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

Esophageal achalasia (EA) is a primary motility disorder characterized by the inability of the lower esophageal sphincter (LES) to relax properly. It is a rare condition in the pediatric population and therefore requires a high index of clinical suspicion. Delayed diagnosis can lead to significant morbidity. Treatment is aimed at reducing LES pressure, which helps relieve symptoms. We present the case of a 10-year-old male patient, with a history of IgE-mediated food allergy to dairy and peanuts, born and raised in the Turks and Caicos Islands, who was referred to our institution with a six-month history of progressive dysphagia for solids, postprandial vomiting, and significant weight loss. A barium esophagram revealed severe dilation of the esophageal body, with a distal esophagus showing the classic "bird's beak" appearance. High-resolution esophageal manometry confirmed the diagnosis of type I EA. The patient underwent a peroral endoscopic myotomy (POEM), an innovative procedure that has proven to be effective, safe, and durable in the management of pediatric achalasia. This technique is available in experienced centers with specialized equipment and may represent a first-line treatment option in children with esophageal achalasia. To our knowledge, this is the youngest patient reported in Colombia with esophageal achalasia who achieved a successful clinical outcome following POEM.

Peru has a high incidence and mortality rate of stomach and colorectal cancers. While chromoendoscopy (CE) with indigo carmine dye is the gold standard for gastrointestinal tumor early detection, its accessibility is limited in Peru due to cost and infrastructure restrictions. This study explores the potential of a natural alternative: anthocyanin dye extracted from purple corn (PC), a widely consumed and accessible food source in Peru. A PC decoction was prepared by boiling the PC and adjusting the pH to 8. A 38-year-old male patient underwent colonoscopy, finding a rectal polyp followed by CE with both IC and PC solution (PCS). The PCS effectively stained the colonic mucosa, allowing for visualization of the lesion. In this report, PCS is presented as a potential cost-effective and readily available natural contrast agent for CE, particularly relevant for low-resource environments in Peru. Further research and collaboration are needed to address standardization and staining duration for more reliable and accurate results.

Colorectal cancer is one of the tumors with the highest incidence and mortality worldwide. Despite being considered a preventable pathology due to the modifiable risk factors and the appropriate use of screening strategies, there are currently still important barriers with respect to access to health services and adoption of the screening tests, which is reflected in a non-negligible percentage of patients with the presence of metastasis or unresectable disease at the time of diagnosis. The most frequent sites of metastasis in colorectal cancer are widely known, however, these patients may present metastatic lesions to unusual sites that have not been frequently reported in the literature. We present the unusual case of a patient with colon cancer with metastasis to the esophagus.

Endoscopic ultrasound (EUS)-guided sampling is a safe and reliable method for obtaining pathological results of gastrointestinal and adjacent gastrointestinal lesions. Some colon lesions are located in the muscular layer or even in the serosa beneath the mucosa, so conventional colonoscopy with forceps biopsy is often negative. In patients with colon cancer, forceps biopsy during colonoscopy is the current standard diagnostic modality. However, there are cases that are difficult to confirm with forceps biopsy, such as stenosing tumors, or those originating from deep layers. Endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) is a useful alternative for diagnosis in these cases. We present the successful case of a 62-year-old male with a history of progressive weight loss and a colonic mass at the splenic flexure, whose colonoscopy was unsuccessful, therefore a FNB puncture by EUS was performed, via transgastric route, reaching a histological diagnosis of colon adenocarcinoma. This case highlights the feasibility of FNB by EUS in the acquisition of colonic lesions through the stomach in cases of inconclusive colonoscopy.

Introduction: Gastric cancer (GC), with nearly 90% being sporadic adenocarcinomas, is preceded by gastric premalignant conditions (GPC). Accurate detection of GPC during esophagogastroduodenoscopy (EGD) can enhance the identification of high-risk patients and improve early GC diagnosis. However, GPC detection rates during EGD vary among endoscopists, potentially leading to differences in GC rates after a negative EGD (GC post-EGD).

Objective: This study aimed to assess the correlation between the GPC detection rate and the rate of GC post-EGD among endoscopists.

Materials and methods: We conducted an observational study of EGDs at a community hospital between 2010 and 2019. GPC were defined as glandular atrophy, intestinal metaplasia, and dysplasia. EGDs were categorized into three groups: (i) benign, (ii) GPC, and (iii) malignant findings. GC post-EGD was defined as a diagnosis of gastric adenocarcinoma within three years of an EGD negative for malignancy. GPC detection rates and GC post-EGD were calculated for each endoscopist.

