Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru最新文献

Helicobacter pylori (H. pylori) is the primary etiological agent of gastric adenocarcinoma, which affects over 60% of the global population, with a significant prevalence in Latin America. Given its impact on the affected population, it is crucial to understand the diagnostic tools available for detecting this infection. While clarithromycin-based therapies are still widely used, the high rates of resistance to this antibiotic in the region needs the establishment of alternative, more effective treatments as the standard of care, such as bismuth-based quadruple therapy or high-dose dual therapy with amoxicillin. In cases of refractory infection, local data registries are valuable for informed decision-making.

Endoscopic submucosal dissection (ESD) is the technique of choice in the management of early gastric cancer. Recently, it is also considered as an absolute indication in selected cases of early undifferentiated gastric cancer (U-EGC).

Objectives: In the present study, the first documented cases of ESD in patients with U-EGC are presented and analyzed.

Materials and methods: Retrospective and multicenter study carried out from February 2018 to April 2024. Twelve cases were included with a final histopathological diagnosis of U-EGC after undergoing ESD under absolute indication. En bloc and curative resection rates, incidence of adverse events, and surgical outcomes in cases referred to surgery are described.

Results: The median age of the patients was 54.5 years, with a female predominance. All lesions were resected en bloc. There were no complications associated with ESD. The histopathological results revealed a predominance of the signet ring cell subtype. A 66.7% curative resection was achieved. Five patients were referred to surgery after ESD, without finding residual cancer or affected lymph nodes in the surgical specimens. There were no recurrences at a median follow-up of 7.5 months.

Conclusions: The findings suggest that DES is a safe and effective treatment for selected cases of U-EGC in Peru, achieving curative resection rates similar to those published in eastern studies.

Objective: This review aims to evaluate the efficacy and safety of premedication comprising mucolytics and/or defoaming agents to improve the quality of visualization during elective upper digestive endoscopy (elective upper GI endoscopy) procedure.

Materials and methods: A systematic review of the literature contained in electronic databases (Medline/Pubmed, Embase, and Lilacs) was performed to identify randomized controlled trials and systematic reviews that assessed patients undergoing upper gastrointestinal endoscopy (elective upper GI Endoscopy) under sedation, after being premedicated with mucolytics and/or defoaming agents for mucous clearance. A meta-analysis was conducted to determine the relative efficacy and safety profile of such premedication.

Results: In patients undergoing an elective procedure, premedication with defoaming and/or mucolytic agents improved the visibility score of the gastric antrum during upper GI endoscopy. The use of combined agents such as simethicone vs. water and N-acetyl cysteine (NAC) vs. water showed significant differences in favor of the active substance; however, no significant differences were found between the use of simethicone alone vs. simethicone + NAC. The use of pronase and dimethylpolysiloxane, among others, produced no significant difference (additive effect) in the visualization score. This is associated with the limited number of studies that performed similar comparisons and the heterogeneity of the outcomes. No major adverse effects were reported in the studies that were included regarding safety outcomes (i.e., volume of fluids required for clearance, risk of bronchoaspiration, and disinfection of equipment).

Conclusions: The results of this review evidence that premedication with simethicone (a drug registered in Colombia for use against functional gastrointestinal disorders; ATC group A03A) is safe and effective for improving the quality of visualization during elective upper GI endoscopy procedures. However, no significant differences were observed in the visualization quality with the use or addition of other agents. The use simethicone should be set as off-label use and should be implemented at the prescriber's discretion. The use of simethicone as a premedication is recommended to improve the endoscopic visualization score in elective procedures.

The role of Helicobacter pylori in the pathogenesis of peptic ulcers and gastric adenocarcinoma is widely known; however, it is not entirely understood how bacterial infection is closely related to the genesis of follicular gastritis and some types of gastric lymphoma. Diagnosing and pathogenic mechanisms follicular gastritis remain challenging. Therefore, this article aims to examine the role of H. pylori in the development of follicular gastritis. In addition, it emphasizes the clinical and histopathological fundamentals. A broader overview of follicular gastritis is presented, and implementing preventive strategies, such as H. pylori eradication remains the standard treatment.

