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

Introduction: Adenoma detection rate (ADR) and sessile serrated lesion (SSL) detection rate (SDR) are crucial quality indicators for colonoscopy, as their improvement contributes to effective prevention of colorectal cancer. Artificial intelligence (AI) has been shown to significantly increase ADR. This study compared white light imaging (WLI) versus AI-assisted WLI for neoplasia detection.

Materials and methods: This was a prospective, randomised trial of screening, surveillance, and symptomatic patients. Our primary objective was to evaluate ADR. Secondary objectives included SDR, mean number of adenomas per patient (MAP), neoplasia detection rate (NDR), advanced ADR (AADR), and colonoscope withdrawal time.

Results: A total of 621 adenomas were diagnosed in 711 patients, with 310 adenomas in the WLI group and 311 adenomas in the WLI+AI group (p=0.65). Eighty-three SSLs and two intramucosal carcinomas were also detected, totalling 706 neoplasms. ADR was 45.9% in the WLI group and 50.8% in the WLI+AI group (p=0.20). ADR was 54.4% for screening, 49.0% for surveillance, and 40.0% for symptomatic patients (p=0.01). Marginal significance was observed in the WLI+AI group for screening patients (61.5% vs. 49.2%, p=0.06). SDR was 9.0% for both groups. MAP (0.9 vs. 0.9, p=0.34), NDR (51.0% vs. 56.8%, p=0.13), and AADR (8.4% vs. 7.6%, p=0.78) did not differ significantly between the groups. Withdrawal time was similar for the WLI (12.4 ± 5.1 min) and WLI+AI (12.2 ± 4.1 min) groups (p=0.32).

Conclusions: AI-assisted colonoscopy demonstrated high ADR and NDR. While without statistical relevance overall, marginal significance was observed for screening patients.

Dysphagia is defined as an alteration in the swallowing process, which is divided into two phases: oropharyngeal and esophageal. Identifying the location of the disorder is essential for guiding the diagnostic evaluation. Oropharyngeal dysphagia is mainly associated with chronic neurological diseases, as well as structural causes such as Zenker's diverticulum, certain neoplasms, or medication-related factors. Esophageal dysphagia, on the other hand, may result from obstruction (strictures, Schatzki rings, cancer), motility disorders (achalasia, distal esophageal spasm), or inflammatory processes, with gastroesophageal reflux disease and eosinophilic esophagitis being the most common causes. The initial clinical assessment, based on symptoms, helps guide further diagnostic studies. If oropharyngeal dysphagia is suspected, laryngoscopy should be performed and the patient referred to an otolaryngologist or a speech-language pathologist. In cases of suspected esophageal dysphagia, endoscopy and esophagography are recommended. Impedance pH monitoring, manometry, and computed tomography are indicated when specific diagnoses are suspected.

Introduction: Worldwide, women represent a significant part, and even the majority, of medical personnel, evidencing a global trend towards the feminization of the profession. However, challenges persist in gender equality in leadership and academic roles. Understanding how women endoscopists manage the delicate balance between their demanding careers and personal lives is crucial to ensuring equitable professional environments.

Objective: This research thoroughly explored these dynamics, seeking to understand the unique challenges, coping strategies and factors that influence the successful integration of personal and professional life for these specialists.

Materials and methods: a survey was designed that addressed aspects of personal life, academic training, incorporating the Maslach Burnout Inventory (MBI) and the adapted MacDonald and MacIntyre job satisfaction scale.

Results: The non-probabilistic sample included 202 female endoscopists aged between 29 and 73 years. It was found that those with children perceived difficulties in career advancement and a lack of workplace support during child-rearing. Nevertheless, there were no significant differences between women with and without children in the perception of workplace discrimination, professional advancement opportunities, or specialized training capabilities. A negative relationship was found between age and the perception of burnout. Job satisfaction, in turn, showed no correlation with any personal variables.

Conclusion: These results suggest that, while motherhood imposes work-life balance challenges, professional experience may mitigate burnout, regardless of job satisfaction. Support and mentorship policies are required to achieve an inclusive environment.

