Revista de gastroenterologia de Mexico (English)最新文献

Introduction and aim: Right-sided colon cancer (RSCC) is characterized by distinct clinical features and recurrence patterns. Our study aimed to develop a predictive model for distant recurrence in patients with RSCC who underwent curative surgery, employing the Random Forest machine learning algorithm, based on clinical and histopathologic variables.

Materials and methods: A retrospective analysis of 64 patients treated within the time frame of 2016-2024 was conducted. The variables included age, sex, lymphovascular invasion, and number of lymph nodes evaluated (transformed for inverse interpretation). Oversampling was employed to balance the dataset and a Random Forest model for predicting distant recurrence (defined as that occurring at least six months after surgery) was constructed. Its performance was evaluated through accuracy, sensitivity, F1 score, and area under the ROC curve (AUC).

Results: The model achieved an AUC of 0.76 in the test set, with 75% sensitivity and 100% specificity. The most relevant variables were low lymph node harvest, older age, male sex, and lymphovascular invasion. A simplified model with those four variables maintained 95% accuracy. A clinical risk scale based on cumulative scores was developed that classified patients into low-risk and high-risk groups, with distant recurrence rates of 8.3% and 56.3%, respectively.

Conclusion: The predictive model showed a robust capacity for stratifying the distant recurrence risk, supporting the use of machine learning algorithms as a complementary tool in the individualized management of RSCC.

Introduction and aims: The performance of gastroenteric anastomosis (GEA) utilizing endoscopic ultrasound (EUS) and lumen-apposing metal stents (LAMSs) is safe and effective for treating malignant gastric outlet obstruction, but not in benign disease, due to unpredictable GEA closure after LAMS removal. Our aim was to evaluate different endoscopic techniques for creating a durable GEA in porcine models.

Material and methods: An animal study in porcine models was conducted at the vivarium of a tertiary care hospital in Mexico City, between September and November 2023. Five techniques were carried out: direct technique (DT), radial cut (RC) technique, linear cut (LC) technique, absolute ethanol sclerotherapy (AES), and argon plasma coagulation (APC). Technical efficacy, safety, and lasting patency of the anastomosis at 4 weeks after the intervention and LAMS removal were evaluated.

Results: Ten porcine models, 2 per group, were included. Technical success was 100% and clinical success 0%. Procedure times were 29 min for the DT, 88 min for the RC technique, 74 min for the LC technique, 41 min for AES, and 75 min for APC. The RC technique had the largest anastomosis area (742 mm²). There was one adverse event (10%); it was mild and did not require any additional intervention.

Conclusions: Although clinical success was not achieved with any of the techniques, the technical modifications were safe, providing a better understanding of the mechanisms involved in GEA and paving the way for new explorations.

Introduction: The incidence of esophageal adenocarcinoma (EAC) has increased. Although there are screening and surveillance programs, especially for patients with Barrett's esophagus (BE), they have limited effectiveness in detecting early disease. Post-endoscopy esophageal adenocarcinoma (PEEC), diagnosed after previous negative endoscopies, raises concerns about the accuracy of current endoscopic practices in high-risk patients.

Aims: Primary aim: to estimate the rate of PEEC and analyze its characteristics in patients at three hospital centers in Medellín, Colombia.

Specific aims: • To compare characteristics between patients with PEEC and those diagnosed at the first endoscopy. • Evaluate the prevalence of BE in the two cohorts and its relation to PEEC. • Analyze the anatomic location of PEEC.

Materials and methods: An observational cohort study was conducted that included 473 patients diagnosed with esophageal cancer between 2012 and 2023 at three centers in Medellín, Colombia, 31 of whom had PEEC. Their demographic, clinical, and survival data were evaluated using the STROBE guidelines for cohort studies (pages 22-26).

Results: The PEEC rate was 6.6%. Patients with PEEC presented with fewer alarm symptoms (35% vs 63%, p = 0.002), a higher prevalence of BE (42% vs 23%, p = 0.016), and were diagnosed at an earlier stage of disease. The previous endoscopies failed to detect lesions, especially in the proximal esophagus.

Conclusions: PEEC is a frequent entity, especially in patients with BE and proximal lesions. Optimizing endoscopy through advanced imaging techniques and strict surveillance protocols is required.

Introduction and aims: Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis. Frailty and malnutrition are comorbidities associated with cirrhosis, impacting patient quality of life and survival. The aim of this study was to evaluate frailty and food intake quality in patients with chronic HCV infection, with or without cirrhosis, and the association between demographic, clinical, and anthropometric variables.

Material and methods: A cross-sectional study was conducted at the hepatitis clinic of the Hospital Civil de Guadalajara Fray Antonio Alcalde. Each participant was evaluated using the Liver Frailty Index (LFI), the mini-survey for assessing dietary intake quality (Mini-ECCA v.2), and upper arm anthropometry.

Results: Of the sample of 52 patients, nearly 40% presented with chronic HCV alone and close to 80% were classified as pre-frail on the LFI. The study patients had a mean handgrip strength of 25.5 ± 11.1 kg and under 10% had a healthy diet.

Conclusions: There was a high prevalence of frailty in the patients with inadequate dietary intake. In addition, the arm circumference measurement was positively correlated with handgrip strength, highlighting the importance of considering arm anthropometry in those patients as part of their nutritional assessment.