Factors related to advanced colorectal neoplasm at the Policlínico Peruano Japonés.

BACKGROUND: Identifying persons at high risk for advanced colorectal neoplasia can aid in the prevention of colon cancer. Previous studies have shown that some patients can present with proximal advanced neoplasia with no distal findings. AIMS: To determine the factors related to advanced neoplasia and advanced proximal colorectal neoplasia in a Latin American population. MATERIAL AND METHODS: A prospective, cross-sectional, observational, analytic study was conducted. It included patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of January and July 2012. Advanced neoplasia was defined as the presence of lesions ≥ 10mm with a villous component, high-grade dysplasia, or carcinoma. The splenic flexure was the limit between the proximal and distal colon. RESULTS: A total of 846 patients were included in the study. Advanced neoplasia was detected in 108 patients (12.8%) and advanced proximal neoplasia in 55 patients (6.7%), 42 (76.4%) of whom had no neoplasia in the distal colon. Factors related to advanced neoplasia found in the multivariate analysis were age, at the intervals of 50-59 (p=0.019), 60-69 (p=0.016), and ≥ 70 years (0.002) and male sex (p=0.003). In the evaluation of advanced proximal neoplasia, the multivariate analysis identified the 60-69 year age interval (p=0.039) and advanced distal neoplasia (p=0.028) as factors related to advanced proximal disease. The ROC curve established the age cut-off point at 60 years for initially performing colonoscopy, rather than sigmoidoscopy. CONCLUSIONS: Age and sex are related to advanced neoplasia, whereas age and advanced distal neoplasia are related to advanced proximal neoplasia.

Correlation between proximal serrated polyp detection and clinically significant serrated polyps: inter-endoscopist variability.

INTRODUCTION AND AIMS: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. METHODS: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. RESULTS: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). CONCLUSIONS: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate.

Correlation between proximal serrated polyp detection and clinically significant serrated polyps: inter-endoscopist variability. / Correlación entre la detección de pólipos serratos proximales y pólipos serratos clínicamente significativos: variabilidad interendoscopista.

INTRODUCTION AND AIMS: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. METHODS: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. RESULTS: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). CONCLUSIONS: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate.

[Sensitivity of the parietal cell to the effect of pentagastrin in men living at high altitude]. / Sensibilidad de la célula parietal a la acción de la pentagastrina en el hombre de altura.

This study evaluates the response of the gastric mucosa to pentagastrin in a group (HAG) of 17 andean subjects compared to a similar group of 17 subjects at sea level (LAG). Both groups had normal fundic, body and antrum mucosa as demonstrated by endoscopic and histological means. Each group underwent two assays, the first one with a dose of 6 micrograms/kg and 72 hours later, the second administration with 3 micrograms/kg. In the HAG the acid response expressed as concentration and output was significantly greater with 6 micrograms/kg that with 3 micrograms/kg. In the LAG the difference was not statistically significant. The ANOVA analysis showed, for both determinations, free and total acidity, a different response pattern between the HAG and LAG for both doses. The response of both groups to the 3 micrograms/kg reveals a lesser sensitivity to pentagastrin of the parietal cell in HAG.

[Early gastric cancer]. / Cáncer gástrico incipiente: reporte de 40 casos.

Younger than 40 years old reached a 27.5% and the group of older than 40 years old reached a 72.5%. The predominant sex was the female that reached a 65%. Ulcerated and depressed lesions reached to 70%. The clinical symtomatology referred was ulcerous syndrome in 42.5% and non-characteristic epigastralgy in 35% with symptoms which last less than 6 months or between 6 and 12 months or between 1 and 2 years near 30% in each one of the groups. In 25% of the patients, radiological and/or endoscopic diagnosis of peptic ulcer was found that have obtained alleviation with antitulcerous treatment.

[Acute pancreatitis: use of a new prognostic stage system]. / Pancreatitis aguda: aplicación de un nuevo sistema de estadiaje pronóstico.

The spectrum of clinical severity of acute pancreatitis varies widely, but the most important is to predict high risk patients, so that, a number of classification systems have been proposed with the main focus is on laboratory findings. The purpose of this paper was to validate the Rabeneck Clinical prognostic staging system (using clinical features and comorbid illness) which classified in three stages: I, II and III. We conducted a retrospective study in 51 patients admitted to Hospital Arzobispo Loayza, from 1988 to 1994. 42 (82.4%) were female and 9 (17.6%) male. The average age was 40.3 years. The range hospital stay was 3 to 41 days. Ultrasonographically we found some alterations in pancreas texture about 84.4% and gallbladder stones in 57.7%. The mortality rates according to Rabeneck system were stage I: O of 44 (0%); stage II: 1 of 4 (25%); stage III 2 of 3 (66.7%) In conclusion the new prognostic staging system is easy to use, simple and require no additional laboratory test, so that utility to our institutional situation.

[Villous adenoma: clinical, endoscopic and histopathologic aspects]. / Adenoma velloso: aspectos clínicos, endoscópicos e histopatológicos.

A ten years retrospective study of villous adenomas at the Arzobispo Loayza Hospital was carried out. 24 patients with this problem were found, the mean age was 62 years, clinical symptoms were: rectal bleeding (87.5%), mucus diarrhea (58.2%) and abdominal pain (37.5%). According to the Histopathologic study, there were 14 (58%) adenomas with carcinoma and the existence of carcinoma was proportional to the adenoma's size, we didn't find carcinoma in the adenomas smaller than 2 cm. The endoscopy was useful to detect invasive carcinoma in the 88% of cases meanwhile the endoscopic biopsy detected only 27% of cases. The endoscopic polipectomy was suitable when the adenomas were smaller than 3 cm.

[Clinical evaluation of the use of proglumide in the treatment of the peptic ulcer semebrome]. / Valoración clínica del uso de la proglumida en el tratamiento del sindrome ulceroso

The authors have made a clinical evaluation of Proglumida in 27 patients suffering from Peptic ulcer. Proglumida was administered orraly, 2 tables of 200 mg 3 times a day, 1.200 mg in 24 hours, during a period varying from 21 to 28 days. The painful symptoms improved in 96% of the pain occurred in 59% during the first 7 days of treatment. The dispeptic symptoms improved in all cases, disappearing completely in 74%, but in a slower fashion than the pain, and in 68% of the cases only from the second week of treatment onward. The objectivation of the pain by palpation of the epigastrium improved in all cases and did so in a significant form in 59% of the cases during the first seven days of treatment. No undesireable side effects have been observed in any of the cases. We believe that Proglumida is a pharmacological drug of positive action in the treatment of the ulcer syndrome, because of its favorable action and the absence of secondary side effects.

[Famotidine in the treatment of duodenal peptic ulcer]. / Famotidina en el tratamiento de la úlcera péptica duodenal.

A multicenter, open study was designed to evaluate the efficacy and tolerability of a novel and potent H2 receptor antagonist, Famotidine, in the treatment of duodenal ulcer. Thirty-four patients with endoscopically proven active duodenal ulcer were treated with Famotidine, 40 mg, one tablet, at bedtime, for six weeks. Follow-up endoscopic exams were done every two weeks until ulcer healing was obtained. One patient was excluded from further analysis as he failed to follow the protocol. Healing rates achieved were 48.5%, 91% and 97% by the second, fourth and sixth week of treatment respectively. After 72 hours 52% of the patients were asymptomatic and 79% at the end of the first week of treatment. Famotidine was well tolerated, no clinical neither laboratory adverse events were observed during the study. Famotidine, a novel H2 receptor antagonist appears to be effective and well tolerated in the treatment of most patients with duodenal ulcer.