[Pan American Crohn's and Colitis Organization (PANCCO) and the Interamerican Society of Endoscopy (SIED) consensus on endoscopy in inflammatory bowel disease]. / Consenso de endoscopia en enfermedad inflamatoria intestinal de la Organización Panamericana de Crohn y Colitis (PANCCO) y la Sociedad Interamericana de endoscopia (SIED).

INTRODUCTION: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications. MATERIALS AND METHODS: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement. RESULTS: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD. CONCLUSIONS: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.

[Traversing the path to success in bariatric surgery: the fundamental role of bariatric endoscopy]. / Recorriendo el camino hacia el éxito en cirugía bariátrica: el rol fundamental de la endoscopia bariátrica.

Obesity has become a growing global epidemic, demanding effective solutions for its management. Bariatric-metabolic surgery is currently the best therapeutic option for patients with morbid obesity and associated comorbidities. This review article addresses the importance of endoscopy in the preoperative and postoperative evaluation, as well as in the detection and management of complications associated with bariatric surgery.

Recorriendo el camino hacia el éxito en cirugía bariátrica: el rol fundamental de la endoscopia bariátrica / Traversing the path to success in bariatric surgery: the fundamental role of bariatric endoscopy

RESUMEN La obesidad se ha convertido en una creciente epidemia de alcance global, exigiendo soluciones efectivas para su manejo. Actualmente, la cirugía bariátrica-metabólica es la mejor opción terapéutica en los pacientes con obesidad mórbida y comorbilidades asociadas. Este artículo de revisión aborda la importancia de la endoscopia en la evaluación pre y post operatoria, así como en la detección y manejo de las complicaciones asociadas a la cirugía bariátrica.

ABSTRACT Obesity has become a growing global epidemic, demanding effective solutions for its management. Bariatric-metabolic surgery is currently the best therapeutic option for patients with morbid obesity and associated comorbidities. This review article addresses the importance of endoscopy in the preoperative and postoperative evaluation, as well as in the detection and management of complications associated with bariatric surgery.

Protección radiológica en endoscopia

La endoscopía digestiva ha evolucionado de una técnica puramente diagnóstica a un procedimiento terapéutico. Esto es posible en muchos casos gracias al uso de fluoroscopía, lo cual conlleva la exposición a radiaciones ionizantes tanto de los pacientes como del personal actuante. La colangiopancreatografía retrógrada endoscópica (CPRE), que requiere necesariamente de fluoroscopia, es catalogada por la Food and Drug Administration como un examen con potencial riesgo de desencadenar lesiones inducidas por radiación. El presente artículo de revisión repasa los efectos biológicos de las radiaciones, los tipos de equipos radiológicos utilizados en CPRE, así como las magnitudes y unidades dosimétricas, para finalmente abordar los elementos de radio protección en la sala de endoscopia. El objetivo es brindar al lector la informacion para poder realizar estos procedimientos con la mayor seguridad radiológica tanto para los pacientes como para el personal ocupacionalmente expuesto.

Endoscopy has evolved from a purely diagnostic technique to a therapeutic procedure. This is possible in many cases thanks to the use of fluoroscopy, which entails exposure to ionizing radiation for both patients and the personnel involved. Endoscopic retrograde cholangiopancreatography (ERCP), which necessarily requires fluoroscopy, is classified by the Food and Drug Administration as an examination with a potential risk of triggering radiation induced injuries. This article reviews the biological effects of radiation, the types of radiological equipment used in ERCP, as well as the magnitudes and dosimetric units, to finally address the radio protection elements in the endoscopy room. The objective is to provide the reader with the information to be able to perform these procedures with the greatest radiological safety for both patients and occupationally exposed personnel.

[Radiation protection in endoscopy]. / Protección radiológica en endoscopia.

Endoscopy has evolved from a purely diagnostic technique to a therapeutic procedure. This is possible in many cases thanks to the use of fluoroscopy, which entails exposure to ionizing radiation for both patients and the personnel involved. Endoscopic retrograde cholangiopancreatography (ERCP), which necessarily requires fluoroscopy, is classified by the Food and Drug Administration as an examination with a potential risk of triggering radiation induced injuries. This article reviews the biological effects of radiation, the types of radiological equipment used in ERCP, as well as the magnitudes and dosimetric units, to finally address the radio protection elements in the endoscopy room. The objective is to provide the reader with the information to be able to perform these procedures with the greatest radiological safety for both patients and occupationally exposed personnel.

