Use of N-acetylcysteine plus simethicone to improve mucosal visibility in upper digestive endoscopy via systematic alphanumeric-coded endoscopy: a randomized, double-blind controlled trial.

Background: The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method. Methods: This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects. Results: A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group. Conclusion: The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.

Escrutinio para el cáncer de colon: ¿cuál fue el impacto en los primeros 2 años de la pandemia de COVID-19? Experiencia en una clínica privada ambulatoria.

BACKGROUND: COVID-19 pandemic had a negative impact on colorectal cancer (CRC) screening programs. OBJECTIVE: The care strategy was modified throughout the pandemic, this paper evaluates its impact and short-term consequences. METHODS: A retrospective, descriptive and cross-sectional study was carried out in a private ambulatory endoscopic center, in average risk subjects. The study compared two periods: pre-pandemic and pandemic (subdivided into pre-vaccination and vaccination). RESULTS: During this period, 54.4% of scheduled colonoscopies were due to the screening program. The average age was 60.4 ± 7 years. Women were 52.0%. The overall cancellation rate was 41.1%, higher during pre-vaccination period. There were no differences in the degree of colonic cleansing, colonoscope exit time, and patient satisfaction. The adenoma detection rate (38.4% vs. 42.8% vs. 36.4%; p = 0.8) and the total number of adenomas (p = 0.02) was statistically significant during the pre-vaccination period. The rate of adenoma/patient showed a higher trend during this period (p = 0.06). The number of colorectal cancers was 10, without differences between periods. CONCLUSION: In conclusion, the impact of the decrease in screening colonoscopy procedures for CRC detection was similar to what was seen worldwide. In this period no increase in cancer cases, although this effect may be observed in the long term.

ANTECEDENTES: La pandemia de COVID-19 tuvo un impacto negativo en el programa de detección del cáncer colorrectal (CCR). OBJETIVO: La estrategia de atención cambió y se evaluó su impacto a corto plazo. MÉTODO: Se realizó un estudio retrospectivo, descriptivo y transversal, en un centro endoscópico ambulatorio privado, en sujetos con riesgo promedio de CCR. El estudio comparó dos períodos: prepandemia y pandemia (subdividido en prevacunación y vacunación). RESULTADOS: El 54.4% de las colonoscopias fueron por escrutinio. La edad promedio fue de 60.4 ± 7 años. El 52.0% fueron mujeres. La tasa de cancelaciones fue del 41.1%, siendo mayor durante el período prevacunación. No hubo diferencias en el grado de limpieza colónica, el tiempo de salida ni la satisfacción del paciente. La tasa de detección de adenomas (38.4% vs. 42.8% vs. 36.4%; p = 0.8) y el número total de adenomas (p = 0.02) tuvieron una significancia en el período prevacunación. El índice adenoma/paciente fue mayor durante este período (p = 0.06). El número de CCR fue de 10 (1.9%), sin diferencias entre los períodos. CONCLUSIÓN: Se concluye que la repercusión por la disminución en los procedimientos de escrutinio fue similar a lo visto en todo el mundo y no se encontró un aumento de los casos de cáncer, aunque este efecto podrá observarse a largo plazo.

Inteligencia artificial en la colonoscopia de tamizaje y la disminución del error.

Artificial Intelligence (AI) has the potential to change many aspects of healthcare practice. Image discrimination and classification has many applications within medicine. Machine learning algorithms and complicated neural networks have been developed to train a computer to differentiate between normal and abnormal areas. Machine learning is a form of AI that allows the platform to improve without being programmed. Computer Assisted Diagnosis (CAD) is based on latency, which is the time between the captured image and when it is displayed on the screen. AI-assisted endoscopy can increase the detection rate by identifying missed lesions. An AI CAD system must be responsive, specific, with easy-to-use interfaces, and provide fast results without substantially prolonging procedures. AI has the potential to help both, trained and trainee endoscopists. Rather than being a substitute for high-quality technique, it should serve as a complement to good practice. AI has been evaluated in three clinical scenarios in colonic neoplasms: the detection of polyps, their characterization (adenomatous vs. non-adenomatous) and the prediction of invasive cancer within a polypoid lesion.

