[Midazolam versus dexmedetomidine for sedation for upper gastrointestinal endoscopy]. / Midazolam versus dexmedetomidina en sedación para procedimientos endoscópicos de tubo digestivo alto.

BACKGROUND: The diagnostic upper gastrointestinal endoscopy (UGI) is a safe procedure although 50% to 60% morbidity and mortality due to cardiopulmonary complications. OBJECTIVE: To compare safety and efficacy of dexmedetomidine vs. midazolam in UGI. METHODS: We conducted a randomized controlled, double-blind, clinical trial to compare the two drugs. Patients with an indication of UGI were randomized to receive sedation with dexmedetomidine or midazolam during the procedure. We compared age, sex, physical status (ASA), body mass index (BMI), degree of sedation (Ramsay scale), recovery time and degree of satisfaction with the procedure. RESULTS: Forty patients with an indication of UGI were included (20 in each arm). Both groups showed a similar distribution by sex, age, BMI and ASA physical status. The level of sedation was similar starting and ending the procedure according to the Ramsay scale. The dexmedetomidine group had a shorter recovery time (7.1 vs. 15.8 min, p <0.05) and satisfaction (9.9 vs. 9.0, p <0.05). Adverse effects occurred in similar proportions in both groups. CONCLUSIONS: Midazolam and dexmedetomidine are suitable for endoscopic procedures of upper digestive tract. Dexmedetomidine offers shorter recovery time and better patient's satisfaction.

[Inflammatory myoglandular polyp (Nakamura polyp): a case report]. / Pólipo mioglandular inflamatorio (pólipo de Nakamura): reporte de un caso.

Inflammatory myoglandular polyp (IMGP) is a rare nonneoplastic polyp of the large bowel, characterized by inflammatory granulation tissue in the lamina propia, proliferation of smooth muscle and hyperplastic glands with variable degree of cystic changes. Clinical course is benign and etiology unclear, but it has been associated to chronic inflammation due to fecal stasis and abnormal colonic motility. Clinically may be asymptomatic or produce hematochezia. At endoscopy the appearance may be that of a pedunculated or semi-pedunculated polyp, with soft or lobulated surface, with hyperemia and even partial erosions. We present a 33 year-old male with hematochezia caused by an IMGP in the descending colon. Initial diagnosis was a well differentiated adenocarcinoma, which proved to be an IMGP on final pathology. Hematochezia resolved after resection.