Should prophylactic measures to prevent postpolypectomy bleeding after resection of large colorectal polyps be used? / ¿Deben realizarse medidas profilácticas para evitar el sangrado postpolipectomía luego de resecar pólipos colorrectales grandes?

Post-polypectomy bleeding after colonoscopy with resection of large colorectal polyps can cause significant morbidity (readmission for monitoring, transfusion, repeat endoscopy and therapy) and a significant cost to hospitals and insurers. Nevertheless prophylactic endoscopic measures could reduce risk of post-polypectomy bleeding. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including 10 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded prophylactic endoscopic measures could be effective in reducing post-polypectomy bleeding after resection of large colorectal polyps.

Luego de resecar pólipos colorrectales grandes por vía endoscópica, existen medidas hemostáticas profilácticas que podrían disminuir el riesgo de sangrado postpolipectomía, y así evitar nuevos procedimientos, transfusiones u hospitalizaciones innecesarias, con el deterioro en la calidad de vida de los pacientes y el aumento de los costos que esto implica. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que incluyen 10 estudios controlados aleatorizados. Los combinamos mediante un metanálisis y generamos tablas de resumen de resultados utilizando el método GRADE. Concluimos que las medidas hemostáticas endoscópicas profilácticas reducen el riesgo de sangrado postpolipectomía luego de resecar pólipos colorrectales grandes.

La colonoscopia en la pesquisa de cáncer colorrectal / Colonoscopy in screening for colorectal cancer

El cáncer colorrectal representa una de las primeras causas de muerte por cáncer en todo el mundo y también en la Argentina. En los últimos años la pesquisa de cáncer de colon ha cobrado gran importancia y se ha postulado a la colonoscopia como el patrón de oro. En esta revisión resumimos las evidencias de este método poniendolo en contexto con las complicaciones y desventajas.

Colorectal cancer is one of the leading causes of cancer deathworldwide and also in Argentina. In the past few years colorectalcancer screening has become more popular and colonoscopyhas been postulated as the gold standard. In thisreview we analyzed the evidence supporting this methodin contrast with its complications and disadvantages.

Finding sessile serrated adenomas: is it possible to identify them during conventional colonoscopy?

BACKGROUND AND AIM: Proximal colorectal cancer may arise from sessile serrated adenomas (SSAs). Recognition of these lesions during colonoscopy can optimize the endoscopic approach. We aimed to identify specific endoscopic features of SSA with conventional colonoscopy. METHODS: Patients undergoing screening colonoscopies from January 2011 to September 2012, in whom colonic polyps were found, were prospectively included in our study. Polyp morphology, location, polyp pit pattern (Kudo classification), and other previously reported features of SSA were evaluated. Histological examination was conducted independently by two pathologists. Multivariate analysis was performed to identify independent predictors of SSA. RESULTS: A total of 272 patients were included, and 440 polyps were evaluated (1.6 polyps per patient). Thirty-four polyps (8%) were SSA, 135 (31%) hyperplastic, and 249 (56%) adenomas. The most prevalent endoscopic features of SSA were right-side location (94%), type II Kudo pit pattern (91%), mucus cap (41%), flat morphology (29%) and red-colored surface (26%). Multivariate analysis revealed that flat morphology (p = 0.002, OR = 3.81 CI 1.53-9.09), red-colored surface (p < 0.001, OR = 12.97 CI 4.43-37.69), right-side location (p < 0.001, OR = 22.21 CI 5.09-135.94) and mucus cap (p < 0.001, OR 8.77 CI 3.76-20.44) were independent predictors of SSA. CONCLUSION: We were able to identify specific features of SSA during conventional colonoscopy, which may help to identify, and therefore to optimize the endoscopic approach of these lesions.

[Colorectal cancer screening with colonoscopy]. / La colonoscopia en la pesquisa de cáncer colorrectal.

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

La colonoscopia en la pesquisa de cáncer colorrectal / Colorectal cancer screening with colonoscopy

El cáncer colorrectal representa una de las primeras causas de muerte por cáncer en todo el mundo y también en la Argentina. En los últimos años la pesquisa de cáncer de colon ha cobrado gran importancia y se ha postulado a la colonoscopia como el patrón de oro. En esta revisión resumimos las evidencias de este método poniendolo en contexto con las complicaciones y desventajas.(AU)

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.(AU)

La colonoscopia en la pesquisa de cáncer colorrectal / Colorectal cancer screening with colonoscopy

El cáncer colorrectal representa una de las primeras causas de muerte por cáncer en todo el mundo y también en la Argentina. En los últimos años la pesquisa de cáncer de colon ha cobrado gran importancia y se ha postulado a la colonoscopia como el patrón de oro. En esta revisión resumimos las evidencias de este método poniendolo en contexto con las complicaciones y desventajas.

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

La colonoscopia en la pesquisa de cáncer colorrectal. / [Colorectal cancer screening with colonoscopy].

Colorectal cancer is one of the leading causes of cancer death worldwide and also in Argentina. In the past few years colorectal cancer screening has become more popular and colonoscopy has been postulated as the gold standard. In this review we analyzed the evidence supporting this method in contrast with its complications and disadvantages.

[Diffuse gastric cancer associated with Ménétrier's disease]. / Adenocarcinoma gástrico difuso asociado a enfermedad de Ménétrier.

BACKGROUND: Ménétrier's disease is a rare disease of the stomach generally described as hypertrophic gastropathy. Its etiology is unknown and its malignant potential is controversial. Only a few reports supporting its association with gastric cancer have been found. We present a case of gastric cancer associated with Ménétrier's disease. CASE REPORT: We present a 72 year-old-male with epigastric pain and early satiety during the last 5 months. He had been treated with proton pump inhibitors with unfavorable response and began with loss of weight and asthenia. An upper digestive endoscopy showed an erythematous nodular gastric mucosa, with enlarged folds. An abdominal CT scan demonstrated a circumferential parietal thickening of the gastric wall and adenopathies. A gastric macrobiopsy done by endoscopic mucosal resection evidenced a mucin infiltrating adenocarcinoma with invasion of the lamina propria. Subtotal gastrectomy was done. The histology showed a stomach with changes compatible with Ménétrier's disease and diffuse infiltration by a highly undifferentiated adenocarcinoma (plastic linitis). CONCLUSION: A patient with diffuse gastric adenocarcinoma and Ménétrier's disease is reported.