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.

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.

Severe gastritis in the Peruvian Andes.

OBJECTIVE: To compare the Helicobacter pylori-associated pathology in gastric biopsies taken from patients living at sea level with those taken from patients living at high altitude. METHODS AND RESULTS: We included 38 patients from a hospital in the Andean city of La Oroya, Peru, located at 3700 m in altitude, and 40 control patients taken from Comas Clinic located in the city of Lima at sea level. Fibrepanendoscopy and multiple biopsies were performed in all the patients followed by histopathological examination. In the antrum, patients from the Andean town had a higher prevalence of glandular lymphoid adherence lesions, active germinal centres, moderate to severe chronic atrophic gastritis, intestinal metaplasia and moderate to severe total deep gland loss, than did patients from the coastal town. Furthermore, the severity of the histological lesions seen in the gastric body and cardia was significantly greater in the high-altitude patients than in those from sea level. CONCLUSION: This study suggests that the severity of H. pylori-associated gastric lesions seen on histopathological examination is greater in patients living at high altitude, the cause of which is most probably multifactorial but nonetheless principally altitude related.

Comparación de la prevalencia de la infección del estómago por el Helicobacter pylori en el Perú en población japonesa y peruana / Comparison of the prevalence of Helicobacter pylori stomach infection in Peruvian and Japanese population

Se ha planteado la posibilidad de una predisposición racial para adquirir la infección del estómago por el Helicobacter pylori. Sin embargo, no se ha tenido en cuenta el nivel socioeconómico de los pacientes. Objetivo: Comparar la prevalencia de la infección por Helicobacter pylori en la población japonesa residente en el Perú y en peruanos nativos, con similares condiciones socioeconómicas. Material y métodos: Estudio prospectivo realizado en el Policlínico Peruano-Japonés (Lima-Perú), donde incluimos a dos grupos de pacientes: japoneses y peruanos nativos con síntomas crónicos del tracto gastrointestinal superior, ambos de nivel socioeconómico medio y alto. Se excluyeron pacientes con úlcera péptica. Para diagnosticar la infección se utilizó la prueba de la ureasa, la Reacción en Cadena de la Polimerasa (PCR) y serología con ELISA IgG. Resultados: Evaluamos 168 pacientes de raza japonesa (edad promedio 54.6±12.62 años, 75% mujeres), y los comparamos con 161 peruanos (edad 42.12±14.48 años, 61.5% mujeres). Utilizando la prueba de la ureasa, la prevalencia de infección por el Helicobacter pylori en peruanos fue de 47.8% y en japoneses de 47.0% (p=0.88). Utilizando PCR, en peruanos fue de 49.7% y en japoneses 43.5% (p=0.28). Conclusiones: En el Perú, las personas de raza y ascendencia japonesa pura comparados con población peruana del mismo estrato social y similar grupo etáreo, tienen similar prevalencia de la infección por el Helicobacter pylori, con lo que podemos postular que en el Perú y en estos grupos étnicos no existe predisposición racial para adquirir la infección.

Objective: To compare the prevalence of Helicobacter pylori infection in native Peruvians and Japaneses residing in Peru. METHODS: Prospective study carried out at [quot ]Policlinico Peruano-Japonés[quot ] (Lima-Perú). We included Peruvians and Japaneses residing in Peru with chronic symptoms of the upper gastrointestinal tract. Both groups were from medium to high socioeconomic status. We excluded patients with peptic ulcer. PCR, rapid ureasa test and IgG ELISA were used to diagnose the infection. RESULTS: We evaluated 168 Japaneses (mean age 54.6 +/- 12.62 years, 75% female), and 161 Peruvians (mean age of 42.12 +/- 14.48 years, 61.5% female). Using the rapid ureasa test, the prevalence of Helicobacter pylori infection in Peruvians was 47.8%, and in Japaneses 47.0% (p=0.88). Using PCR, in Peruvians was 49.7% and in Japaneses 43.5% (p=0.28). CONCLUSION: Peruvians and Japaneses residing in Peru have a similar prevalence of Helicobacter pylori infection, after controlling factors such as socioeconomic status and age, suggesting that in Peru and in these ethnic groups, there is no racial predisposition to acquire the infection.

[Campylobacter pyloridis and socioeconomic levels]. / Campylobacter pilórico y nivel socio-económico.

The purpose of this study was to determine if there was any relationship between the socio-economic level of patients and the colonization of the stomach by Campylobacter pyloridis. We have studied 256 patients who underwent esophagogastroduodenoscopy because they had upper gastrointestinal symptoms of this group, 143 from Arzobispo Loayza Hospital (38 males and 105 females) and 122 from the private practice of three of the authors (77 males and 45 females). The ages ranged from 16 to 75 years (media 45.5 years). In each case biopsies of the antrum were taken and stained with hematoxylin-eosin and Warthin-Starry Silver Stein. We classified patients into 3 different groups based on where they lived: nuclear districts, intermediate districts, and peripheral districts. In Lima, the type of district from the patient strongly correlates with their socio-economic status. The hospital and private patients differed significantly in the distribution of which type of district their patients came from. In contrast there was a no marked similarity between these two patient groups in their rate of colonization by Campylobacter pyloridis. It appears that the socio-economic level of peruvian patients, presenting to clinic with symptomatic gastro-intestinal disease is not an important factor with pyloric campylobacter infection.

[Campylobacter pyloric, chronic gastritis, gastric ulcer and duodenal ulcer]. / Campylobacter pilórico, gastritis crónica, úlcera gástrica y úlcera duodenal.

After the initial report of Marshall and Warren, several publications have also demonstrated the presence of pyloric campylobacter in an elevated percentage of cases of chronic gastritis and peptic ulcer. We present our experience studying 672 patients examined by esophagogastroduodenoscopy after referral to clinical because of upper gastrointestinal symptoms. We used an Olympus GIF-K2 panendoscope taking two biopsies from the gastric antrum. Specimens were stained with hematoxilin-eosin and silver. In our experience these methods have given us the best results in detecting this bacteria. Diagnosis of gastric and duodenal ulcer was made by endoscopic criteria and chronic gastritis diagnosed by histology. Chronic gastritis was categorized into active and inactive based in the invasion of polymorphonuclear into mucosa. We have also quantitated damage of the mucin producing cells as well as the degree of bacterial colonization. We have found pyloric campylobacter in 91.8% of patients suffering from chronic active gastritis, 72.7% of patients with diagnosis of gastric ulcer and 84.2% of cases of duodenal ulcer. Our results agree with the ones reported by other authors. We conclude that pyloric campylobacter is not an opportunist microorganism within the stomach because it produces inflammatory changes as well as damage of the mucin producing cells. Its presence may play some role in the etiology of gastritis and peptic ulcer disease.