Introduction: Esophageal adenocarcinoma (EAC) is increasing in Western countries, and Barrett's esophagus (BE) represents its only known premalignant condition. BE affects approximately 1-2% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). Data from Latin America and Chile remain limited.

Objectives: To determine the prevalence of BE, the neoplasia detection rate (NDR), and the endoscopic quality criteria associated with neoplasia detection in a Chilean university center.

Materials and methods: A longitudinal cohort study including all patients with BE identified among upper gastrointestinal endoscopies performed at the Red de Salud UC CHRISTUS between January 2015 and December 2022. Patients with a history of other digestive neoplasms or referred with previously diagnosed BE/EAC were excluded. Demographic, endoscopic, and histopathological variables were analyzed. BE prevalence was defined as the number of histologically confirmed BE cases over the total diagnostic endoscopies performed during the study period. NDR was defined as the presence of high-grade dysplasia (HGD) or EAC on index endoscopy among BE patients. Multivariable logistic regression was applied to identify factors independently associated with NDR.

Results: A total of 422 patients were diagnosed with BE (62% men; mean age 58 years, range 17-87). The overall prevalence of BE was 0.46% (422/91,723), increasing from 0.33% in 2015 to 0.72% in 2022. The low-grade dysplasia detection rate was 3.8% (16/422) and the NDR 1.7% (7/422). The mean BE length was 3,7 cm (range 1-18 cm). The Prague classification and chromoendoscopy were reported in 66% (280/422) and 44% (185/422) of procedures, respectively. Factors independently associated with neoplasia detection were age (OR 1.08; 95% CI 1.01-1.16), use of chromoendoscopy (OR 10.1; 95% CI 1.03-96), and presence of a visible lesion (OR 43.7; 95% CI 4.9-393).

Conclusion: The prevalence of BE in this Chilean cohort was 0.46%, showing an upward trend approaching international reports. The use of chromoendoscopy and the detection of visible lesions were independently associated with higher neoplasia detection, underscoring the importance of adherence to endoscopic quality standards in BE evaluation.

Crohn's disease (CD) is a chronic, multifactorial inflammatory condition that can affect any part of the gastrointestinal tract and is associated with systemic, extraintestinal, and atypical manifestations. Hemophagocytic lymphohistiocytosis (HLH), also known as macrophage activation syndrome, is a rare and severe inflammatory disorder that may occur secondary to infections, malignancies, or autoimmune diseases. Its association with CD is extremely uncommon. We report the case of an 8-year-old male who initially presented with nonspecific symptoms including lower limb pain, lumbalgia, and progressive abdominal pain, evolving into respiratory failure and cardiogenic shock, which required admission to the intensive care unit (ICU). He developed bicytopenia, persistent fever, rash, bilateral pleural effusion, hyperferritinemia, hypertriglyceridemia, and signs of systemic inflammation, raising clinical suspicion for HLH. Infectious and hematologic malignancies were ruled out. The patient received intravenous immunoglobulin, broad-spectrum antibiotics, antifungal agents, and immunomodulatory treatment. Gastrointestinal symptoms included melena-like diarrhea, hematochezia, abdominal distension, and elevated fecal calprotectin levels. Abdominal CT imaging showed colonic wall thickening and mesenteric lymphadenopathy. Esophagogastroduodenoscopy, colonoscopy, and histopathological analysis confirmed the diagnosis of CD. Treatment with infliximab was initiated, leading to a favorable clinical response. This case underscores an atypical presentation of CD associated with HLH, posing significant diagnostic and therapeutic challenges.

Duodeno-caval fistula (DCF) is an extremely rare entity that can have potentially lethal consequences. It is associated with infectious, neoplastic, traumatic processes, or foreign bodies. We report a case of DCF secondary to the migration of a metallic wire from the duodenum to the inferior vena cava (IVC), accompanied by extensive venous thrombosis. A 48-year-old male with no relevant medical history presented with fever and nonspecific abdominal pain. He was admitted with an initial diagnosis of acute dengue in the context of an ongoing epidemic. Computed tomography revealed a linear metallic foreign body crossing the second portion of the duodenum, penetrating the visceral wall, and lodging within the lumen of the IVC, with air inside and extensive venous thrombosis. Upper digestive video endoscopy (EGD) was performed, with successful extraction of the foreign body. The patient received intravenous antibiotic therapy for 10 days and oral anticoagulation for 6 months. Clinical evolution was favorable, and the patient recovered without complications. DCF due to a foreign body is extremely rare. Endoscopic management can be successful in selected cases, avoiding invasive surgical procedures.