La inteligencia artificial (IA) tiene el potencial de cambiar muchos aspectos de la práctica sanitaria. La discriminación y la clasificación de imágenes tiene muchas aplicaciones dentro de la medicina. Se han desarrollado algoritmos de aprendizaje automático y redes neuronales complicadas para entrenar a una computadora a diferenciar las áreas normales de las anormales. El aprendizaje automático es una forma de IA que permite que la plataforma mejore sin ser programada. El diagnóstico asistido por computadora (CAD) se basa en latencia, que es el tiempo entre la imagen capturada y cuando es mostrada en la pantalla. La endoscopia asistida por IA puede incrementar la tasa de detección al identificar lesiones obviadas. Un sistema CAD de IA debe ser sensible, específico, con interfaces fáciles de usar, y proporcionar resultados rápidos sin prolongar sustancialmente los procedimientos. La IA tiene el potencial de ayudar tanto a endoscopistas entrenados como a los que están en entrenamiento. En vez de ser un sustituto para una técnica de alta calidad, deberá servir como un complemento de las buenas prácticas. La IA ha sido evaluada en tres escenarios clínicos en las neoplasias colónicas: la detección de pólipos, su caracterización (adenomatosos vs. no adenomatosos) y la predicción de cáncer invasor dentro de una lesión polipoide.

Usefulness of optical enhancement endoscopy combined with magnification to improve detection of intestinal metaplasia in the stomach.

Background and study aims The light blue crest observed in narrow band imaging endoscopy has high diagnostic accuracy for diagnosis of gastric intestinal metaplasia (GIM). The objective of this prospective study was to evaluate the diagnostic accuracy of magnifying i-scan optical enhancement (OE) imaging for diagnosing the LBC sign in patients with different levels of risk for gastric cancer in a Mexican clinical practice. Patients and methods Patients with a history of peptic ulcer and symptoms of dyspepsia or gastroesophageal reflux disease were enrolled. Diagnosis of GIM was made at the predetermined anatomical location and white light endoscopy and i-scan OE Mode 1 were captured at the two predetermined biopsy sites (antrum and pyloric regions). Results A total of 328 patients were enrolled in this study. Overall GIM prevalence was 33.8 %. The GIM distribution was 95.4 % in the antrum and 40.5 % in the corpus. According to the Operative Link on Gastritis/Intestinal-Metaplasia Assessment staging system, only two patients (1.9 %) were classified with high-risk stage disease. Sensitivity, specificity, positive​ and negative predictive values, positive and negative likelihood ratios, and accuracy of both methods (95 % C. I.) were 0.50 (0.41-0.60), 0.55 (0.48-0.62), 0.36 (0.31-0.42), 0.68 (0.63-0.73), 1.12 (0.9-1.4), 0.9 (0.7-1.1), and 0.53 (0.43-0.60) for WLE, and 0.96 (0.90-0.99), 0.91 (0.86-0.94), 0.84 (0.78-0.89), 0.98 (0.94-0.99), 10.4 (6.8-16), 0.05 (0.02-0.12), and 0.93 (0.89-0.95), respectively. The kappa concordance was 0.67 and the reliability coefficient was 0.7407 for interobserver variability. Conclusions Our study demonstrated the high performance of magnifying i-scan OE imaging for endoscopic diagnosis of GIM in Mexican patients.

Results of the fecal immunochemical test in a colorectal cancer screening program in Mexico.

