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

Bleeding involves morbidity and mortality in patients with acute myeloid leukemia (AML) receiving induction therapy. The concomitant presentation of gastrointestinal and uterine bleeding is rare as described in the literature, and its approach is not standardized. The following is an illustration of a case in which interventionism was effective and safe. A 44-year-old woman recently diagnosed with acute myeloid leukemia was started on induction therapy with cytarabine and idarubicin and presented 10 days after its initiation with rectorrhagia, melena and abnormal uterine bleeding. Due to clinical deterioration, she was transferred to the intensive care unit and required massive transfusion therapy. She needed angiotomography of the abdomen, with a probable area of active bleeding in the thin loop of the proximal jejunum, as well as contrasted resonance of the abdomen and pelvis, with multiple myomatosis and endometrial thickening. Abdominal arteriography was performed, requiring supra-selective embolization of the distal branch of the superior mesenteric artery supplying the jejunum. Subsequently, selective aorto-iliac arteriography was performed, proceeding to complete occlusion with coils of uterine arteries bilaterally. Post-procedure evolution, without new signs of bleeding. Imaging control ruled out complications. She completed the induction scheme and was discharged on the 45th day of hospitalization to continue the chemotherapy maintenance scheme on an outpatient basis. Early arteriography and embolization are viable, safe and effective procedures both for the management of gastrointestinal and uterine bleeding in patients with AML receiving induction therapy.

Objective: To describe the effectiveness of perioperative chemotherapy and adjuvant chemotherapy in the survival of patients with gastric carcinoma after gastrectomy with D2 lymphadenectomy (T2-T4a) and to determine the association between the intervening factors of the study and the survival of this group.

Materials and methods: Observational study, retrospective cohorts, in patients who received perioperative or adjuvant chemotherapy at a Peruvian cancer institute from January 2007 to December 2022. To determine actuarial survival, the Kaplan-Meier method and the log-rank test were used to compare 2 survival curves.

Results: A total population of 82 patients was evaluated, of which 46 received adjuvant chemotherapy and 36 perioperative chemotherapy, with the most commonly used regimen being CAPOX and EOX/EOX, respectively. Clinical characteristics did not significantly influence overall survival and only the primary tumor (T) had a statistically significant association, with T4a being more frequent in the perioperative chemotherapy group than in the adjuvant modality group (80.6% vs 47.8%; p=0.002). When comparing both therapeutic modalities, it was evident that patients who received perioperative chemotherapy had a longer survival at 5 years (53.2%), however, this was not statistically significant (p=0.230).

Conclusions: Perioperative chemotherapy presented greater survival compared to adjuvant chemotherapy at 12, 36 and 60 months; however, these differences were not statistically significant.

In Latin America, the prevalence of Inflammatory Bowel Disease (IBD) has increased in recent years, creating a growing need for diagnostic tools both for its detection and for ongoing monitoring. Intestinal ultrasound (IUS) has become a well-established, non-invasive, accurate, and well-tolerated tool to evaluate IBD activity in real time-even during the same medical consultation. Available evidence supports its usefulness in accurately determining inflammatory activity and identifying associated complications. At the time of diagnosis and initiation of treatment, IUS has proven to be the ideal non-invasive study for close monitoring, assessing therapeutic response, and making early treatment adjustments. Multiple systematic reviews and meta-analyses have shown that its diagnostic accuracy is comparable to that of colonoscopy or magnetic resonance imaging. Additionally, IUS allows for therapeutic monitoring and prognosis assessment in a more accessible, non-invasive way, with greater patient adherence compared to other diagnostic modalities. This review article aims to analyze the optimal use of IUS and its current role in the management of patients with IBD.

Gastrointestinal tract polyps exhibit a wide range of characteristics, from benign to potentially malignant lesions. Vanek's polyp, a rare entity, is characterized by its inflammatory infiltrate and vascular alterations, often leading to confusion with adenomatous lesions. We present the case of a 77-year-old woman with a one-month history of rectal bleeding, requiring hospitalization during one of the episodes. Colonoscopy revealed a pedunculated polyp, which was resected without complications. Histopathological analysis showed a lymphoplasmacytic infiltrate, multiple vessels with fibrinoid necrosis, and no neoplastic atypia. Due to the nonspecific nature of the report, immunohistochemical studies were performed, revealing CD34 positivity in the vessels and vimentin positivity in mesenchymal cells. These findings suggest a differential diagnosis from inflammatory fibroid polyps. Vanek's polyps are uncommon lesions that require accurate diagnosis and appropriate management. Recent trends show an increase in the identification of these polyps, likely due to advancements in diagnostic techniques.