[Endoscopic dilation of the gastrointestinal tract]. / Dilataciones endoscópicas del tracto gastrointestinal.

The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation indications, benefits and risks for each of the existing systems of dilations.

Dilataciones endoscópicas del tracto gastrointestinal / Endoscopic dilation of the gastrointestinal tract

Las dilataciones en el tracto gastrointestinal se llevan a cabo para aliviar la obstrucción sintomática, ya sea funcional u orgánica, secundarias a una variedad de patologías tanto benignas como malignas. Con el advenimiento de las nuevas tecnologías, virtualmente toda estenosis digestiva puede ser manejada en forma mínimamente invasiva. Pese a su amplia difusión en la práctica actual, existen pocos estudios controlados que comparen las diferentes modalidades de dilatación. En el presente artículo realizamos una revisión de esta técnica, así como de la evidencia disponible para su aplicación en los diferentes segmentos del tracto gastrointestinal. El futuro de la dilatación incluye el desarrollo de dilatadores que permitan evaluar la dilatación durante su realización. Estos advenimientos, así como la ejecución de estudios controlados prospectivos van a mejorar las indicaciones, beneficios y riesgos para cada uno de los sistemas de dilatación existentes.

The endoscopic dilation of the gastrointestinal tract is carried out to relieve either functional or organic disorders, secondary to a variety of both benign and malignant diseases. With the advent of new technologies, virtually all digestive stenosis can be managed in a minimally invasive way. Despite its wide dissemination in actual practice, there are few controlled studies comparing the different forms of endoscopic dilation. In this article, we review this technique and the evidence available for application in different segments of the gastrointestinal tract. The future of the dilations includes the development of dilators to assess dilation during the procedure. These advents and the implementation of prospective controlled studies will improve the indications, benefits and risks for each of the existing systems of dilations.

A review on endoscopic palliation of obstructive jaundice before surgery.

Since its development, endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a simple diagnostic technique to an important therapeutic procedure. Obstructive jaundice is often the first and most common complication in patients with malignant disease of the extrahepatic biliary tract. Although preoperative biliary drainage (PBD) may be instituted in many centers, different studies have reported divergent results regarding its benefits in reducing the complications of hepatopancreatobiliary surgery, especially with regard to pancreatoduodenectomy for pancreatic cancer. In this review, we will summarize the current literature of PBD and describe its indications, possible benefits, and, when indicated, the appropriate interval before surgery.

Leopard skin sign: the use of narrow-band imaging with magnification endoscopy in celiac disease / Signo de la "piel de leopardo": el uso de endoscopía con magnificación y narrow banding en enfermedad celiaca

Celiac disease (CD) is an immune reaction to gluten containing foods such as rye, wheat and barley. This condition affects individuals with a genetic predisposition; it targets the small bowel and may cause symptoms including diarrhea, malabsorption, weight loss, abdominal pain and bloating. The diagnosis is made by serologic testing of celiac-specific antibodies and confirmed by histology. Certain endoscopic characteristics, such as scalloping, reduction in the number of folds, mosaic-pattern mucosa or nodular mucosa, are suggestive of CD and can be visualized under white light endoscopy. Due to its low sensitivity, endoscopy alone is not recommended to diagnose CD; however, enhanced visual identification of suspected mucosal abnormalities through the use of new technologies, such as narrow band imaging with magnification (NBI-ME), could assist in targeting biopsies and thereby increasing the sensitivity of endoscopy. This is a case series of seven patients with serologic and histologic diagnoses of CD who underwent upper endoscopies with NBI-ME imaging technology as part of their CD evaluation. By employing this imaging technology, we could identify patchy atrophy sites in a mosaic pattern, with flattened villi and alteration of the central capillaries of the duodenal mucosa. We refer to this epithelial pattern as ôLeopard Skin Signõ. Since epithelial lesions are easily seen using NBI-ME, we found it beneficial for identifying and targeting biopsy sites. Larger prospective studies are warranted to confirm our findings.

