Ultrasonography is an accurate technique for the diagnosis of gastrointestinal tumors in patients without localizing symptoms.

INTRODUCTION AND OBJECTIVES: This study compared the accuracy of ultrasonography in the diagnosis of gastrointestinal tumors in patients with several degrees of clinical suspicion. MATERIAL AND METHODS: We recruited patients that were suspect for gastrointestinal neoplasia but with no evidence of localizing symptoms (group A), and patients that were suspect for colon cancer (group B) or for gastric cancer (group C). Accuracy in the diagnosis was compared for: gastric cancer in groups A and C, and for colon cancer in groups A and B. The comparison was made by using the contingency coefficient, which quantifies coincidence of endoscopic and ultrasonographic diagnoses. RESULTS: Seventy-nine patients were included in group A (48 males), wherein 12 colon and 5 gastric neoplasms were detected. Group B was comprised of 153 patients (78 males) and included 66 patients with colorectal cancer (CCR). Group C contained 58 patients (35 males), 31 of whom were diagnosed with gastric cancer. The accuracy of sonography for diagnosing colon cancer was 95.5% for group A and 87.5% for group B. The contingency coefficient for endoscopy vs. ultrasonography was greater for group A: 0.658 than for group B: 0.549. The diagnostic accuracy for gastric cancer was 97.4% for group A and 86.2% for group C. The contingency coefficient between endoscopic and ultrasonographic diagnoses was also greater in group A (0.618) than in group C (0.588). CONCLUSIONS: The accuracy of ultrasonography in diagnosing colon and gastric cancer is not lower in patients without localizing symptoms.

La ecografía es una técnica sensible en el diagnóstico de las neoplasias gastrointestinales en pacientes sin síntomas localizadores / Ultrasonography is an accurate technique for the diagnosis of gastrointestinal tumors in patients without localizing symptoms

Introducción y objetivos: en todos los estudios publicadoshasta la fecha se ha evaluado la precisión de la ecografía en eldiagnóstico del cáncer de colon y del cáncer gástrico en pacientesen los que esta era la sospecha diagnóstica o ya con un diagnósticoestablecido de esta patología. Nosotros, en este estudio, comparamosla sensibilidad de la ecografía en pacientes con diferentesgrados de sospecha clínica.Material y método: reclutamos pacientes con sospecha deneoplasia digestiva, sin evidencia de síntomas localizadores (grupoA), pacientes con sospecha de cáncer de colon (grupo B) y pacientescon sospecha de cáncer gástrico (grupo C). Comparamosla precisión de la ecografía en el diagnóstico del cáncer gástricoen los grupos A y C, y la precisión en el diagnóstico del cáncer decolon en los grupos A y B. El parámetro usado en la comparaciónes el coeficiente de contigencia que cuantifica la coincidencia dediagnóstico endoscópico y ecográfico.Resultados: se han incluido 79 pacientes en el grupo A (48varones y 31 mujeres, con una edad media de 69,3 años), en losque se han diagnosticado 12 neoplasias colónicas y 5 gástricas. Elgrupo B se compone de 153 pacientes (78 varones y 75 mujeres,con una edad media de 66,5 años) e incluye 66 pacientes conCCR. Finalmente, el grupo C está formado por 58 pacientes (35varones y 23 mujeres, con una edad media de 67,4 años), siendodiagnosticados de cáncer gástrico 31 pacientes. La precisión de laecografía en el diagnóstico del cáncer de colon fue del 95,5% enel grupo A y del 87,5% en el grupo B. El coeficiente de contingenciaentre los diagnósticos endoscópico y ecográfico tambiénfue superior en el grupo A: 0,658 frente a 0,549. La precisión dela ecografía en el diagnóstico del cáncer gástrico fue del 97,4% enel grupo A y del 86,2% en el grupo C...(AU)

