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

Introduction: Despite advancements in therapeutic strategies, corticosteroids continue to play a role in inducing remission in Inflammatory Bowel Disease (IBD). Unfortunately, these drugs are often misused.

Objectives: To assess the dose and duration of corticosteroid therapy,and the subsequent change in treatment among patients with IBD.

Materials and methods: We conducted a descriptive, retrospective observational study on patients with IBD under follow-up at the IBD Program of Clínica Universidad de los Andes from January 2021 to August2022.

Results: Four hundred and thirty-two IBD were included, with 63% being women,with a median age of 42 years (14-94), 66% had ulcerative colitis (UC). Sixty-six percentageof patients had received corticosteroids during the course of their disease (range 1-9 times) for a median duration of 12 weeks (2-48 weeks), with prednisone being the most frequently used corticosteroids (53%). Seventy-seven percentage of patients had received treatment for over 3 months or in supratherapeutic doses (prednisone > 60 mg day). There was a change in the treatment after the use of corticosteroid in 28% of patients compared to 90% after entering the program (p<0.001, CI95%: 1.83-2.49). During the Program's follow-up, 10% received corticosteroids (71% prednisone, 29% budesonide) with no variations based on IBD type, gender, age, or treatment. No patient received corticosteroids for over 3 months or in supratherapeutic doses in our IBD Program.

Conclusion: This study emphasizes the importanceof evaluating corticosteroids use as a quality-of -care marker in IBD. The management of these patients through a specialized program could mitigate the excessive use of these drugs.

Esophago-jejunal anastomoses fistula could be mortal. Currently there is a wide therapeutic measure ranging from conservative management, endoscopic therapy and surgery. Endoscopic management has been positioned above other strategies due to minimal invasion which improves survival and reduces mortality. The endoscopic treatment of esophagojejunal fistulas can be varied with numerous techniques described to achieve their closure. These techniques include the placement of covered or partially covered self-expanding stents, the use of metal clips, alone or assisted by the loop technique, the use of endoscopic closed subatmospheric pressure therapy and, more recently, the use of endoscopic suture. In our service we use the techniques according to the characteristics of the fistula. In the case presented, it was decided, at the time of the endoscopy, to use clips with the help of a Cap to facilitate the technique and in the terminal closure angle, given the redundant tissue that was difficult to approach, we chose to place a clip Padlock®; With this, closure of the lesion was achieved in a few days with excellent clinical outcomes.

Pancreatic ductal adenocarcinoma during pregnancy is extremely rare. Overall, including our case, only 19 cases confirmed antepartum have been reported to date. We report the case of a 37 year-old woman at 24 weeks of pregnancy in whom a pancreatic adenocarcinoma was identified during investigation of a suspected acute pancreatitis. Surgery was postponed until fetal maturity. However, chemotherapy was not tolerated, clinical condition of the mother worsened after cesarean section, and surgical findings revealed an unresectable disease. Patient died due to septic shock and multiple organ failure, but her child is in very good health. Pancreatic ductal adenocarcinoma during pregnancy carries the same poor prognosis of the general population. A pregnant with severe epigastric pain radiating to the back, in the presence of jaundice and weight loss, should rule out a pancreatic neoplasm. In case a malignancy is identified, the histology diagnosis is required, and decisions should be taken as a consensus between the mother and a multidisciplinary team in a referal center.

Endoscopic procedures, currently, are characterized by being minimally invasive diagnostic and therapeutic methods, which allow the management of a wide number of pathologies and in the hands of a good operator, present few complications. Both traumatic and spontaneous splenic rupture is a rare entity, mainly associated with abdominal trauma or splenomegaly due to hematological diseases, respectively. Splenic rupture secondary to endoscopic studies is a complication with a mortality close to 5%, of which only 100 cases have been reported to date, none of them in Colombia. Thereafter is the case of a patient who, after an upper digestive endoscopy and colonoscopy, presented a splenic rupture, in whom the non-operative management initially proposed failed, requiring emergent splenectomy, with satisfactory results.

Diphyllobothrium spp. is a parasite with global distribution. Diphyllobothriasis is the human infestation by this parasite. Symptoms usually occur a few weeks after infection and include nausea, diarrhea, and abdominal pain; less frequently, prolonged or severe infections can lead to anemia. The endoscopic finding of the tapeworm is an incidental finding. The inflammation associated with diphyllobothriasis can be considered in the differential diagnosis of ileal ulcers. We present the case of a woman in whom a tapeworm and one ileal ulcer were found, histology suggested lymphoid proliferation; however, the clonality study showed that these inflammatory changes were secondary to diphyllobothriasis.