BACKGROUND: Colorectal cancer (CRC) is one of the main five causes of morbidity and mortality by oncologic diseases in our country and worldwide. Recently, fecal immunochemical test (FIT) has proven to be a noninvasive screening test that allows to select patients most likely to have a pre-malign lesion in order to perform a colonoscopy. OBJECTIVE: To report the findings of a CRC screening program using FIT in our country population. METHOD: A multicentric study was performed, by inviting open population older than 50 years to participate in a CRC screening. Quantitative FIT specific for human hemoglobin was used, with a cut point of 100 ng/ml or higher to consider as positive. Those patients with positive results were asked to undergo a colonoscopy. In the cases where polypoid lesions were found, biopsies were performed. RESULTS: In total, 751 FIT were processed, and 51 (6.8) of those were positive, with a rate of 15.9 premalign lesions for 1,000 individuals, and 1.3 patients with CRC for every 1,000. CONCLUSIONS: The present study matches worldwide reports, supporting the initiative of establishing a formal and standardized CRC screening program in the public health sector.

ANTECEDENTES: El cáncer colorrectal (CCR) es una de las cinco primeras causas de morbimortalidad por cáncer en nuestro país y en todo el mundo. La prueba inmunoquímica fecal (FIT, fecal immunochemical test) es una herramienta de tamizaje no invasiva que permite seleccionar a los sujetos con mayor probabilidad de lesión premaligna en la colonoscopia. OBJETIVO: Reportar los resultados del programa de escrutinio para CCR mediante FIT en población abierta en México. MÉTODO: Estudio multicéntrico nacional en población abierta mayor de 50 años a través de medios de difusión masiva para participar en un programa de escrutinio de CCR. Se utilizó FIT cuantitativa específica para detectar hemoglobina humana con un punto de corte de 100 ng/ml (prueba positiva). Se realizó colonoscopia a los positivos. Se tomaron biopsias dirigidas de las lesiones premalignas/cáncer para análisis histopatológico. RESULTADOS: Se procesaron 751 FIT, de las cuales 51 (6.8%) fueron positivas, con una tasa de 15.9 lesiones premalignas por cada 1,000 sujetos evaluados, y 1.3 pacientes con CCR por cada 1,000 pacientes. CONCLUSIONES: Nuestro estudio concuerda con lo reportado en la literatura mundial, apoyando así la iniciativa de fomentar el establecimiento de un tamizaje formal y estandarizado dentro del sector de salud pública.

Evaluation of the satisfaction of the patient undergoing screening colonoscopy and quality of the procedure.

BACKGROUND: Screening colonoscopy requires quality parameters to determine its efficacy to detect cancerous or precancerous lesions. Limitations of the procedure are the patient's rejection, difficulty for its preparation or lack of preparation. OBJECTIVE: To assess whether patient satisfaction correlates with the quality of the procedure. METHOD: 100 consecutive patients for a screening colonoscopy were included, they were randomized to use a preparation with polyethylene glycol (PEG) or sodium picosulfate (P). In addition, a second parameter evaluated was related to a follow-up phone call performed to half of the patients prior to the study, during the preparation time. RESULTS: P was better tolerated and qualified, however, there was no difference with the quality of preparation, adenomatous polyps detection rate, cecum insertion rate and patient satisfaction. A difference was found in whom had a follow-up phone call. DISCUSSION: A good colon preparation is a key factor to have a quality colonoscopy, and it has been shown important that a good relationship for explain the doubts and follow the preparation. CONCLUSION: It was found that the type of preparation and patient follow-up during the study correlate with the quality of the study and patient satisfaction.

ANTECEDENTES: La colonoscopia de escrutinio requiere parámetros de calificación para determinar su eficiencia en la detección de lesiones cancerosas o precancerosas. Sus limitantes son su rechazo, la dificultad durante su preparación o la falta de preparación. OBJETIVO: Evaluar la satisfacción del paciente y los criterios de calidad del estudio. MÉTODO: Se incluyeron 100 pacientes enviados para colonoscopia de escrutinio asignados aleatoriamente a uno de dos grupos de preparación colónica: polietilenglicol (PEG) o picosulfato de sodio (P), para evaluar la satisfacción y la limpieza colónica. Otra evaluación fue por medio de llamada de refuerzo al momento de la preparación. RESULTADOS: Con P se tuvieron mejores tolerabilidad y calificaciones de satisfacción, en comparación con PEG. No hubo diferencia para la calidad de la limpieza, la tasa de detección de pólipos adenomatosos ni la intubación cecal. La llamada telefónica de reforzamiento incrementó la satisfacción, la limpieza colónica y la tasa de detección de adenomas. DISCUSIÓN: Una relación estrecha con el paciente durante su proceso de limpieza y explicación del procedimiento se ha visto como uno de los factores más importantes para lograr una colonoscopia de alta calidad. CONCLUSIÓN: El tipo de preparación colónica y la intervención durante la preparación se relacionaron con una mejor calidad del estudio y una mayor satisfacción del paciente.

