the groups (log rank=6.007; P=0.05), survival being greatest in the group submitted to neoadjuvant chemoradiotherapy, followed by the group submitted to neoadjuvant radiotherapy compared to the group submitted to esophagectomy alone as the initial treatment of choice. CONCLUSION: Radiotherapy and chemotherapy neoadjuvants in patients with squamous cell carcinoma of the esophagus offers benefits and increases survival.

Gastric adenocarcinoma after gastric bypass for morbid obesity: a case report and review of the literature.

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.

[Barrett's esophagus associated to caustic stenosis of the esophagus]. / O esôfago de Barrett associado à estenose cáustica do esôfago.

BACKGROUND: The esophageal stenosis secondary to the ingestion of caustic products is frequent in Brazil, mainly due to an attempt suicide. The Barrett's esophagus is consequence of the chronic gastroesophageal reflux. The literature consulted showed that are a rare association. CASUISTIC AND METHODS: From 1981 to 2000 were admitted and treated in the "Gastrocentro" State University of Campinas, SP, Brazil, 120 patients presenting caustic stenosis of the esophagus, and during the follow-up were found nine cases with Barrett's esophagus associated (7,5%). The time of caustic ingestion varied from 4 years to 54 years (mean 29 years), and they were four males and five females, eight whites and one black, with the mean age of 57,7 years (43 to 72 years). RESULTS: All the cases presented dysphagia and the flexible upper endoscopy showed stenotic areas and caustic esophagitis sequels. Three patients referred symptoms of gastroesophageal reflux, but hiatus hernia were found in only one case. The Barrett's esophagus was found in the middle third of the esophagus above the stenotic areas in three cases, and in the distal third in six cases. The dysphagia was treated with periodic esophageal dilatations. Two patients presenting severe symptoms of reflux were submitted to modified Nissen fundoplication by videolaparoscopy, with good results. CONCLUSIONS: The Barrett's esophagus in these patients could be associated to the caustic ingestion, because it is not situated in the distal third of the esophagus, as commonly found in reflux esophagitis. Its is very important the follow-up and biopsies of the Barrett's esophagus, due to the possibility of malignancy.