Introduction and objectives: this study compared the accuracyof ultrasonography in the diagnosis of gastrointestinal tumorsin patients with several degrees of clinical suspicion.Material and methods: we recruited patients that were suspectfor gastrointestinal neoplasia but with no evidence of localizingsymptoms (group A), and patients that were suspect for coloncancer (group B) or for gastric cancer (group C). Accuracy in thediagnosis was compared for: gastric cancer in groups A and C,and for colon cancer in groups A and B. The comparison wasmade by using the contingency coefficient, which quantifies coincidenceof endoscopic and ultrasonographic diagnoses.Results: seventy-nine patients were included in group A (48males), wherein 12 colon and 5 gastric neoplasms were detected.Group B was comprised of 153 patients (78 males) and included66 patients with colorectal cancer (CCR). Group C contained 58patients (35 males), 31 of whom were diagnosed with gastric cancer.The accuracy of sonography for diagnosing colon cancer was95.5% for group A and 87.5% for group B. The contingency coefficientfor endoscopy vs. ultrasonography was greater for groupA: 0.658 than for group B: 0.549. The diagnostic accuracy forgastric cancer was 97.4% for group A and 86.2% for group C.The contingency coefficient between endoscopic and ultrasonographicdiagnoses was also greater in group A (0.618) than ingroup C (0.588).Conclusions: the accuracy of ultrasonography in diagnosingcolon and gastric cancer is not lower in patients without localizingsymptoms(AU)

[Usefulness of digestive ultrasonography in the assessment of ulcerative colitis extent]. / Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa.

INTRODUCTION: A full examination of the colon should be avoided upon finding severe endoscopic lesions in patients with ulcerative colitis. However, knowledge of the precise extent of disease is quite important for disease prognosis and the making of therapeutic decisions. Therefore, any validation of a non-invasive technique to assess the extent of ulcerative colitis gains a lot of interest and importance. MATERIAL AND METHOD: The study included patients that were previously diagnosed of having ulcerative colitis or were beginning to suffer from the disease. A prospective and blind evaluation was carried out to determine the precision of digestive ultrasonography in assessment of ulcerative colitis extent. All ultrasonography was carried out by the same person and was always performed prior to carrying out a full endoscopic study, which is used as the gold standard. The hydrocolonic ultrasonograpy technique was not used in any of the cases. RESULTS: A total of 20 patients -13 males (65%) and 7 females (35%), with an average age of 51.7 years (aged between 24-82 years)- were included in the study. Endoscopic studies revealed severe disease in 5 cases (25%), moderate disease in 12 patients (60%), and mild lesions in the 3 remaining cases (15%). A colonic ultrasonogram was considered satisfactory in 18 cases (90%), and the extent of disease as established by ultrasonography was in all cases consistent with that established through colonoscopy: 3 patients (16.6%) had ulcerative proctitis, 9 patients (50%) had left-sided ulcerative colitis, and 6 (33.3%) had extensive colitis. CONCLUSIONS: Digestive ultrasonography allows to study the colon in most patients, especially when inflammatory activity is present, and provides a greater accuracy in assessing ulcerative colitis extent, which is independent of its activity level.

Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa / Usefulness of digestive ultrasonography in assessment of ulcerative colitis extent

Introducción: el hallazgo de lesiones endoscópicas severasen un paciente con colitis ulcerosa desaconseja la realización deuna exploración completa del colon. No obstante el conocimientode la extensión precisa de la enfermedad tiene gran importanciaen las decisiones terapéuticas a tomar y también en el pronósticode la enfermedad. Por todo ello, la validación de una técnica noinvasiva para el estudio de extensión de la colitis ulcerosa cobragran interés e importancia.Material y método: se incluyen en el estudio pacientes condiagnóstico previo de colitis ulcerosa o en el debut de la enfermedady, de forma prospectiva y ciega se evalúa la precisión de laecografía digestiva en la valoración de la extensión de la colitis ulcerosa.Las exploraciones ecográficas son realizadas todas ellaspor el mismo explorador y siempre con anterioridad al estudio endoscópicocompleto, que se usa como patrón oro. No se empleala técnica hidrocolónica en ningún caso.Resultados: han sido incluidos en el estudio 20 pacientes, 13varones (65%) y 7 mujeres (35%), con una edad media de 51,7años (rango de 24 a 82 años). Los estudios endoscópicos mostraronuna afectación severa en 5 casos (25%), moderada en 12 pacientes(60%) y lesiones leves en los 3 casos restantes (15%). Elestudio ecográfico del colon fue considerado satisfactorio en 18casos (90%) y la extensión de la enfermedad establecida en el estudioecográfico coincide en todos los casos con la determinadapor la colonoscopia: 3 pacientes (16,6%) presentaban una proctitisulcerosa, 9 (50%) una colitis izquierda y 6 (33,3%) una colitisextensa.Conclusiones: la ecografía digestiva permite el estudio delmarco colónico en la mayoría de los pacientes, especialmente siexiste actividad inflamatoria, permitiendo establecer con gran precisiónla extensión de la colitis ulcerosa, independientemente delgrado de actividad de la misma