Efficacy of the Combination of Pinaverium Bromide 100 mg Plus Simethicone 300 mg in Abdominal Pain and Bloating in Irritable Bowel Syndrome: A Randomized, Placebo-controlled Trial.

GOALS: We aimed to evaluate the efficacy and safety of PB+S (pinaverium bromide 100 mg plus simethicone 300 mg) in patients with irritable bowel syndrome (IBS). BACKGROUND: IBS is a multifactorial disorder; thus, combination therapy with different mechanisms of action is expected to be useful. PB+S has shown effectiveness in an open-label clinical study in IBS. However, there are no placebo-controlled trials. MATERIALS AND METHODS: IBS-Rome III patients with abdominal pain/discomfort for at least 2 days within the week prior to baseline assessment were included in this 12-week, randomized, double-blind, placebo-controlled study of PB+S versus placebo, bid. The primary endpoint was overall symptom improvement, evaluated weekly by the patient (Likert Scale). Secondary endpoints included the weekly improvement in the severity of abdominal pain and bloating assessed both by patients (10-cm Visual Analogue Scale) and investigators (Likert Scale); frequency of Bristol Scale stool types (consistency) evaluated by patients and the IBS Quality of Life scores. RESULTS: A total of 285 patients (female: 83%; 36.5±8.9 y old) received at least 1 dose of PB+S (n=140) or placebo (n=145). No difference was observed in overall symptom improvement between the groups (P=0.13). However, PB+S was superior in abdominal pain (effect size: 31%, P=0.038) and bloating (33%, P=0.019). Patients with IBS-C and IBS-M showed the best improvement in the frequency of stool types with PB+S. No differences were observed in IBS Quality of Life scores and adverse events. CONCLUSIONS: PB+S was superior to placebo in improving abdominal pain and bloating in patients with active IBS. The effect on the frequency of stool consistency was particularly significant in IBS-C and IBS-M.

Acute dysphagia presentation and its association with esophagitis dissecans and concomitant diseases. A diagnostic challenge.

Esophagitis dissecans (ESD) is an uncommon disease that is associated with eosinophilic esophagitis (EoE), candidiasis and/or drugs. We aim to characterize the clinical, endoscopic and histological damage of the mucosal in subjects with dysphagia, its relation to concomitant entities and the treatment response. This is a retrospective observational study in patients with dysphagia and esophageal mucosal damage We included 23 patients (mean age = 55 years) who had GERD symptoms, dysphagia and/or odynophagia. There were 10, 9 and 4 cases of esophagitis dissecans, desquamative/esfacelante (ESD/ES) and fibrostenotic, respectively. ESD/SE is a rare entity with variable clinical, endoscopic and histological spectrum. The association with GERD was frequent.

La esofagitis disecante (ESD) es una enfermedad rara que puede asociarse a esofagitis eosinofílica, candidiásica o medicamentos. Se analizaron las características clinico-endoscópicas e histopatológicas en sujetos con disfagia de corta evolución asociada a afecciones concurrentes. Estudio observacional de cohorte retrospectiva con disfagia y daño mucoso. Se ingresaron 23 pacientes con edad media de 55 años. Todos tuvieron síntomas de reflujo gastroesofágico (ERGE), disfagia y odinofagia. Fueron 10, 9 y 4 casos de ESD, descamativa/esfacelante (ESD/ES) y fibroestenosis, respectivamente. La ESD/SE es una afección rara, con un espectro clínico, endoscópico e histológico variable.

