The role of magnification endoscopy in the early diagnosis of gastric signet ring cell carcinoma.

We present the case of a 67-year-old woman referred to our outpatient clinic presenting dyspepsia. Gastroscopy was performed, showing antral gastritis. Random biopsies were taken, being positive for poorly differentiated Lauren's diffuse gastric adenocarcinoma. Narrow-band imaging gastroscopy was performed, combining random and targeted biopsies, with negative results. The study was completed with echoendoscopy and thoraco-abdominal-pelvic CT scan, showing no relevant pathological findings. Control endoscopic was performed after 12 months, showing no macroscopic lesions. Random biopsies were repeated, being positive for diffuse gastric adenocarcinoma. Gastroscopy with conventional chromoendoscopy was performed, showing a completely flat area of approximately 2cm of diameter in the body-antrum junction, in the greater curvature; it was well delimited and no indigo carmine staining was observed (Figure 1). Electronic magnification was performed, showing disruption of the crypt pattern and aberrant neovessels (Figures 2 and 3). Targeted biopsies were taken, being positive for poorly differentiated gastric adenocarcinoma. The case was discussed in a multidisciplinary session and subtotal gastrectomy was performed. Magnification endoscopy offers a better performance diagnosing early gastric cancer than white light endoscopy. [1] It allows the identification of patterns that can predict malignancy, such as distortion of the mucosal glandular pattern or aberrant proliferation of neovessels. [2] Once the diagnosis has been established, assessing the depth of invasion has great clinical relevance, as it guides therapeutic decisions. Works such as that of Zhou et al. [3] underline the usefulness of linear echoendoscopy in this process.

Hemostatic spray powder TC-325 for GI bleeding in a nationwide study: survival and predictors of failure via competing risks analysis.

BACKGROUND AND AIMS: TC-325 (Hemospray, Cook Medical, Winston-Salem, NC) is an inorganic hemostatic powder recently approved by the U.S. Food and Drug Administration. This study aimed to examine the effectiveness, safety, and predictors of TC-325 failure in a large real-life cohort. METHODS: This was a retrospective study conducted at 21 Spanish centers. All patients treated with TC-325 until September 2018 were included. The primary outcome was treatment failure, defined as failed intraprocedural hemostasis or recurrent bleeding within the first 30 postprocedural days. Secondary outcomes included safety and survival. Risk and predictors of failure were assessed via competing-risk models. RESULTS: The cohort comprised 261 patients, of whom 219 (83.9%) presented with upper gastrointestinal bleeding (GIB). The most common causes were peptic ulcer (28%), malignancy (18.4%), and therapeutic endoscopy-related GIB (17.6%). TC-325 was used as rescue therapy in 191 (73.2%) patients. The rate of intraprocedural hemostasis was 93.5% (95% confidence interval [CI], 90%-96%). Risks of TC-325 failure at postprocedural days 3, 7, and 30 were 21.1%, 24.6%, and 27.4%, respectively. On multivariate analysis, spurting bleeding (P = .004), use of vasoactive drugs (P = .02), and hypotension (P = .008) were independent predictors of failure. Overall 30-day survival was 81.9% (95% CI, 76%-86%) and intraprocedural hemostasis was associated with a better prognosis (adjusted hazard ratio, 0.29; P = .006). Two severe adverse events were noted. CONCLUSION: TC-325 was safe and effective for intraprocedural hemostasis in more than 90% of patients, regardless of the cause or site of bleeding and its use as rescue therapy. In this high-risk cohort treated with TC-325, the 30-day failure rate exceeded 25% and was highest with spurting bleeding or hemodynamic instability.

Cribado de la enfermedad hepática por depósito de grasa: cómo y a quién / Non-alcoholic fatty liver disease. How and who to screen

Resumen La enfermedad hepática por depósito de grasa (EHDG) no asociada al consumo dealcohol puede aparecer en el contexto de múltiples afecciones, pero, sin duda, la principalasociación etiológica es con el síndrome de resistencia a la insulina (RI). En esta revisión pretendemossistematizar el proceso diagnóstico que debe incluir los siguientes aspectos básicos:a) el diagnóstico de sospecha de la EHDG, incluyendo la verificación de la abstinencia alcohólica,la exclusión de otras causas potenciales de esteatosis hepática y el diagnóstico de las potencialesenfermedades asociadas; b) el diagnóstico de la RI; c) el diagnóstico de las potencialesenfermedades asociadas; d) una adecuada valoración del riesgo vascular de estos pacientes;e) el diagnóstico del tipo y localización de la grasa y, finalmente, f) evaluar la severidad de laEHDG, que puede obtenerse mediante técnicas invasivas y no invasivas (AU)

Abstract Non-alcoholic fatty acid disease (NAFLD) can develop in the context of multiple processesbut the main etiologic association is undoubtedly with insulin resistance syndrome. Thepresent review aims to provide a systematic diagnostic approach that should include the followingbasic elements: a) a suspected diagnosis of NAFLD, including confirmation of abstinencefrom alcohol, exclusion of other potential causes of liver steatosis and diagnosis of potentialassociated diseases; b) diagnosis of insulin resistance; c) diagnosis of potential associated diseases;d) adequate evaluation of vascular risk; e) diagnosis of the type and localization of fat,and finally, f) evaluation of the severity of NAFLD, which can be performed through invasiveand non-invasive techniques (AU)

[Non-alcoholic fatty liver disease. How and who to screen]. / Cribado de la enfermedad hepática por depósito de grasa: cómo y a quién.

