[Recommendations of the Society of Gastroenterology of Peru to avoid the spread of SARS-CoV-2 through digestive endoscopy procedures]. / Recomendaciones de la Sociedad de Gastroenterología del Perú para evitar la propagación del SARS-CoV-2 a través de procedimientos de endoscopía digestiva.

The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.

Recomendaciones de la Sociedad de Gastroenterología del Perú para evitar la propagación del SARS-CoV-2 a través de procedimientos de endoscopía digestiva / Recommendations of the Society of Gastroenterology of Peru to avoid the spread of SARS-CoV-2 through digestive endoscopy procedures

RESUMEN El coronavirus SARS-CoV-2 produce la enfermedad llamada COVID-19, actualmente propagándose en una pandemia de rápida evolución. Puede transmitirse por contacto, gotas y aerosoles, y ha sido aislado en secreciones gastrointestinales y heces. Durante la endoscopía digestiva podría ocurrir la transmisión por cualquiera de estos mecanismos. Se recomienda limitar la endoscopía digestiva a casos de hemorragia digestiva, disfagia severa, cuerpo extraño en tracto digestivo, obstrucción biliar con dolor intratable o colangitis, pseudoquiste o necrosis pancreática encapsulada complicada, obstrucción gastrointestinal, y casos con riesgo de deterioro en el tiempo. Se recomienda tamizar a los pacientes en base a la temperatura, síntomas, y factores epidemiológicos para clasificarlos según su riesgo de infección. Para procedimientos en pacientes de riesgo bajo el personal debe usar bata descartable, guantes, protector ocular o facial, mascarilla quirúrgica estándar, gorro descartable, cubiertas descartables para zapatos. En casos de riesgo intermedio o alto, o COVID-19 confirmado, se debe incrementar la protección usando bata descartable impermeable, respirador N95 o similar, y doble guante. En caso de escasez puede ser necesario reutilizar los respiradores N95 hasta un máximo de 5 usos, siguiendo las recomendaciones de CDC sobre la colocación, retiro y almacenamiento para prevenir la contaminación secundaria por contacto. Asimismo todo el equipo de protección debe colocarse y retirarse siguiendo las recomendaciones del CDC. La presencia de personal en la endoscopía debe limitarse al mínimo indispensable. Dicho personal debe tener control diario de temperatura y si ésta es mayor a 37,3 ºC se debe proceder a la evaluación correspondiente. Después de cada procedimiento se debe desinfectar apropiadamente la camilla y superficies de la sala. La desinfección de alto nivel de los endoscopios elimina el SARS-CoV-2.

ABSTRACT The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.

Pólipos gástricos, frecuencia, distribución por edad, sexo y caractertísticas endoscópicas / Gastric polyps, frequency, distribution by age, sex and endoscopic characteristics

Objetivos: Los pólipos gástricos considerados como lesiones elevadas de origen epitelial, tienen distintas características clínicas y endoscópicas. Los objetivos del presente estudio son determinar la frecuencia de pólipos gástricos, distribución por edad y sexo, y sus características endoscópicas. Material y Métodos: Estudio prospectivo, descriptivo, de corte transversal. De un total de 6603 pacientes examinados con endoscopia alta en el HNERM, durante el período de enero del 2002 a mayo del 2003, se detectaron pólipos gástricos en 115 (1.74%) de los cuales de incluyeron 68 en el estudio. Los pólipos gástricos fueron evaluados endoscópicamente (localización, tamaño, color, superficie, consistencia, forma, número), luego fueron extirpados. Por histología se determinó el tipo pólipo gástrico. Resultados: La frecuencia de pólipos gástricos fue: hiperplásicos 51 (75%), adenomatosos 11 (16.2%), de glándulas fúndicas 4 (5.9%) e inflamatorios 2 (2.9%). Los pólipos hiperplásicos fueron significativamente más frecuentes en mujeres (60.8%, p=0.026), en pacientes de más de 70 años (49%, p=0.001), se localizaron mayormente en el antro (60.8%, P=0.026), usualmente midieron menos de 10mm (66.7% P=0.001), el 66.7% fueron de color rojizo (p=0.001) ; además el 19.6%de los pólipos hiperplásicos fueron múltiples. Los pólipos adenomatosos son más frecuentes en mayores de 70 años (63.6%, p=0.001), se localizan más en antro (63.6%, p=0.186), el 81.8% miden más de 10mm (p=0.001), el 63.8% son de color rosado (p=0.001); además no hubieron adenomas múltiples. Conclusiones: Los pólipos gástricos más frecuentes son los hiperplásicos. Usando diferentes características clínicas y endocópicas, es posible efectuar un diagnóstico diferencial y distintivo de los distintos tipos de pólipo gástrico.