Introduction: Colorectal cancer (CRC) is one of the leading causes of cancer-related death in Peru. Endoscopic resection of colorectal polyps has been shown to reduce the incidence and mortality of CRC. Underwater endoscopic mucosal resection (UEMR) has emerged as a safe and effective technique for the management of non-pedunculated polyps.

Objectives: To evaluate the efficacy and safety of UEMR for non-pedunculated colorectal polyps larger than 10 mm in a high-complexity hospital in Lima, Peru.

Materials and methods: Observational, retrospective, and descriptive study of patients aged ≥18 years who underwent UEMR between January and December 2023. En bloc resection, R0 resection, recurrence, and complication rates were analyzed. Clinical, endoscopic, and histopathological data were collected.

Results: A total of 119 UEMRs were performed in 91 patients, with a median age of 72 years. 60.5% of lesions were located in the right colon, and most measured between 10-19 mm. The en bloc resection rate was 80%, and the R0 resection rate was 78%. The complication rate was 15%, including one perforation and two delayed bleeding events. Most complications occurred in the right colon. Recurrence was 3.1%, observed only in piecemeal resections. Histopathological findings included low-grade (47.9%) and high-grade (28.6%) adenomas, as well as 7 carcinomas (5.8%).

Conclusions: UEMR is an effective and safe technique for the treatment of non-pedunculated colorectal polyps larger than 10 mm, particularly for lesions ≤20 mm. Its advantages include a high en bloc resection rate, low complication risk, and low cost.

Helicobacter pylori - is an infection acquired in childhood, especially in countries with high prevalence such as Peru, however, the number of studies in this population is scarce, so the need to describe its prevalence and the need for treatment is evident.

Objectives: To determine, through endoscopy and biopsy, the current prevalence of this infection in Peruvian children with digestive complaints who attend the Hospital Nacional Edgardo Rebagliati Martins.

Materials and methods: A retrospective descriptive study was conducted with 242 patients aged 0 to 14 years, using the electronic medical records from the hospital system.

Results: The prevalence of Helicobacter pylori was 27.2%. There were no characteristic symptoms in the positive versus negative- group. The most relevant endoscopic findings in the positive group were a high frequency of antral nodular gastritis (72.1% vs. 9.8%, p<0.001) and a lower prevalence of endoscopic esophagitis (13.1% vs. 23.6%, p<0.001). Otherwise, histopathological analysis revealed a higher presence of lymphoid follicles (24.5% vs. 4.5%, p<0.001), while chronic inflammation was lower (54% vs. 87.5%, p<0.001).

Conclusions: It is concluded that the histopathological findings associated with positive Helicobacter pyloriare characteristic in this group and prevalence of this bacteria in Peruvian children seen in a pediatric gastroenterology unit is apparently lower than similar previous studies. This highlights the need for further research to evaluate its relationship with the possibility of antimicrobial resistance and the rising of immune-mediated diseases.

Gastric remnant cancer is cancer secondary to partial gastrectomy after five years. Peculiarities due to the gastrectomy status may influence this type of GC. Modifications in the gastric microbiome, luminal pH, dietary habits, increased bile reflux, and Epstein-Barr virus infection, together with the traditional GC risk factors, cooperate to increase the risk of cancer in the remnant stomach. H. pylori infection has been widely associated with GC, and its role in the pathogenesis of the remnant stomach, as well as the preventive effect of its eradication after gastrectomy, are issues of great scientific interest. Bariatric surgery is another condition potentially related to increased GC risk and challenges to its diagnosis. In this scenario, this article aims to review the current evidence of the fundamental aspects involved in developing the gastric remnant cancer.