[Experience with endoluminal functional luminal probe (EndoFLIP) at San Ignacio University Hospital, Bogota, Colombia]. / Experiencia con sonda luminal funcional endoluminal (EndoFLIP) en Hospital Universitario San Ignacio, Bogotá, Colombia.

INTRODUCTION: The EndoFLIP (for its acronym in English: endoluminal functional luminal probe) is a system that measures in real time the compliance index of the gastroesophageal junction and secondary esophageal peristalsis, based on the principle of impedance planimetry. Although this technology is relatively new and its diagnostic usefulness is still being evaluated, its use in clinical practice is increasingly recognized, fundamentally in those patients where there is no conclusive manometric diagnosis of esophageal motor pathology, mainly esophagogastric junction outflow obstruction and achalasia. OBJECTIVE: The aim of the present study is to describe the experience with EndoFLIP at the San Ignacio University Hospital in Bogotá, Colombia. MATERIAL AND METHODS: Descriptive observational case series study, which included patients over 18 years of age who had undergone EndoFLIP at the San Ignacio University Hospital from 2021 to 2022, either in-hospital or outpatient, with a clear indication of performance of the study, previously discussed in the multidisciplinary Gastroenterology Board. RESULTS: A total of 27 patients with an average age of 55 years were included in the study, of which 20 were women (74%) and 7 men (26%). The most frequent indication of the study was an inconclusive diagnosis of outflow tract obstruction identified in high-resolution esophageal manometry according to Chicago 4.0 criteria (14 patients), followed by hypercontractile esophagus (4 patients) and ineffective esophageal motility (3 patients). When evaluating the contractile response, it was found that 9 patients with an inconclusive diagnosis of outflow tract obstruction had a normal response, 3 absent and one altered; and in the patients with an inconclusive diagnosis of achalasia, one of them had a borderline contractile response and two had no response. All patients with a previous diagnosis of absent contractility had an equally absent contractile response in EndoFLIP. CONCLUSION: Endoluminal functional luminal imaging is a technique that evaluates biomechanical properties such as distensibility, volume, pressure and even diameters of sphincter regions such as the gastroesophageal junction, pylorus and anus. Its usefulness has been highlighted for several indications, the most important being manometrically inconclusive diagnoses of esophageal motor disorders such as achalasia and outflow tract obstruction, pathologies that have a significant impact on the quality of life of patients and whose diagnosis is essential to be able to provide the best treatment option.

Dynamic changes in liver function tests do not correctly reclassify patients at risk of choledocholithiasis beyond ASGE 2019 criteria.

Introduction: Dynamic changes in liver function tests have been proposed to correctly reclassify the risk of choledocholithiasis; however, information is scarce and insufficient to recommend its use. Methods: Retrospective cohort of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) due to moderate and high risk of choledocholithiasis according to the 2019 American Society of Gastrointestinal Endoscopy (ASGE) guidelines. We evaluated whether significant changes in liver function tests (bilirubin, transaminases, or alkaline phosphatase), defined as an increase or a reduction ⩾30 or ⩾50% between two measurements taken with a difference of 24-72 h can correctly reclassify the risk of choledocholithiasis beyond the ASGE guidelines. The net reclassification index (NRI) was calculated for patients with and without choledocholithiasis. Results: Among 1175 patients who underwent ERCP, 170 patients were included in the analysis (59.4% women, median 59.5 years). Among patients without a diagnosis of choledocholithiasis, the number of patients correctly reclassified by transaminases was slightly higher than those incorrectly reclassified (NRI = 0.24 for aspartate amino transaminase and 0.20 for alanine amino transaminase). However, among patients with a diagnosis of choledocholithiasis, it led to incorrect reclassification in a greater number of cases (NRI = -0.21 and -0.14, respectively). The benefits of reclassification were minimal for bilirubin and alkaline phosphatase, or for value changes >50%. A subgroup analysis showed similar findings in patients without a history of cholecystectomy and in those with normal bile duct. Conclusion: Dynamic changes in liver function tests do not improve choledocholithiasis risk classification beyond the 2019 ASGE criteria. New criteria should continue to be sought to optimize risk stratification.

Effectiveness and safety of new oral and injectable agents for in-hospital management of type 2 diabetes in general wards: Systematic review and meta-analysis.

BACKGROUND: Current guidelines recommend insulin alone for in-hospital management of diabetes, but growing information suggests that new oral or injectable agents may be as effective and safe. METHODS: Systematic review and meta-analysis with evidence from randomized (RCT) and non-randomized (NRS) studies in PubMed, EMBASE and LILACS databases up to February 10, 2022, for studies including hospitalized type 2 diabetes patients, comparing dipeptidyl peptidase 4 inhibitors (DPP4i), sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP1Ra) with insulin alone for glycemic control and safety outcomes. FINDINGS: 7 RCT and 3 NRTs were included. There were no differences in mean blood glucose, measurements within range or rate of hypoglycemia between DPP4i and insulin. We found a lower mean glucose for GLP1Ra plus insulin subgroup (-16.36 mg/dL, 95 % CI -27.31, -5.41; I2 = 0 %) with lower incidence of hypoglycemia < 70 mg/dL with GLP1Ra (RR 0.31, CI 95 % 0.14-0.70, I2 = 0 %). SGLT2i data was limited. Adverse events rates were similar between treatments. CONCLUSION: Our review suggests that inpatient management in the general ward with DPP4i and GLP1Ra is as effective and safe as management with insulin. More randomized studies are required to support these findings before they could be recommended as usual practice.