Eficacia del endoscopio frontal asistido por cap como método para la evaluación de la ampolla de Vater / Efficacy of cap-assisted forward-viewing endoscopy as a method for the evaluation of the ampulla of Vater

Introducción: la evaluación endoscópica de la ampolla de Vater (AV), aunque recomendada de forma rutinaria, no siempre es posible debido a su configuración anatómica, que puede ocultarla del campo visual del endoscopio frontal. Se ha propuesto como una alternativa eficaz el usoañadido de un cap distal al endoscopio frontal para facilitar la examinación de esta estructura.Objetivos: determinar la eficacia del uso del endoscopio frontal asistido por cap para la valoración completa del AV. Se valoran la morfología del AV, los tiempos de búsqueda y total del procedimiento, así como la seguridad de la técnica.Métodos: estudio prospectivo de un solo brazo con inclusión de los pacientes en quienes se realizó una endoscopia alta electiva. Se excluyeron los pacientes con neoplasia avanzada, anatomía modificada, diagnóstico de estenosis u obstrucción del tracto digestivo superior.Resultados: se analizaron 90 pacientes, 36 hombres (40 %) y 54 mujeres (60 %), un 15,5 % del total con antecedente de un síndrome hereditario para cáncer de colon. El éxito técnico del endoscopio frontal + cap fue del 98,8 %. El AV se clasificó como tipo 1 (clásica) en el 49,4 %; tipo 2 (plana), en el 16,8 %; tipo 3 (protuberante), en el 11,2 %; y tipo 4 (anillada), en el 22,4 %. El tiempo promedio de búsqueda fue de 37,7 segundos (s) (DE ± 31,6), con un tiempo total procedimiento de 487,4 s (DE ± 206,2). No se reportaron eventos adversos.Conclusiones: el uso combinado del endoscopio frontal y cap distal es una técnica efectiva y segura para la visualización completa y caracterización morfológica del AV. (AU)

[Prognostic factors of mortality in the malignant biliary obstruction unresectable after the insertion of an endoscopic stent]. / Factores pronósticos de mortalidad en la estenosis biliar distal maligna irresecable después de la colocación de una prótesis endoscópica.

OBJECTIVE: To determine the factors prognostics of early mortality in the malignant billary estenosis after the endoscopic derivation. BACKGROUND DATA: The surgical, percutaneous or endoscopic derivation is the alternative of palliative treatment in the biliary obstruction unresectable. The factors prognostic the early mortality after surgical derivation are: hemoglobin < 10 g/dL, serum bilirubin > 10 mg/dL and serum albumin < 2.5 g/dL; for the percutaneous derivation they are the sanguineous urea more of 4.3 mmol/L and hemoglobin < 10.9 g/dL; whereas in the single endoscopic derivation type 3 of Bismuth and the infectious complications after the endoscopic colangiography and the absence of the clinical success were factors prognoses of early mortality. METHODS: Descriptive and retrospective analysis of 97 cases with malignant biliary obstruction. The factors were evaluated prognoses of early mortality. Univariated and bivaried analysis and of survival by the method of Kaplan-Meier was made curved. RESULTS: 97 cases were included that presented/displayed unresectable disease and had a biochemical control subsequent to the drainage. They were 58 women and 39 men. More frequent symptoms: ictericia, pain and prurito. 61 cases of distal obstruction and 36 with proximal obstruction. Twenty deaths (25.9%) happened within the 30 later days to the treatment. The bilirubin > 14 mg/dL and the proximal location were like predicting of early mortality. CONCLUSIONS: The obstruction biliary more frequent is located in choledocho distal and is of pancreatic origin. The main factors associated to early mortality are: the bilirubin > of 14 mg/dL and the proximal location reason why is important the suitable selection of patient candidates to endoscopic derivation. The survival is better in the distal obstruction.

[Utility of diagnostic scales for hereditary non-polyposis colon cancer in the Mexican population]. / Utilidad de las escalas diagnósticas para cáncer de colon no polipósico hereditario en la población mexicana.

INTRODUCTION: Hereditary non-polyposis colorectal cancer (HNPCC) represents 2 - 7% of all cancers. Diagnosis is made by means of the Amstedam criteria, or the modified Amsterdam and Bethesda. OBJECTIVE: Aim was to evaluate the clinical application of the diagnostic scales for HNPCC in our population and to determine the clinical characteristics that these patients reveal at the time of diagnosis. METHOD: A retrospective, cross-sectional study in which patients with colon cancer and less than 50 years of age were evaluated in a period of 3 years. The demographic data, patients and relatives history and the characteristics of the tumor were obtained at the time of diagnosis. We applied the Amsterdam criteria, modified Amsterdam and Bethesda to all the patients. RESULTS: 56 of 210 patients were of 50 younger with an average age of 38.3 years. Among the patients 14.3% had familiar cancer history. In 53.6% the tumor was located in right colon, regardless histology they had mucin component and poor cellular differentiation. Only two patients fulfilled criteria of modified Amsterdam and Amsterdam, and no patient fulfilled the Bethesda criteria. CONCLUSIONS: Frequency of CCNPH in our population was 1% by the Amsterdam criteria and modified Amsterdam and 0% by the Bethesda criteria.