Relief of Night-time Symptoms Associated With Gastroesophageal Reflux Disease Following 4 Weeks of Treatment With Pantoprazole Magnesium: The Mexican Gastroesophageal Reflux Disease Working Group.

BACKGROUND/AIMS: To evaluate the effectiveness of pantoprazole magnesium (pantoprazole-Mg) 40 mg in the relief of esophageal and extra-esophageal symptoms of gastroesophageal reflux disease (GERD), particularly night-time symptoms. METHODS: Patients (aged 18-50 years) with 3-month history of heartburn and/or acid regurgitation plus at least one other symptom in the last week were enrolled in a nationwide, prospective and observational study in Mexico. Patients received pantoprazole-Mg 40 mg once daily during 4 weeks. Symptoms were assessed through a physician-administered structured interview and the patient-completed ReQuest in Practice™ questionnaire. Night-time GERD was defined as arousal from sleep during the night due to GERD-associated symptoms. RESULTS: Out of 4,343 patients included at basal visit, 3,665 were considered for the effectiveness per protocol analysis. At baseline, patients had a median of 8 GERD related symptoms. Patients with night-time GERD symptoms (42.7%) were more likely to have extra-esophageal symptoms (P < 0.001) than other GERD patients. Pantoprazole-Mg 40 mg once daily for 4 weeks improved a broad range of GERD-associated symptoms from baseline (80% reduction on physicians assessments; 68-77% reduction on ReQuest in Practice™ dimensions), including both day- and night-time GERD symptoms; improvements were the greatest for extra-esophageal symptoms in patients with night-time symptoms. Pantoprazole-Mg was well tolerated. CONCLUSIONS: Pantoprazole-Mg 40 mg significantly improved a broad range of esophageal and extra-esophageal GERD related symptoms including sleep disturbances, as well as well-being, in patients with daytime or night-time GERD, making it a good option for patients with GERD, especially when extra-esophageal and night-time symptoms are present.

Efficacy, safety, and tolerability of pantoprazole magnesium in the treatment of reflux symptoms in patients with gastroesophageal reflux disease (GERD): a prospective, multicenter, post-marketing observational study.

BACKGROUND: To improve proton pump inhibitor effects, pharmacological modifications have been developed such as the use of enantiomer molecules (e.g., S-omeprazole, S-pantoprazole, or dexlansoprazole), or addition of NaHCO3 (for an immediate release) or magnesium (with a lower absorption for a more sustained effect). OBJECTIVE: The objective of this study was to assess the efficacy, safety, and tolerability of pantoprazole magnesium 40 mg once daily for 4 weeks, on the relief of reflux symptoms in gastroesophageal reflux disease (GERD) patients. METHODS: A phase IV, open-label, prospective, multicenter study was designed. Patients included were prescribed pantoprazole magnesium 40 mg orally once daily for 28±2 days. All patients had a history of persistent or recurrent heartburn and/or acid regurgitation for at least 3 months. Effectiveness and tolerability data obtained from patients who completed a minimum of 4 weeks of pantoprazole magnesium treatment were considered for analysis. RESULTS: The account of baseline characteristics and demographics of GERD symptom intensity was made by analyzing the group of 4,343 patients that fulfilled all inclusion criteria; 54% were females (n=2,345) and 46% (n=1,998) males, with a mean age of 36.2±7.5 years. Severity of symptoms, assessed by the physician using the 4-point Likert scale, reduced by at least 80% from baseline intensity after treatment in the per protocol population. In the case of the intention-to-treat population, the improvement in symptom intensity was 73%. The number of patients that experienced any adverse events was 175/5,027 (3.48%). CONCLUSIONS: Pantoprazole magnesium is a safe, effective, and well-tolerated drug that significantly improves GERD symptoms.

