Acta Gastroenterologica Latinoamericana最新文献

Gastric cancer is one of the most frequent cancers worldwide. It has a poor prognosis associated with late-stage diagnosis, that significantly decreases overall survival. This highlights the importance of prevention and early detection to improve the clinical course of patients. Prevention and early diagnosis of gastric cancer perfectly exemplify the model of precision medicine, a healthcare approach that seeks to place the burden more on the individual than on the general population. This requires not only a comprehensive knowledge of the disease but also the identification of individual factors and the understanding of genetic, molecular and environmental differences, which are key to the development of much more personalized treatment strategies. With this approach, in gastric cancer prevention the subject is always at the center, the measures focus directly on the individual and, secondarily, lead to the optimization of the use of resources. This review briefly discusses primary prevention strategies for gastric cancer based on detection and eradication of Helicobacter pylori and, on the other hand, describes some of the most promising biomarkers for the detection and diagnosis of early gastric cancer identified in blood, saliva, urine, feces, and gastric juice, all of which are components of potential secondary prevention measures.

Introduction: Hepatocellular carcinoma is the most common primary liver tumor (80 to 90%). It is the sixth most frequent tumor and the third that causes the most cancer-related deaths. 85% occurs in Asia and Africa. In Latin America and Argentina, it is not fully represented in the literature due to the socio-economic reality. Most hepatocellular carcinomas present on the basis of cirrhosis.

Objective: To characterize the pidemiology of hepatocellular carcinoma in Tucumán, Argentina.

Material and method: A descriptive, multicentric, study of both public and private activity in the province was carried out. Based on international guidelines, diagnosis and treatment of patients with hepatocellular carcinoma were carried out.

Results: There were 328 patients, with 109 (33.23%) women and 219 (66.76%) men. Of these patients, 294 (89.6%) had cirrhotic liver. The 5-year survival was 6.09% (n:20/328) in stage A and 0.914% (n:3/328) in stage B.

Conclusion: The epidemiology of hepatocellular carcinoma in Tucumán, Argentina was updated; coinciding with the literature. From the epidemiological point of view it showed; a higher prevalence of the disease in males than in females; that stage D at the time of diagnosis was the most prevalent; and that the majority of patients suffered from previous liver diseases.

Introduction: Chronic intestinal pseudo-obstruction is a clinical entity with multiple causes. One of them is intestinal neuronal dysplasia, a rare disease with two subtypes: A and B.

Objective: To present a clinical case of a patient diagnosed with idiopathic gastroparesis associated with type A intestinal neuronal dysplasia.

Clinical case: A 30-year-old female patient with a diagnosis of idiopathic gastroparesis of a long evolution, with multiple hospitalizations and significant weight loss. She developed a aorto-mesenteric compass syndrome that was treated surgically with partial and temporary improvement. A jejunostomy was performed for feeding when symptoms recurred. During this surgical procedure, gastric and jejunal biopsies were performed and a diagnosis of intestinal neuronal dysplasia type A was made.

Conclusion: In the presence of symptoms of intestinal pseudo-obstruction or a diagnosis of idiopathic gastroparesis, it is necessary to consider the involvement of the gastrointestinal plexus. Obtaining an adequate tissue sample and evaluating it with appropriate techniques is of paramount importance to diagnosing the neurogenic etiology of the entity.

We present a case of a patient with a history of unresec-table pancreatic adenocarcinoma who required biliodigestive diversion surgery with Roux-en-Y reconstruction. Due to the presence of portal cavernomatosis, and recurrent episodes of upper gastrointestinal bleeding, gastric devascularization surgery was performed. The patient experienced an initial episode of gastrointestinal bleeding with cardiopulmonary arrest as a complication. After resuscitation, an upper gastrointestinal endoscopy was performed which showed a visible vessel at the gastroenteroanastomosis; a hemostatic clip was placed, and the bleeding stopped. After 72 hours, the patient presented a new episode of hematemesis which led to another upper gastrointestinal endoscopy revealing an area of congestive, friable mucosa with deposits of fibrin and profuse bleeding on the greater gastric curvature; the suspected diagnosis was ischemic gastropathy This area had been recently evaluated by endoscopy and had shown normal characteristics. Endoscopic treatment was performed using TC-325 hemostatic powder (Hemospray ^® , Cook), and the bleeding stopped. The patient responded well to the applied treatment and had a favorable outcome.

Aim: To evaluate the effects of rifaximin through microbiota modulation in a model of hepatocellular carcinoma secondary to non-alcoholic fatty liver disease.

Methods: Three groups of 8 adult male Sprague-Dawley rats each were divided as follows: the HCC group: rats fed a high-fat and choline-deficient diet plus diethylnitrosamine as a carcinogen, the hepatocellular carcinoma treated group: rats fed a high-fat and choline-deficient diet plus diethylnitrosamine and treated with rifaximin and the control group: animals fed standard diet and water. The rats were euthanized after 16 weeks. We performed analyses of liver pathology for non-alcoholic fatty liver disease severity and cancer grading, gene expression in intestinal and hepatic tissues and fecal microbiota.

