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

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.

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.

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.

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.

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.

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.

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.