Proton pump inhibitors in gastroesophageal reflux disease: "a custom-tailored therapeutic regimen".

The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs.Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses.

"Diseñando un traje a la medida": los inhibidores de la bomba de protones en la enfermedad por reflujo gastroesofágico / Proton pump inhibitors in gastroesophageal reflux disease: "a custom-tailored therapeutic regimen"

La Clasificación de Montreal divide la enfermedad por reflujo gastro-esofágico (ERGE) en síndromes esofágicos sintomáticos y con daño a la mucosa y en síndromes extraesofágicos con asociación establecida al ácido y asociación propuesta. En síntomas ERGE típicos el tratamiento con inhibidores de la bomba de protones (IBP) es satisfactorio (> 90%) a 8 semanas en la mayoría de los casos. Las tasas de respuesta a los IBP en la ERGE son muy variables; ya que también dependen de un adecuado diagnóstico clínico de la enfermedad; la endoscopia diferencia el fenotipo macroscópico de la ERGE. La variedad no erosiva (prevalencia 50-70%) tiene una tasa de respuesta sintomática diferente ya que el ácido no es causa suficiente para explicar los síntomas. Las posibles explicaciones a la falla al tratamiento son el apego al tratamiento, alteraciones en el metabolismo y características de IBP y diagnóstico inadecuado. Los síntomas refractarios se relacionan con neutralización del contenido por el uso crónico de IBP. Las manifestaciones extraesofágicas se asocian con otros mecanismos fisiopatológicos como la disfunción del sistema nervioso autónomo. En estas entidades es necesario establecer la relación o no con el ácido para determinar el uso con IBP o considerar otros fármacos. Es decir, necesitamos responder a las preguntas en quien, para qué, cómo y por cuánto tiempo, para diseñar un "traje a la medida". Por último, la seguridad y la tolerabilidad a IBP son factores a considerar en pacientes de edad avanzada que requieren su uso crónico y que generalmente tienen enfermedades crónicas concomitantes (AU)

The Montreal Definition and Classification divides Gastroesophageal Reflux Disease (GERD) into esophageal symptomatic syndromes (and with mucosal damage) and extraesophageal syndromes (with acid established association and proposed association). In typical GERD symptoms, an 8-week treatment with PPIs is satisfactory in most cases (> 90%). Response rates to PPIs in GERD are highly variable, as they also rely on an appropriate clinical diagnosis of the disease; endoscopy differentiates the macroscopic GERD phenotype. The non-erosive variety (50-70% prevalence) has a different symptomatic response rate, as gastric acid is not the sole etiology of symptoms. The possible explanations of treatment failure include treatment adherence, PPI metabolism alterations and characteristics, and inadequate diagnosis. Refractory symptoms are related to gastric content neutralization by the chronic use of PPIs. Extraesophageal manifestations are associated with other pathophysiological mechanisms where an autonomic nervous system disturbance gives rise to symptoms. In these clinical entities, the relationship between symptoms and acid needs to be established in order to determine the use of PPIs, or consider other drugs. In other words, so as to "custom-tailor the best-fitting therapy" we need to answer the questions for whom, for what, how and for how long. Finally, PPI safety and tolerability are factors to be considered in elderly patients requiring chronic PPI use, who usually have chronic concomitant illnesses (AU)

[Capsule endoscopy: The evolution in the diagnosis of small bowel diseases]. / La capsula endoscópica: la evolución en el diagnóstico de las enfermedades del intestino delgado.