Results: All animals in the hepatocellular carcinoma group had non-alcoholic fatty liver disease and developed hepatocellular carcinoma lesions. Rifaximin animals showed less intense non-alcoholic fatty liver disease (assessed by non-alcoholic fatty liver disease activity score [NAS]) compared to the hepatocellular carcinoma group. Both the hepatocellular carcinoma and hepatocellular carcinoma + rifaximin groups showed areas of fibrosis as assessed by picrosirius red. Three animals in the rifaximin group did not develop cancerous lesions. Gut microbiota analyses revealed differences in diversity and composition in the control group vs hepatocellular carcinoma and rifaximin groups. Twelve differentially abundant genera were identified between the hepatocellular carcinoma and rifaximin groups. In the rifaximin group, gene expression of intestinal tight junctions decreased.

Conclusions: In a rodent model of non-alcoholic fatty liver disease-related hepatocellular carcinoma, rifaximin reduces the histological severity of non-alcoholic fatty liver disease and the occurrence of hepatocellular carcinoma, probably by modulating the gut microbiota independently of markers of intestinal permeability.

Meckel's diverticulum is a common congenital anomaly of the small intestine caused by incomplete obliteration of the omphalomesenteric duct. Most patients are asymptomatic, and the diagnosis is usually made incidentally on imaging studies. The most common symptom is painless rectal bleeding; however, the presentation can be varied. There are different diagnostic tools for symptomatic, among which the most sensitive is Meckel's scan. However, direct visualization is the way to make an accurate diagnosis, which can be done through video capsule endoscopy, a useful tool to clarify the etiology of bleeding in the small intestine.

Introduction: Conventional endoscopic methods have shown poor hemostatic efficacy in the treatment of bleeding esophagogastroduodenal tumors. Recent studies have suggested, on the contrary, a high therapeutic success with the use of TC-325 (Hemospray ^® , Cook Medical, Winston-Salem, NC) in this subgroup of patients. Its easy application and its ability to cover a large surface area appear to position it as a promising treatment for this indication, given the diffuse nature of bleeding in this type of lesions.

Objectives: Our primary aim was to evaluate the immediate and 72-hour hemostatic role of TC-325 in patients with upper gastrointestinal bleeding of tumor origin admitted to our institution. Our secondary objective was to analyze their rebleeding rate at one month and complications.

Materials and methods: Retrospective, observational and longitudinal analysis, conducted between March 2018 and May 2022, based on the electronic records of the Digestive Endoscopy Unit of the Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, inpatient medical records and outpatient follow-up records of the Oncology service. We included all patients with upper gastrointestinal tumors with active bleeding verified during upper digestive video endoscopy (UDVE), with data available at least to analyze our primary objective. Clinical, demographic and endoscopic variables were collected, as well as laboratory data, tumor location and bleeding severity.

Results: A total of 21 patients, 81% men, with a mean age of 65 years were included. The most frequent presenting symptom was melena (81%), with gastric location being the most frequent (71.4%), and intestinal adenocarcinoma being the most common histological type. Immediate hemostasis was achieved in 19/21 patients (91%) treated with TC-325. Of the 18 patients who survived to 72 hours, 100% remained free of rebleeding at the end of this period. Furthermore, of the 16 patients alive at 30 days, only 4 (25%) rebleed, which allowed the application of definitive hemostatic treatments in better clinical conditions in 10 of them (3 patients underwent surgery and 7 others received radio and/or chemotherapy). Hemospray treatment was very safe, with no immediate or delayed complications. However, as these patients had locally advanced tumors or disseminated neoplasms, their prognosis was unfavorable, with mortality at 1 and 6 months of 24% and 66% respectively.

Conclusion: Treatment of tumoral upper gastrointestinal bleeding with TC-325 is very effective and safe. Its high rate of immediate and early hemostasis suggests a promising role as a bridging therapy, allowing the subsequent application of more definitive hemostatic treatments. Medium-term mortality remains equally high, given the generally advanced tumor stage.

Artificial intelligence is a field of science and engineering that focuses on the computational understanding of intelligent behaviors and the creation of artifacts that exhibit such behaviors, enabling computers to function and think similarly to humans. This technology assists in overcoming the various challenges that healthcare professionals face, contributing to the diagnosis, management, and prognosis of patients. Currently, several artificial intelligence models have been developed in the field of digestive endoscopy, including some that enable the detection of anatomical structures that can aid in the training of medical professionals, serve as guides during endoscopic procedures, or assist in stratifying pre-malignant and malignant lesions. This reduces false negatives, providing timely treatments. Computerized lesion detection and diagnostic system exist for different segments of the digestive tract, each with specific functions that provide assistance during procedures. All of this has been done with the aim of reducing risks stemming from human and environmental factors, among others, which can affect early diagnosis and management of diseases. Artificial intelligence models for digestive endoscopy can not only enhance the visual impression for endoscopists but also reduce the learning curve through the application of precise technologies, thus bridging the gap between experienced and less experienced endoscopists. This article discusses the technological advancements of artificial intelligence in digestive endoscopy and related future aspects.

The ingestion of foreign bodies is an emergency and one of the accidents with the highest morbidity and mortality in pediatrics. Due to their characteristics and location, some represent a challenge for endoscopic extraction, so it is important to have various accessories and technical skills to achieve extraction. The objective of this article is to present a series of cases of ingestion of difficult-to-extract foreign bodies that required unconventional techniques and that could serve as a guide for the treatment of similar cases.