La enfermedad celiaca (EC) es una reacción inmune a los alimentos que contienen gluten como el centeno, el trigo y la cebada. Esta condición afecta a las personas con predisposición genética, comprometiendo al intestino delgado causando síntomas como diarrea, mala absorción, pérdida de peso, dolor abdominal y meteorismo. El diagnóstico se hace con estudios serológicos de anticuerpos específicos celiacos y es confirmado por histología. Algunas características endoscópicas tales como ôscallopingõ, reducción en el número de pliegues, patrón mucoso tipo mosaico o mucosa nodular, son sugestivos de EC y se pueden observar con endoscopía de luz blanca. Debido a su baja sensibilidad la endoscopía por sí sola no se recomienda para diagnosticar EC, sin embargo, una visualización cuidadosa de las anormalidades mucosas sospechosas a través de nuevas tecnologías como ôNarrow Band Imaginingõ con magnificación (NBI-ME) puede ayudar a dirigir las biopsias y así incrementar la sensibilidad de la endoscopía. Esta es una serie de siete casos con diagnóstico serológico e histológico de EC a quienes se les realizó una endoscopía digestiva alta con NBI-ME. En ellos se pudo identificar sitios de atrofia parcelar en un patrón de mosaico, con vellosidades aplanadas y alteración de los capilares de la mucosa duodenal. Nos referimos a esta alteración como el ôSigno de la Piel de Leopardoõ. Como las lesiones epiteliales se ven fácilmente usando NBI-ME, lo encontramos beneficioso para identificar y dirigir los sitios donde tomar las biopsias. Estudios prospectivos más grandes deben realizarse para confirmar nuestros hallazgos.

Entrenamiento en endoscopia con modelos “ex vivo” y “simuladores virtuales: nuevos métodos de enseñanza / Endoscopy training by using ex vivo and simulators: a new teaching tool

En las últimas décadas, el modelo tradicional de enseñanza de la endoscopia digestiva ha sido en base al método tutorial profesor-alumno, basado en modelos teóricos. Hoy en día, los simuladores presentan las ventajas de la realidad virtual. El aparato manipulado es similar al utilizado en la práctica clínica, es seguro, lo que permite un uso ilimitado, con mejor costobeneficio para las instituciones y con un rendimiento superior con respecto a otros modelos de entrenamiento. Por otra parte, los simuladores biológicos son una herramienta viable, accesible y asequible para simular lesiones gastrointestinales, lo que permite la formación en endoscopia con un alto grado de similitud en el aspecto endoscópico. En la presente revisión, analizamos ambos modelos, presentando sus ventajas para el entrenamiento del endoscopista de los tiempos actuales...

In recent decades, the traditional teaching model of gastrointestinal endoscopy has been based on the teacher-student tutorial method based on theoretical models. Today, simulators have the advantages of virtual reality. The handling apparatus is similar to that used in clinical practice; it is safe, which allows unlimited use, cost-effective for institutions and with superior performance over other training models. Besides, biological simulators are a viable, accessible and affordable tool to simulate gastrointestinal lesions, allowing training in endoscopy with a high degree of similarity in the endoscopic appearance. In this review, we analyze both models, showing its advantages for the training of the endoscopist of the times...

[Analysis of radiation exposure to medical staff and patients during ERCP in Uruguay]. / Evaluación de la radiación recibida por personal y pacientes durante la CPRE en el Uruguay.

BACKGROUND: The ERCP procedure requires the use of fluoroscopy with the subsequent exposure to ionizing radiation. The doses received by patients, physicians and assistants in the endoscopy have never been recorded in our area. This analysis describes the findings of the MIRED_Uy study (measuring radiation in digestive endoscopy in Uruguay). Objective. To determine radiation exposure received by patients, physicians and assistants during ERCP. METHODS: Data were collected from 33 procedures conducted by four endoscopists, supported by endoscopy assistants. All staff took basic radiation-protection measures. The magnitudes measured were the kerma area product (KAP) for the patient and the effective dose (E) and the equivalent doses in hand (HM) and lens of the eyes (HC) for the operators. RESULTS: Mean value for PKA was 24 Gy.cm2 (range: 0.04-71) equivalent to 312 chest x-rays. The mean fluoroscopy time was 2.3 minutes (range: 0.45 a 5.70 minutes). The E mean per procedure was 3.69, 5.14 y 3.69 muSv, for physician, first and second assistant respectively. The dose in hand for the physician was 19.4 muSv and the dose in lens was 7.94 muSv. CONCLUSIONS: The first results of measuring ERCP radiation doses in Uruguay are presented These procedures expose the patient and staff to measurable radiation doses, which should be taken into account to minimize their risks.

[Contributions of endoscopic ultrasound to pancreatic cystic lesions]. / Aportes de la ecografía endoscópica a las lesiones quísticas del páncreas.