Objectives: Gastric polyps considerated like elevated epithelial lesions, have distinctive clinical and endoscopical characteristics. The objectives of this studio are to determine the frequency of gastric polyps, age and sex distribution, and their endoscopic characteristics. Material and methods: Prospective, descriptive and transversal studio. From 6603 patients examined with upper gastrointestinal endoscopies in HNERM, between 2002 January and 2003 may, were detected 115 patients with gastric polyps (1.74%), 68 from them were included in the studio. The gastric polyps were evaluated endoscopically (location, size, color, surface, consistency, form and number), then were extirpated. Using pathology, the type of gastric polyp was determined. Results: The frequency of gastric polyps: hyperplastics 51 (75%), adenomatousus 11 (16.2%), fundic glands 4 (5.9%), inflammatory 2 (2.9%). Hyperplastic polyps were significantly more frequent in women (60.8%, p=0.026), in patients older than 70 (49%, p=0.001), were located usually in antrum (60.8%, p=0.026), usually sized less than 10mm (66.7%, p=0.001), 66.7% were of red color (p=0.001); 19.6% were multiple. Adenomatous polyps were more frequent in patients older than 70 (63.6%, p=0.001), located in antrum (63.6%, p=0.186), 81.8% sized more than 10mm (p=0.001), 63.8% were of pink color (p=0.0001); were not multiple polyps. Conclusions: Hyperplastic polyps are the most frequent type of polyp. Using the distinctive clinical and endoscopical characteristics, it’s possible to do a differential diagnosis of each kind of gastric polyp.

Tumoraciones hepáticas con marcada elevación de alfa-fetoproteína, no siempre corresponden a carcinoma hepatocelular / Liver tumors with markedly elevated alpha-fetoprotein, not always correspond to hepatocellular carcinoma

Los carcinomas gástricos secretores de alfa-fetoproteína (AFP), constituyen una entidad rara, pero bien definida. Estos tumores, son agresivos y de pobre pronóstico. Se reporta el caso de una paciente con tumoraciones hepáticas y elevación notable de AFP, secundarias a un carcinoma gástrico. La coloración histoquímica confirmó el diagnóstico.

Gastric cancers that secrete alpha-fetoprotein area rare but well defined entity. These tumors tend to be aggressive with a poor prognosis. We report a case of a patient with liver tumors and high level of AFP, secondary to gastric cancer. The histochemical staining confirmed the diagnosis.

¿Tumor de colon?...No... Apendicitis retrocecal / Colon tumor?...No... Appendicitis retrocecal

La apendicitis es reconocida como una de las causas más comunes de abdomen agudo. Una buena anamnesis y un buen examen físico es casi diagnóstico cuando el cuadro se presenta en forma típica. Los casos atípicos pueden estar relacionados a la edad, la localización, o la presencia de condiciones asociadas tales como el embarazo o el estado de inmunidad; y son realmente difíciles de diagnosticar. Se presenta el caso de una paciente mujer de 28 años de edad, que ingresa con un cuadro de dolor abdominal a predominio de epigastrio con irradiación a HCD y flanco derecho, a quien se le realizó un estudio colonoscópico donde se evidenció una lesión de aspecto tumoral.

Apendicitis is recognized as a common cause of acute abdomen. An adequate interrogatory and physical examination is almost diagnostic in typical presentation. Atypic presentation are related to age, localization and presence of associated conditions as pregnancy or inmune disorders, and sometimes are difficult to diagnose. We present a case of a 28 years female with abdominal pain, with presentation mainly in right upper quadrant. Examinations performed including a colonoscopic examination showed a tumoral cecal lession.