Wireless capsule endoscopy is a diagnostic procedure to study the pathology of the small intestine physiologically and painlessly. The capsule dimensions are 11 x 26 mm, and takes 2 picture per second whilst 8 hours. Unexplained occult gastrointestinal tract bleeding is the main indication, but everyday new indications for its use come to the literature. Our objective were to review our experience about the clinical usefulness and impact in our clinic. We included 45 cases, excluding 3 because of technical problems. There were 24 women and 18 men, with an average age of 54 years old (18 to 86 years old). Indications for the study were: Gastrointestinal bleeding of obscure origin in 24 cases, anemia in 6 cases, chronic diarrhea in 8 cases, chronic abdominal pain in 2 cases and Crohn's disease in 2 cases. The source of bleeding in the first group was identified in 18 patients (75%), where jejunal and ileal angiodysplasias were found in 11 patients, in 4 cases there were ulcers or erosions, in one case a Meckel diverticulum was found and, in the last one an hammartomatous lesion with an active bleeding was found. In chronic diarrhea patients a lesion was found in 5 cases (62.5%), where mucosal atrophy were found in two patients who responded to a free gluten diet, and in 3 patients acute inflammations with ulcers were treated as Crohn's disease. In the patients with anemia a lesion was found in 2 cases (33%), where a submucosal tumor and a jejunal ulcer were the findings. No lesions were found in the patients with chronic abdominal pain. Finally in the patients with Crohn's disease we were able to know the extent and one patient presented two stenotic lesions. In conclusion, wireless capsule endoscopy is a useful diagnostic tool that let us study easily the small intestine and should be integrated to different study protocols as gastrointestinal bleeding of obscure origin, chronic diarrhea and evaluation of Crohn's disease. It is not useful for abdominal pain, nevertheless we just studied two patients.

Control Manométrico en la cirugía laparoscópica antirreflujo gastroesofágico / Manometric control in the laparoscopic gastroesophageal antireflux surgery

El propósito de este estudio es el de valuar la seguridad, utilidad y eficacia del control manométrico pre y transoperatorio en la cirugía laparoscópica antirreflujo gastroesofágico. Fue un estudio prospectivo, aleatorizado, longitudinal, observacional y comparativo de 35 pacientes, que fueron sometidos a cirugía laparoscópica antirreflujo en los Hospitales ABC y Español de de la Ciudad de México, entre mayo 93 y octubre 95; fueron 19 hombres y 16 mujeres con un promedio de edad de 27 años. Se distribuyeron en dos grupos: El grupo 1 incluyó 20 pacientes con control manométrico pre y transoperatorio. EL grupo 2 estuvo integrado por 15 pacientes que fueron sometidos a cirugía laparoscópica antirreflujo sin estudio manométrico. El periodo de seguimiento varió entre dos semanas y 30 meses. En el grupo 1, ninguno de los pacientes presentó disfagia postoperatoria. En el grupo 2, cuatro sujetos tuvieron disfagia postoperatoria; de éstos, dos requirieron dilataciones esofágicas. El control manométrico en la cirugía laparoscópica antirreflujo es un método útil, seguro y eficaz que aumenta el índice terapéutico, reduce las complicaciones postoperatorias, la incidencia de disfagia y la tasa de recurrencia

Función inadecuada del esfinter de ODDI: Tratamiento endoscópico y evaluación a largo plazo / Inadequate function of Oddi-s sphincter. Endoscopic treatment and long term follow up

El síndrome de función inadecuada de esfinter de Oddi, es una entidad clínica de difícil diagnóstico y tratamiento controvertido. El diagnóstico se sospecha con bases clínicas, bioquímicas, ultrasonográficas y endoscópica, pero se corrobora solamente con la manometría. Estudiamos a 35 pacientes, 23 mujeres y 12 hombres con edad promedio de 56.4 años. Todos tenian antecedentes de colecistectomía y continuaban con dolor similar, 33 tenían elevación de la fosfatasa alcalina, en todos se demostro dilatación de la vía biliar mayor a 12 mm y retardo en el vaciamiento del medio de contraste mayor a 45 minutos. La manometría demostró presión elevada de esfinter de Oddi mayor a 30 mmHg. En todos los casos realizamos una esfinterotomía endoscópica amplia sin complicaciones. Hicimos evaluación clínica, bioquímica y endoscópica cada 3 meses durante el primer año y cada 6 meses durante el segundo y tercer año. Treinta y un pacientes (89.6