Results: A total of 18,635 EGDs were performed by nine endoscopists. Gastric biopsies were obtained in 2,415 (13%) EGDs, identifying 533 GPCs (2.9%). The GC post-EGD rate was 1.26 per 1,000 EGDs. The detection rate of GPC varied between 1.8% and 5.8%, while GC post-EGD rates ranged from 0 to 3.36 per 1,000 EGDs. A negative correlation trend was observed between GC post-EGD and GPC detection rate (rs=-0.65, p=0.057), which was statistically significant for dysplasia (rs=-0.69, p=0.037).

Conclusion: The detection rate of GPC-particularly dysplasia-showed a negative correlation with GC post-EGD in a community hospital within a low-risk setting during the period from 2010 to 2019.

Uveal melanoma is the most common ocular cancer in adults, originating from melanocytes in the uvea. Although rare, its high metastatic potential, primarily to the liver, poses a significant challenge to patient prognosis. Gastric metastasis, though infrequent, may indicate advanced disease, with an incidence of up to 60% in post-mortem studies. We present the case of a 47-year-old patient with a history of uveal melanoma who developed gastric and hepatic metastases, as well as brain lesions, ultimately leading to her death within a short period.

Introduction: This article summarizes the clinical practice guideline (CPG) for the evaluation and management of upper gastrointestinal bleeding (UGIB) in the Social Security of Peru (EsSalud).

Methods: A guideline development group comprising medical specialists and methodologists, formulated clinical questions addressed by CPG. Systematic evidence searches were conducted for each question during 2024. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of the evidence and formulate the recommendations. The CPG was approved through Resolution No. 000022-IETSI-ESSALUD-2024.

Results: This CPG addressed 11 clinical questions, divided into four topics: risk assessment, initial management, variceal UGIB management, and non-variceal UGIB management. Based on these questions, 11 recommendations (7 strong recommendations and 4 weak recommendations), 24 good clinical practices, and 2 flowcharts were formulated. For the 2024 guideline update, no new evidence was found to change the recommendations' direction or strength.

Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for evaluating and managing UGIB in EsSalud.

Objective: The objective of this study is to analyze the main clinical and epidemiological factors related to the risk of malignancy in intraductal papillary mucinous neoplasia of the pancreas in a cohort of patients seen at a referral clinic in Lima, Peru, based on the criteria of the IAP/Fukuoka guidelines.

Materials and methods: This is a retrospective cohort study, which evaluated patients diagnosed with pancreatic IPMN from December 2015 to August 2023. They were classified according to involvement of the main branch, side branch, and mixed pancreatic ducts, considering aspects such as high-risk stigmata, concerning factors, age, sex, medical history, and others.

Results: A total of 253 patients with pancreatic IPMN were included, 71.2% had side branch IPMNs, 9% had main branch IPMNs, and 19.8% were mixed. 49 patients (19.4%) underwent surgery at the time of diagnosis due to high-risk stigmata or factors concerning for malignancy. The remaining 204 patients were enrolled in a follow-up program for a mean of 31 months (6-100 months). During follow-up, a decision was made to operate on 38 of them. Of the 87 patients operated on, 36.7% presented invasive cancer and 11.4% high-grade dysplasia. The presence of a mural nodule greater than 5 mm increased the probability of malignancy 11.21 times; jaundice increased the risk of malignancy by more than 5 times. Wirsung duct dilation between 5 and 9.9 mm had a prevalence ratio (PR) of 2.12, and for dilation greater than 10 mm, a PR of 4.69 (p<0.05). The presence of three or more risk factors showed a PR of 6.77 in the bivariate analysis, and an adjusted prevalence ratio (aPR) of 17.11 in the multivariate analysis.

Conclusion: Diagnosis and periodic monitoring of IPMNs allow for early detection of potentially malignant lesions, allowing for timely, often curative, surgery. However, there is currently no reliable way to diagnose and identify which cystic lesions already present or are likely to present malignant characteristics, thus providing clear indications for surgical intervention in these patients.

Introduction: No data on quality of life (QoL) in paediatric IBD in Colombia. The aim of this study was to determine QoL using the IMPACT-III questionnaire in a sample of patients from different centres.

Materials and methods: Cross-sectional study of paediatric IBD patients followed in 3 centres in different cities, between June and November 2022. Eligible subjects were identified, information was collected on different dates, and the IMPACT-III questionnaire (score ranges from 35 to 175, with higher scores indicating better QoL) was administered once.

Results: 33 patients were included. 23/33 (69.7%) female, mean age 14.9 (range 6-17.9) years. 94% with inactive or mild disease. 20 patients with ulcerative colitis (UC), 13 with Crohn's disease (CD). The median score in UC was 147 (122-152), while in CD it was 126 (105-135). Systemic symptoms and emotional functioning were most affected, with median scores of 13 (12-14) and 27 (20-31) in UC and 11 (9-11) and 23 (20-26) in CD. No statistically significant differences were observed.

Conclusions: The quality of life of children with IBD is challenging due to several factors. More support and education is needed for these patients.