Introduction: a full examination of the colon should be avoidedupon finding severe endoscopic lesions in patients with ulcerativecolitis. However, knowledge of the precise extent of disease isquite important for disease prognosis and the making of therapeuticdecisions. Therefore, any validation of a non-invasive techniqueto assess the extent of ulcerative colitis gains a lot of interestand importance.Material and method: the study included patients that werepreviously diagnosed of having ulcerative colitis or were beginningto suffer from the disease. A prospective and blind evaluation wascarried out to determine the precision of digestive ultrasonographyin assessment of ulcerative colitis extent. All ultrasonographywas carried out by the same person and was always performedprior to carrying out a full endoscopic study, which is used as thegold standard. The hydrocolonic ultrasonograpy technique wasnot used in any of the cases.Results: a total of 20 patients –13 males (65%) and 7 females(35%), with an average age of 51.7 years (aged between 24-82years)– were included in the study. Endoscopic studies revealed severedisease in 5 cases (25%), moderate disease in 12 patients(60%), and mild lesions in the 3 remaining cases (15%). A colonicultrasonogram was considered satisfactory in 18 cases (90%), andthe extent of disease as established by ultrasonography was in allcases consistent with that established through colonoscopy: 3 patients(16.6%) had ulcerative proctitis, 9 patients (50%) had leftsidedulcerative colitis, and 6 (33.3%) had extensive colitis.Conclusions: digestive ultrasonography allows to study thecolon in most patients, especially when inflammatory activity ispresent, and provides a greater accuracy in assessing ulcerativecolitis extent, which is independent of its activity level

[Idiopathic ductopenia in adults as a cause of cryptogenic cirrhosis and complications of portal hypertension]. / Ductopenia idiopática del adulto como causa de cirrosis criptogenética y complicaciones de la hipertensión portal.

We describe a 56 years old male patient with long-term chronic liver disease of unknown etiology presenting with esophageal varices rupture. Prophylaxis of re-bleeding with propranolol and endoscopic sclerotherapy failed to prevent further haemorrhagic events and the placement of a transjugular intrahepatic portosystemic shunt (TIPS) was needed. The portal hemodynamic data revealed sinusoidal portal hypertension and the liver biopsy displayed ductopenic cholestasis. The patient met all criteria of idiopathic ductopenia. Subsequently, the jaundice worsened and the patient required liver transplantation.

[The incidence of gastric carcinoma after gastrectomy for peptic ulcer in the Vigo region. A case-control study]. / Frecuencia del carcinoma gástrico postgastrectomía para úlcera péptica en la comarca de Vigo. Estudio caso-control.

After reviewing 10,000 upper gastrointestinal endoscopies performed at the endoscopy unit of the city of Vigo over a 38 month period, we have found 485 partial gastric resections for peptic ulcer, 357 gastric carcinomas were found, of which 26 occurred after partial gastric resection for peptic ulcer. Therefore the incidence of gastric cancer in this area was 22-23/100,000. The frequency of gastric cancer after partial resective surgery was lower than expected during the first 20 years after surgery. However, thereafter a significant increase of gastric cancer occurred in those patients in which a Billroth-II but not Billroth-I procedure was used.