Efecto de la sonda nasogástrica sobre la mucosa del esófago / Effect of nasogastri tube on esophageal mucosa

El objetivo de este trabajo fue establecer y conocer las alteraciones endoscópicas e histológicas que provoca la sonda nasogástrica en el esófago. Estudiamos 30 pacientes en quienes se colocó una sonda nasogástrica: 20 hombres y 10 mujeres con edad promedio de 48 años. Ninguno de estos enfermos tenía historia de enfermedad esofágica ni datos clínicos, endoscópicos o histológicos de reflujo gastroesofágico. En 20 de ellos se colocó en el postoperatorio, en 7 por pancreatitis, en 3 por hemorragia del tubo digestivo, y en uno para alimentación enteral. La segunda endoscopia se realizó de 24 horas a 25 días después de colocada la sonda y en todos se tomaron biopsias del tercio distal del esófago. Las alteraciones endoscópicas que se encontraron con mayor frecuencia fueron: hiperemia de moderada a intensa, puntilleo hemorrágico submucoso, fibrina, coágulos adheridos a la pared, erosiones superficiales y úlceras profundas a nivel de la unión esofagogástrica, en 12 enfermos se encontró además hemorragia activa de origen esofágico. Las alteraciones histológicas que se encontraron desde el primer día de colocada la sonda, en orden de aparición fueron las siguientes: edema intraepitelial, congestión de los vasos, aparición de polimorfonucleares, presencia de trombos de fibrina en vasos submucosos, isquemia y regeneración del epitelio, úlcera esofágica y finalmente regeneración epitelial. Las alteraciones endoscópicas e histológicas se correlacionaron en cuanto a severidad de acuerdo al tiempo de permanencia de la sonda. La sonda nasogástrica daña al esófago en forma severa, esta lesión se produce al menos por 2 mecanismos: irritación local de la sonda sobre el epitelio esof

Utilidad de la sonda nasobiliar durante el tratamiento de la coledocolitiasis con litotricia extracorporea / Usefulness of nasobiliary catheter during treatment of choledocholithiasis with extracorporeal lithotripsy

En el período comprendido de abril a junio de 1990, se trataron 5 pacientes del sexo femenino con edad promedio de 47 años. Todos tenían historia de colecistectomía de 1 mes a 15 años. La sintomatología era de dolor abdominal e ictericia en 4 y solamente ictericia en 1. En 3 casos la litiasis era intrahepática y en 2 la litiasis era gigante y no se consideraron candidatas a tratamiento endoscópico. A todos los pacientes se les efectúo esfinterotomía y colocación de sonda nasobiliar. se procedió al tratamiento de litotricia extracorporea y posteriormente se dejaba solución salina en infusión por la sonda nasobiliar. En todos los pacientes excepto en uno, se solucionó el problema con una sola sesión. Se concluye que la colocación de una sonda nasobiliar para la instilación de solución salina como complemento al tratamiento de la litotricia extracorpórea de la litiasis de la vía biliar, evita la obstrucción de la vía biliar con los fragmentos que se formen, arrastra a los fragmentos hasta el duodeno y ayuda a la localización del cálculo durante el procedimiento

Agentes etilógicos de las infecciones de vías urinarias no complicadas en el Instituto Nacional de Pediatría / Etiologiaal agents of non compliaated urinary infections at the Instituto Nacional de Pediatria

Se estudiaron 200 niños con infección de vías urinarias. A todos se les practicó urocultivos y estudios radiológicos, con el fin de descartar malformación de vías urinarias; el sexo feminino fue el más afectado y las bacterias gémenes encontradas fueron E. coli, Enterobacter sp y Klebsiella sp; Streptococcus gamma, Proteus sp y Staphylococcus sp y Streptococcus pneumoniae. Se recomienda que a todos los pacientes con enfermedades cardiovasculares congénitas, tumorales e inmunosuprimidos se les efectúen urocultivos, debido a la frecuencia de esta infección urinaria por gérmenes oportunistas y que clínicamente pasan inadvertidos