Introduction: The weakest part of the duodenal wall is the ampulla of Vater, since here the circular arrangement of the duodenal musculature is destructured to integrate the sphincter of Oddi. This characteristic could be the reason why most duodenal diverticula appear in the juxtapapillary region, even including the papilla inside.

Objective: The objective of the research was to determine the patients diagnosed with juxtapapillary diverticulum (JD) after endoscopic retrograde cholangiopancreatography (ERCP), who were confused with different previous diagnoses.

Materials and methods: Retrospective study with intentional sample, where ERCP was performed on a universe of 12,686 patients who were referred with different previous gastrointestinal pathologies, therefore, they required diagnosis or treatment with this procedure.

Results: Of the 12,686 patients who underwent ERCP, between 01/07/2014 and 28/06/2024, a total of 872 (6.9%) presented a confirmatory diagnosis of juxtapapillary diverticulum, a diagnosis that differed partially or totally from the one presented before the procedure.

Conclusions: The prevalence detected was one of the highest reported for Latin America. DY is generally asymptomatic, affecting mostly elderly patients, but when it is symptomatic, they present different signs and symptoms, which simulate a wide variety of diagnoses, where the clinical and previous imaging studies do not provide sufficient clues for a correct analysis, therefore, ERCP is the perfect tool for the timely diagnosis and treatment of DY, clearing previous diagnostic doubts.

Introduction: Gastric cancer (GC) is the leading cause of oncologic death in Chile. Since 2006, the health authority has recommended upper gastrointestinal endoscopy (UGE) for symptomatic individuals ≥40 years old. In 2010, the UGE coverage in this group was estimated at 14%.

Objective: To evaluate UGE coverage for GC screening in Chile using data from the National Health Survey (NHS) 2016-17.

Materials and methods: The NHS 2016-17 surveyed 6,233 adults about the presence of persistent epigastric pain, possible upper gastrointestinal bleeding, and UGE. UGE prevalences among different groups were compared, and multivariate models adjusted for sex, age, income, education, area of residence, and belonging to an indigenous group were constructed.

Results: Both persistent epigastric pain and possible upper gastrointestinal bleeding were reported by 4.7%, being higher in the ≥ 40-year-old group and lower educational level. The prevalence of UGE performed at least once in life reached 20.8%, being higher in women, ≥40 years old, privately insured individuals, and the non-indigenous Hispanic population. The coverage of UGE in the last year among symptomatic individuals ≥40 years old increased to 19.8%, with no significant differences in the multivariate analysis.

Conclusion: The coverage of UGE in the last year in symptomatic individuals ≥40 years old for GC screening in Chile is 19.8%. Lowest socioeconomic status and indigenous peoples are disadvantaged groups.

Potassium-competitive acid blockers (PCABs) constitute an emerging class of drugs for the treatment of acid-related disorders. They represent an alternative to proton pump inhibitors (PPIs), which have been the standard therapy but present certain limitations. Currently, PCABs are available in Latin America and offer a promising therapeutic option. This review compares both drug classes across various key aspects. Potassium-competitive acid blockers (PCABs) offer significant advantages over proton pump inhibitors (PPIs) in terms of speed of action, potency, and duration of acid suppression, as well as efficacy in the treatment of erosive esophagitis and Helicobacter pylori eradication, among other aspects. Additionally, they exhibit lower interindividual variability. Currently, PCABs are available in Latin America and represent a promising therapeutic option. This review compares both drug classes across various key aspects.

Introduction: Several variables have been studied to predict difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP), but none have been identified that can effectively predict this difficulty and help make decisions to prevent complications.

Objectives: To determine whether endoscopic variables of the duodenal papilla, as well as the sign of bile aspiration, are associated with difficult cannulation during ERCP.

Materials and methods: A prospective and analytical study that included 203 patients who underwent ERCP, establishing an association between the type of duodenal papilla, location, presence of periampullary diverticulum and the sign of bile aspiration, and difficult cannulation.

Results: 140 (69.97%) women and 63 (31.03%) men were included, with an average age of 54.35 years. Difficult cannulation criteria were present in 32.51% of patients. Type 1 duodenal papilla had a lower rate of difficult cannulation, while types 3 and 4 had a higher cannulation difficulty (OR=1.89, 95% CI: 1.01-3.54 and OR=4.37, 95% CI: 1.54-12.4 respectively). The distal location of the duodenal papilla had an OR=1.32 for difficult cannulation, while the presence of a periampullary diverticulum had an OR=0.54 and the endoscopic sign of bile aspiration OR=0.9, without being statistically significant.

Conclusion: Types 3 and 4 duodenal papilla are significantly associated with difficult cannulation. The location of the papilla, as well as the presence of a periampullary diverticulum and bile aspiration, are not significantly associated with difficult cannulation.

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.