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.

Evaluation of eight cases of early gastric cancer.

We review eight cases of early gastric cancer which occurred in five female and three male patients. In seven patients the main complaint was epigastric pain and in one melena. In seven of the eight cases, endoscopic diagnosis was established on the first examination and confirmed by biopsy. Types of early gastric cancer observed were: type I, one case; IIa, one case; IIc three cases: III, two cases and type III + IIc, one case. In five cases the neoplasia was located in the antrum, two in the pre-pyloric region, two along the greater curvature and one in the anterior wall. Three cases were located in the body of the stomach, two in the lower third of the lesser curvature and one in the upper third of the greater curvature. From the histopathologic standpoint four cases were differentiated adenocarcinomas, three undifferentiated adenocarcinomas and one case mucus carcinoma. In no case did we encounter regional lymph node metastases. Postoperative survival rates at the present time varies between one and five years.

[Determination of serologic markers of hepatitis B virus in high risk areas at the Central Air Force Hospital of Peru]. / Determinación de marcadores serológicos del virus de la hepatitis B en áreas de alto riesgo del Hospital Central Fuerza Aérea del Perú.

In the present paper, the serologic markers of Hepatitis B virus were studied in 123 people belonging to the Hospital Central de la Fuerza Aérea del Perú that had been working in areas of high risk to get contact with this virus. The determination was done with the enzimo inmuno assay (EIA Abbot) and the results were the following: In 15 individuals (12.1%), at least one positive marker was found, evidence which proved to have been in contact with the virus in some moment of his life. Only one carrier (0.8%) was found, in 6 (4.8%) the presence of anti-HBc as only marker was found and in 8 (6.5%) the presence of Anti-HBc and Anti-HBs was observed which means post infection immunity. The great number of the individuals in which the markers were found, were male: 13 (16.0%) against only 2 (4.7%) female. There wasn't great difference with relation to the prevalency of markers according to the years of work like there has been observed in other greater series. It can be concluded that in this group the incidence of infection due to VHB was no greater than that of general population, which indicates us the little contact that they have had with the contaminating material during their professional life.

Evaluation of eight cases of early gastric cancer.

Foram revisados 8 casos de cancer gastrico precoce, sendo cinco em mulheres e tres em homens. Em sete casos a queixa principal era de dor no epigastrio, e em um caso era melena Sete dos oito casos foram determinados por diagnostico endoscopico no primeiro exame e confirmados pela biopsia. Observou-se os seguintes tipos de cancer gastrico precoce: tipo I, um caso; IIa, um caso; III, dois casos e III + IIc, um caso. Em cinco casos o neoplasma estava localizado no antro: dois na zona pre-pilorica, dois ao longo da grande curvatura e um na parede anterior. Tres casos estavam localizados no corpo do estomago, dois no terco inferior da pequena curvatura e um no terco superior da grande curvatura.Do ponto de vista histopatologico, quatro casos eram adenocarcinomas diferenciados e tres indifereciados, e um caso de carcinoma mucoso Em nenhum caso encontramos metastases para linfonodos. A media de sobrevida pos-operatoria varia de um a seis anos

Importancia del seguimiento de la úlcera gástrica. / Importance of the Gastric Ulcer folow-up.

Se revisa el segimiento de 105 casos de úlcera gástrica diagnosticados por endoscopía; seguidos con un mínimo de dos exámenes endoscópicos y biopsias y 5 operados luego del examen inicial. Al final del estudio 24 pacientes más habían sido operados. En 85 casos(80.95%)el diagnóstico endoscópico inicial de úlcera péptica fue confirmado. En tres pacientes(2.86%)se diagnosticó endoscópicamente úlcera maligna pero las biopsias y el seguimiento demostraron que eran benignas. En 13 (12.38%)se sospechó endoscópicamente malignidad siendo al final lesiones benignas. En 4 (3.81%) se diagnosticó en un primer exámen úlcera benigna y posteriormente resultaron ser adenocarcinomas. En dos de estos casos se observó el ciclo de la úlcera maligna. Se revisan otras variantes como tamaño localización y concomitancia de otras lesiones y se concluye que es importante el seguimiento endoscópico y con biopsias de las lesiones ulceradas gástricas.