Cystic lesions of the pancreas are peculiar in relation to their diagnosis and treatment. The use of endoscopic ultrasonography (EUS) has provided better sensitivity and specificity to differentiate benign from malignant cysts, condition that provides an early diagnosis and an effective and definite treatment.

Endoscopic ultrasound hemostasis techniques.

Since its development, endoscopic ultrasound (EUS) has evolved from a simple diagnostic technique to an important therapeutic tool for interventional endoscopy. EUS analysis provides real-time imaging of most major thoracic and abdominal vessels, and the possibility to use needle puncture with a curved linear array echoendoscope as a vascular intervention. In this review, we describe the endoscopic ultrasound approach to vascular therapy outside of the gastrointestinal wall.

A review on endoscopic palliation of obstructive jaundice before surgery / Una revisión de la paliación endoscópica de la ictericia obstructiva antes de la cirugía

Since its development, endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a simple diagnostic technique to an important therapeutic procedure. Obstructive jaundice is often the first and most common complication in patients with malignant disease of the extrahepatic biliary tract. Although preoperative biliary drainage (PBD) may be instituted in many centers, different studies have reported divergent results regarding its benefits in reducing the complications of hepatopancreatobiliary surgery, especially with regard to pancreatoduodenectomy for pancreatic cancer. In this review, we will summarize the current literature of PBD and describe its indications, possible benefits, and, when indicated, the appropriate interval before surgery.

Desde su desarrollo, la colangiopancreatografía retrógrada endoscópica ha evolucionado de una técnica puramente diagnóstica a un procedimiento netamente terapeútico. La ictericia obstructiva es a menudo la primera y más común de las complicaciones en los pacientes con enfermedad maligna de la vía biliar extrahepática. Aunque el drenaje biliar preoperatorio (DBP) puede ser realizado en múltiples centros, diferentes estudios han reportado resultados divergentes con respecto a sus beneficios en la reducción de las complicaciones de la cirugía biliopancreática, especialmente con respecto a duodenopancreatectomía para el cáncer de páncreas. En esta revisión, resumimos la literatura actual del DBP y describimos sus indicaciones, posibles beneficios y cuando esté indicado, el intervalo apropiado antes de la cirugía.

Endoscopic ultrasound hemostasis techniques / Técnicas de hemostasia por ultrasonido endoscópico

Since its development, endoscopic ultrasound (EUS) has evolved from a simple diagnostic technique to an important therapeutic tool for interventional endoscopy. EUS analysis provides real-time imaging of most major thoracic and abdominal vessels, and the possibility to use needle puncture with a curved linear array echoendoscope as a vascular intervention. In this review, we describe the endoscopic ultrasound approach to vascular therapy outside of the gastrointestinal wall.

Desde su introducción, la ultrasonografía endoscópica (USE) evolucionó de una técnica diagnóstica a un procedimiento terapéutico. La USE proporciona una imagen en tiempo real de la mayoría de los grandes vasos torácicos y abdominales, brindando la posibilidad de utilizar la aguja de punción a través del ecoendoscopio como una intervención vascular. En esta revisión, describimos la intervención vascular por fuera de la pared gastrointestinal mediante ecoendoscopia.

"Leopard skin sign": the use of narrow-band imaging with magnification endoscopy in celiac disease.

Celiac Disease (CD) is an immune reaction to gluten containing foods such as rye, wheat and barley. This condition affects individuals with a genetic predisposition; it targets the small bowel and may cause symptoms including diarrhea, malabsorption, weight loss, abdominal pain and bloating. The diagnosis is made by serologic testing of celiac-specific antibodies and confirmed by histology. Certain endoscopic characteristics, such as scalloping, reduction in the number of folds, mosaic-pattern mucosa or nodular mucosa, are suggestive of CD and can be visualized under white light endoscopy. Due to its low sensitivity, endoscopy alone is not recommended to diagnose CD; however, enhanced visual identification of suspected mucosal abnormalities through the use of new technologies, such as narrow band imaging with magnification (NBI-ME), could assist in targeting biopsies and thereby increasing the sensitivity of endoscopy. This is a case series of seven patients with serologic and histologic diagnoses of CD who underwent upper endoscopies with NBI-ME imaging technology as part of their CD evaluation. By employing this imaging technology, we could identify patchy atrophy sites in a mosaic pattern, with flattened villi and alteration of the central capillaries of the duodenal mucosa. We refer to this epithelial pattern as "Leopard Skin Sign". Since epithelial lesions are easily seen using NBI-ME, we found it beneficial for identifying and targeting biopsy sites. Larger prospective studies are warranted to confirm our findings.