Telemedicine has grown during the COVID-19 pandemic. Gastroenterology at Clínica Universidad de los Andes has continued it post-pandemic. Usability is the measure by which users evaluate the effectiveness, efficiency, and satisfaction in telemedicine. The usability of this type of consultation in Chile is unknown.

Objective: To evaluate the level of usability among patients attended through teleconsultations in Gastroenterology at Clínica Universidad de los Andes (March-August 2023).

Materials and methods: A cross-sectional descriptive study on the level of usability using the adapted and modified Telehealth Usability Questionnaire. It consists of 12 items (score range 12-84) and comprises 2 factors: effectiveness and ease of use. Sociodemographic characteristics were also evaluated.

Results: A total of 150 questionnaires were analyzed. A high level of usability was observed (median: 81; range 54-84), with high scores in effectiveness (median: 28; range 20-28) and ease of use (median: 53; range 30-56), without significant differences according to sex, age, educational level, geographic location, and health insurance. Of the respondents, 76.7% were aged 30 to 64 years. 36% resided in the metropolitan region, 61% were women, and 80% were from the private health system. 29% consulted for abdominal pain, 20% for inflammatory bowel disease, and 17% for abnormal liver function tests. For 53.3%, it was their first consultation, and 46.7% were in follow-up via this method.

Conclusion: In this cohort, telemedicine is perceived as an effective and easy-to-use tool, with a high level of usability regardless of the patients' sociodemographic characteristics. Therefore, in gastroenterology, telemedicine appears to be a form of healthcare accepted by patients.

Colonic polyp refers to lesions that exhibit a protrusion of the mucosa, regardless of histology. The most recent WHO classification is based on a better understanding of these lesions; however, its application in daily practice could be subject to interobserver variability biases that could have clinical implications.

Objectives: To determine the interobserver variability in the histopathological reporting and grading of dysplasia of samples obtained from elevated colon lesions in a private laboratory in the city of Lima.

Materials and methods: Observational, descriptive, and prospective study: Case series type. All biopsies of elevated colon lesions received over a period of 3 months were evaluated by two observers without clinical information of the cases, to diagnose the lesions according to the WHO classification. In cases of diagnostic differences, the cases were evaluated together to reach a consensus.

Results: A Kappa coefficient value of 0.458 was obtained in the diagnostic classification of elevated colon lesions, while a Kappa value of 0.416 in the evaluation of dysplasia; indicating moderate agreement.

Conclusions: Despite achieving moderate agreement between evaluators, this work demonstrates the importance of not only relying on morphological criteria for diagnostic classification, but also including criteria of location and size of these lesions to increase diagnostic accuracy.

Oesophageal cancer corresponds to a malignant neoplasm with a poor prognosis. Neuroendocrine tumors of the esophagus are very rare, accounting for less than 2%. When clinically manifested by permanent, progressive dysphagia and general impact, they usually correspond to locally advanced tumors with a poor prognosis. We present the case of a 45-year-old man who attended medical attention for persistent and progressive dysphagia, who was diagnosed with neuroendocrine carcinoma of the oesophagus. The diagnosis was reached through endoscopy, revealing an extensive, vegetative and stenosing lesion occupying three-quarters of the oesophageal circumference. Histology confirmed the diagnosis of poorly differentiated small cell malignancy with positive immunohistochemistry for chromogranin A and synaptophysin. In light of the diagnosis of small cell neuroendocrine carcinoma of the oesophagus with locaregional extension, stage IV, palliative treatment with chemotherapy, radiotherapy and percutaneous endoscopic gastronomy was proposed, with a survival of only 6 months.

The endoscopic placement of a biliary stent presents adverse events, including proximal migration in the bile duct, a situation that can be so challenging to resolve that surgery must sometimes be resorted to. We present the case of a 83-year-old patient who underwent endoscopic retrograde cholangio pancreatography (ERCP) for acute cholangitis and a plastic biliary stent was placed for stenosis in the distal common bile duct. Four months later, proximal migration of the stent was evident; conventional extraction techniques were performed without success. Due to not having a cholangioscope, a novel method was designed in which a forceps is slid along a hydrophilic guide and guided to the distal portion of the stent in order to successfully trap and extract it. It is concluded that the "zipline" technique is an effective method that could be used safely in patients with proximal migration of a biliary stent in which its adherence to the biliary wall does not allow it to be linked with common methods, especially in situations where direct cholangioscopy is not available.