Objectives: Pancreatic duct leaks can cause ascites, and fluid amylase can be used as a marker to suggest pancreatic duct leak; however, there is no reference parameter or cutoff value for diagnosis. We assessed whether a novel ratio of ascitic fluid to serum amylase can reliably predict pancreatic leaks and need for endoscopic retrograde cholangiopancreatography (ERCP).

Materials and methods: Patients who had fluid amylase from ascitic fluid and serum amylase within one week of confirmed pancreatic leaks via ERCP were included along with appropriate medical and surgical controls.

Results: A total of sixteen patients were included in the study group. The mean ascitic fluid amylase to serum amylase ratio in the study group was 243, and 0.3511, and 0.9406 for medical and surgical controls respectively. The cutoff ratio to predict pancreatic leaks was 6.89 with 100% sensitivity and specificity (p-value 0.0000000000001347).

Conclusions: Patients with a fluid to serum amylase ratio of at least 6.89 should be considered high risk for pancreatic leak with consideration to proceed directly to ERCP.

Introduction: Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections are a global public health concern. In 2019, there were 295.9 million people with chronic hepatitis B and 57.8 million with HCV, and less than 20% were aware of their status. In 2017, there were 37 million people with HIV, and 75% were diagnosed. Creating accessible screening strategies remains a challenge. The use of rapid diagnostic tests (RDTs) is a cost-effective and simple option. The endoscopy unit is an ideal setting due to its high patient flow and qualified personnel.

Objective: To evaluate the use and acceptance of two RDTs for detecting HIV, HBV, and HCV in patients undergoing endoscopic examination and to determine the percentage of refusal to undergo testing.

Materials and methods: An observational cross-sectional pilot study was conducted. Adults entering two Endoscopy Centers in Santiago were enrolled for outpatient endoscopic examination and were administered two RDTs: Montebio and HCV/HBsAg/HIV Rapid Test after counseling and informed consent.

Results: 358 out of 375 patients (96%) accepted the test. 79% were female. The average age was 50±17 years. One subject tested positive for HCV in both tests (0.27%). There were no positive results for HBV/HIV. 17 patients (4.2%) declined the test. The refusal rate by gender was 8.8% (male) vs. 2.7% (female) (p=0.009). The overall experience was positive, and 98% would recommend the process.

Conclusions: The use of RDTs in endoscopy represents an opportunity for systematic detection of infected patients with a high level of acceptance.

We report the case of a 68-year-old female patient who had a gastrointestinal stromal tumor involving muscularis propria of the gastric body that was removed through submucosal tunneling endoscopic resection, with favorable follow-up after 5 years, with no signs of recurrence.

In this article, we present an exceptionally rare and challenging clinical case. It concerns a 65-year-old woman who, while eating, accidentally ingested a thorn. This foreign body, after being swallowed, migrated from the proximal esophagus, until it penetrated the left internal jugular vein. This unusual phenomenon presented as the main symptom, high dysphagia of acute course, accompanied by a hematoma in the left hemicollar. This case not only highlights the potential seriousness of accidental foreign body ingestion, but also the possibility of migration to potentially serious infrequent locations leading to diagnostic and therapeutic challenges. Foreign body migration through soft tissue and subsequent impact on critical vascular structures are extremely rare events and require immediate and specialized medical intervention.

We report the case of an elderly patient with progressive dysphagia to solids and later to liquids, and weight loss. The patient underwent an upper endoscopy, which showed multiple stenoses and trachealization. Biopsies were taken and a diagnosis of lymphocytic esophagitis was made. Pneumatic dilation to 12 mm was performed, and the patient recovered with no recurring symptoms. Dysphagia in the elderly should not be overlooked, and physicians should consider lymphocytic esophagitis as a differential diagnosis.