[Endoscopy training by using ex vivo and simulators: a new teaching tool]. / Entrenamiento en endoscopia con modelos "ex vivo" y "simuladores virtuales": nuevos métodos de enseñanza.

In recent decades, the traditional teaching model of gastrointestinal endoscopy has been based on the teacher-student tutorial method based on theoretical models. Today, simulators have the advantages of virtual reality. The handling apparatus is similar to that used in clinical practice; it is safe, which allows unlimited use, cost-effective for institutions and with superior performance over other training models. Besides, biological simulators are a viable, accessible and affordable tool to simulate gastrointestinal lesions, allowing training in endoscopy with a high degree of similarity in the endoscopic appearance. In this review, we analyze both models, showing its advantages for the training of the endoscopist of the times.

Aportes de la ecografía endoscópica a las lesiones quísticas del páncreas / [Contributions of endoscopic ultrasound to pancreatic cystic lesions].

Cystic lesions of the pancreas are peculiar in relation to their diagnosis and treatment. The use of endoscopic ultrasonography (EUS) has provided better sensitivity and specificity to differentiate benign from malignant cysts, condition that provides an early diagnosis and an effective and definite treatment.

Evaluación de la radiación recibida por personal y pacientes durante la CPRE en el Uruguay / [Analysis of radiation exposure to medical staff and patients during ERCP in Uruguay].

BACKGROUND: The ERCP procedure requires the use of fluoroscopy with the subsequent exposure to ionizing radiation. The doses received by patients, physicians and assistants in the endoscopy have never been recorded in our area. This analysis describes the findings of the MIRED_Uy study (measuring radiation in digestive endoscopy in Uruguay). Objective. To determine radiation exposure received by patients, physicians and assistants during ERCP. METHODS: Data were collected from 33 procedures conducted by four endoscopists, supported by endoscopy assistants. All staff took basic radiation-protection measures. The magnitudes measured were the kerma area product (KAP) for the patient and the effective dose (E) and the equivalent doses in hand (HM) and lens of the eyes (HC) for the operators. RESULTS: Mean value for PKA was 24 Gy.cm2 (range: 0.04-71) equivalent to 312 chest x-rays. The mean fluoroscopy time was 2.3 minutes (range: 0.45 a 5.70 minutes). The E mean per procedure was 3.69, 5.14 y 3.69 muSv, for physician, first and second assistant respectively. The dose in hand for the physician was 19.4 muSv and the dose in lens was 7.94 muSv. CONCLUSIONS: The first results of measuring ERCP radiation doses in Uruguay are presented These procedures expose the patient and staff to measurable radiation doses, which should be taken into account to minimize their risks.

Evaluación de la radiación recibida por personal y pacientes durante la CPRE en el Uruguay. / [Analysis of radiation exposure to medical staff and patients during ERCP in Uruguay].

BACKGROUND: The ERCP procedure requires the use of fluoroscopy with the subsequent exposure to ionizing radiation. The doses received by patients, physicians and assistants in the endoscopy have never been recorded in our area. This analysis describes the findings of the MIRED_Uy study (measuring radiation in digestive endoscopy in Uruguay). Objective. To determine radiation exposure received by patients, physicians and assistants during ERCP. METHODS: Data were collected from 33 procedures conducted by four endoscopists, supported by endoscopy assistants. All staff took basic radiation-protection measures. The magnitudes measured were the kerma area product (KAP) for the patient and the effective dose (E) and the equivalent doses in hand (HM) and lens of the eyes (HC) for the operators. RESULTS: Mean value for PKA was 24 Gy.cm2 (range: 0.04-71) equivalent to 312 chest x-rays. The mean fluoroscopy time was 2.3 minutes (range: 0.45 a 5.70 minutes). The E mean per procedure was 3.69, 5.14 y 3.69 muSv, for physician, first and second assistant respectively. The dose in hand for the physician was 19.4 muSv and the dose in lens was 7.94 muSv. CONCLUSIONS: The first results of measuring ERCP radiation doses in Uruguay are presented These procedures expose the patient and staff to measurable radiation doses, which should be taken into account to minimize their risks.