[Double review of the right colon vs single review during colonoscopy for the detection of colon polyps and adenomas: systematic review of the literature]. / Doble revisión de colon derecho vs revisión simple durante la colonoscopia para la detección de pólipos y adenomas de colon: revisión sistemática de la literatura.

Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. OBJECTIVE: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). MATERIALS AND METHODS: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. RESULTS: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). CONCLUSION: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.

[E-VAC therapy as treatment of complications in gastrointestinal surgery in a gastroenterology reference center in Colombia: Case series]. / Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulas and postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulas at different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulas are potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Multimodal Endoscopic Management of Esophageal Perforations as a Complication of Peroral Endoscopic Myotomy for a Zenker's Diverticulum.

Zenker's diverticulum develops because of a weakness in Killian's triangle, leading to a mucosal and submucosal herniation. Its treatment has evolved from morbid surgical interventions to safer endoscopic techniques such as peroral endoscopic myotomy (Z-POEM). Despite being a safe technique, Z-POEM is not free of complications such as perforations, bleeding, pneumoperitoneum, and pneumothorax, for which new endoscopic techniques have been developed. We present the case of a 53-year-old man taken to a Z-POEM who postoperatively presented dehiscence of the mucosotomy and a mediastinal collection, managed with a vacuum-assisted endoscopic closure device.

Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos

Las fístulas y dehiscencias anastomóticas postoperatorias gastrointestinales se presentan de forma frecuente y muchas son manejadas quirúrgicamente, sin embargo, las intervenciones endoscópicas han mostrado mejorar desenlaces de curación y tiempo de estancia hospitalaria. Se describe la experiencia de la terapia de cierre asistida por vacío (E-VAC), en el manejo de fístulas y dehiscencias anastomóticas postoperatorias, en un centro de referencia gastrointestinal en Colombia. Se realizó un estudio serie de casos en pacientes con dehiscencia de anastomosis y fístula a diferentes niveles del tracto digestivo, tratados mediante E-VAC, por el servicio de gastroenterología de la clínica universitaria Colombia, en Bogotá, durante un periodo comprendido de febrero 2019 y noviembre 2021. Se describieron variables sociodemográficas, clínicas y quirúrgicas. Se describen 6 casos, 4 de tracto digestivo inferior y 2 de tracto digestivo superior. El 83% fueron hombres, la edad media fue de 51,8 años (+/-17,5). La indicación de E-VAC fue fístula anastomótica colorrectal en el 66%, siendo la ubicación anatómica más frecuente la anastomosis colorrectal (66%), con menor frecuencia a nivel de los cardias (16%) y esófago (16%). El tamaño del defecto se describió entre el 20 y el 80% en pacientes sometidos a terapia E-VAC, siendo el tiempo promedio de hospitalización 22.5 días con un número de recambios promedio de siete por paciente. Las fugas y fístulas anastomóticas son complicaciones potencialmente mortales en pacientes llevados a intervenciones quirúrgicas gastrointestinales, en las que la terapia E-VAC ha mostrado ser eficaz y segura, promoviendo el cierre del defecto y el drenaje de colecciones presentes, igualmente disminuyendo el tiempo de estancia hospitalaria.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulasand postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulasat different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulasare potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Doble revisión de colon derecho vs revisión simple durante lacolonoscopia para la detección de pólipos y adenomas de colon: revisión sistemática de la literatura

El tamizaje por colonoscopia es un método efectivo para prevenir cáncer de colon a traves de la detección de pólipos sobre los cuales se desarrolla en un mayor porcentaje el cáncer de colon; sin embargo la detección de estas lesiones varía en los diferentes segmentos del colon y de ellos en colon derecho su tasa detección suele ser menor. Objetivo: El objetivo de este estudio es evaluar si la doble revisión endoscópica de colon derecho durante la colonoscopia es un mecanismo para mejorar su rendimiento en cuanto a la tasa de detección de pólipos (TDP) y la tasa de detección de adenomas (TDA). Materiales y métodos: Revisión sistemática y metaanálisis de la literatura de estudios clínicos aleatorizados que realizaron una doble revisión del colon derecho por colonoscopia comparado con una revisión simple para mejorar la detección de pólipos y adenomas. El protocolo de esta revisión se publicó en PROSPERO bajo el código CRD42022356509. Resultados: Se incluyeron 5 estudios que incluyeron 2729 participantes. Se informó la detección de pólipos en 585/1197 pacientes (48,87%) después de la segunda revisión, en comparación con 537/1206 (44,52%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,09 (IC 95%: 0,97-1,23) (I2 fue de 44%). Se informó la detección de adenomas en 830/1513 pacientes (54,75%) después de la segunda revisión, en comparación con 779/1509 (51,62%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,06 (IC 95%: 1,00-1,13) (I2 fue de 0%). Conclusión: La segunda examinación del colon derecho por colonoscopia puede tener una modesta mejoría en la detección de pólipos y adenomas.

Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. Objective: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). Materials and methods: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. Results: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). Conclusion: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.