Non-alcoholic fatty acid disease (NAFLD) can develop in the context of multiple processes but the main etiologic association is undoubtedly with insulin resistance syndrome. The present review aims to provide a systematic diagnostic approach that should include the following basic elements: a) a suspected diagnosis of NAFLD, including confirmation of abstinence from alcohol, exclusion of other potential causes of liver steatosis and diagnosis of potential associated diseases; b) diagnosis of insulin resistance; c) diagnosis of potential associated diseases; d) adequate evaluation of vascular risk; e) diagnosis of the type and localization of fat, and finally, f) evaluation of the severity of NAFLD, which can be performed through invasive and non-invasive techniques.

Resultados del programa de detección precoz de cáncer colorrectal en Cantabria durante el período noviembre de 2008 a marzo de 2010 / Results of the screening program for colorectal cancer screening in Cantabria, Spain, during the period november 2008-march 2010

Fundamento: Por su elevada incidencia y mortalidad el cáncer colorrectal (CCR) se considera un importante problema de Salud Pública. Los programas de cribado están adquiriendo cada vez mayor relevancia en su abordaje dada la importancia del diagnóstico precoz en la disminución de la mortalidad por esta causa. El objetivo de este trabajo es presentar el desarrollo y resultados del programa de cribado poblacional de CCR en Cantabria. Métodos: Estudio descriptivo del programa de cribado de carácter bienal diseñado para la población de 55 a 69 años a partir de la base de datos de la Tarjeta Sanitaria (92.605 personas). La determinación de sangre oculta en heces (SOH) por método inmunoquímico cualitativo es la prueba de cribado, empleándose la colonoscopia óptica como confirmación. La población recibe una carta de invitación, debiéndose citar en su Centro de Salud si aceptan participar. Tras aplicar los criterios de exclusión, las personas con resultado positivo en el test son citadas para colonoscopia. Aquellos en los que se detecta un carcinoma invasivo son remitidos directamente al Servicio de digestivo. Resultados: En el periodo de estudio estaban cubiertas por el programa 35.005 personas (37,8 % de la población diana). De las invitadas (7.406) participaron 2.384 (32,1%). Fueron detectados un carcinoma «in situ», 2 invasivos y 43 adenomas de alto riesgo. Conclusión: Por su integración en Atención Primaria, ausencia de aparataje, fácil uso y rápida realización, el test de detección de SOH inmunoquímico cualitativo facilita la extensión del cribado, con resultados similares a los de los test inmunoquímicos cuantitativos(AU)

Background: The colorectal cancer (CCR) is a Public Health problem because of its high incidence and mortality. Screening programs are important for early detection of CCR. An early detection of this illness could decrease its mortality. The objectives of our study are to present the colorectal cancer screening program in Cantabria and its main results. Methods: Descriptive study of a two-year screening program for population in the 55 – 69 years age range, according to the Cantabria Health Service data base (92,605 people). The screening test used a qualitative immunochemical method in search of faecal occulted blood (FOB), complemented by optical colonoscopy confirmation. Eligible people were invited to participate in the screening program by means of personal letter and, in case of acceptance, they were dated in their primary Health Center. After application of exclusion criteria, selected people with a positive result test were submitted to optical colonoscopy. Those in which an invasive cancer was detected were directly addressed to the Digestive Service. Results: The program was offered to 35,005 (37.8 %) of the eligible population of Cantabria at the end of study period. 2,384 persons participated (32.1%). The main colonoscopy findings were 1 «in situ» cancer, 2 invasive cancer and 43 high-risk adenomas. Conclusion: Due to its integration into primary care, lack of apparatus, ease use and fast implementation, qualitative immunochemical test FOBT facilitates the extension of screening, with similar results to those of quantitative immunochemical test(AU)

[Results of the screening program for colorectal cancer screening in Cantabria, Spain, during the period November 2008-March 2010]. / Resultados del programa de detección precoz de cáncer colorrectal en Cantabria durante el periodo noviembre de 2008 a marzo de 2010.

BACKGROUND: The colorectal cancer (CCR) is a Public Health problem because of its high incidence and mortality. Screening programs are important for early detection of CCR. An early detection of this illness could decrease its mortality. The objectives of our study are to present the colorectal cancer screening program in Cantabria and its main results. METHODS: Descriptive study of a two-year screening program for population in the 55 - 69 years age range, according to the Cantabria Health Service data base (92,605 people). The screening test used a qualitative immunochemical method in search of faecal occulted blood (FOB), complemented by optical colonoscopy confirmation. Eligible people were invited to participate in the screening program by means of personal letter and, in case of acceptance, they were dated in their primary Health Center. After application of exclusion criteria, selected people with a positive result test were submitted to optical colonoscopy. Those in which an invasive cancer was detected were directly addressed to the Digestive Service. RESULTS: The program was offered to 35,005 (37.8 %) of the eligible population of Cantabria at the end of study period. 2,384 persons participated (32.1%). The main colonoscopy findings were 1 «in situ¼ cancer, 2 invasive cancer and 43 high-risk adenomas. CONCLUSION: Due to its integration into primary care, lack of apparatus, ease use and fast implementation, qualitative immunochemical test FOBT facilitates the extension of screening, with similar results to those of quantitative immunochemical test.