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1.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 560-567, 01-dic-2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1357659

ABSTRACT

Introducción: el sangrado gastrointestinal de origen oscuro es una entidad poco frecuente y se reserva a los casos en los que ya se ha realizado exploración del intestino delgado (endoscópica/radiológica) sin encontrar la causa. Actualmente el estándar de oro es la videocápsula, que se ha descrito como una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las enfermedades del intestino delgado. Objetivo: describir variables demográficas, indicaciones, hallazgos, segmento explorado, tratamiento y tiempo de procedimiento quirúrgico de la enteroscopía transoperatoria en 15 pacientes con diagnóstico de sangrado de tubo digestivo de origen oscuro. Material y métodos: se incluyeron 15 pacientes adultos con el diagnóstico de sangrado de origen oscuro con panendoscopía y colonoscopía negativa a sangrado. A todos se les realizó laparotomía exploradora y enteroscopía transoperatoria con un gastroduodenoscopio. Resultados: se realizaron 15 enteroscopías transoperatorias con gastroduodenoscopio; 10 en mujeres y 5 en hombres, con promedio de edad de 67.2 años. Se exploró la tercera y cuarta porción del duodeno, yeyuno e íleon terminal. Los diagnósticos encontrados fueron enfermedad de Crohn en 1 paciente (6.66%), adenomas en 2 (13.3%), divertículo yeyunal en 6 (40%) y angiectasias en 6 casos (40%). La localización fue en yeyuno [12 casos (80%)] e íleon [3 casos (20%)]. Conclusiones: la enteroscopía intraoperatoria es una alternativa diagnóstica en el sangrado de origen oscuro cuando no se cuente con la enteroscopía doble balón o la videocápsula endoscópica.


Background: Bleeding of dark origin is a rare entity and it is reserved for cases in which exploration of the small intestine has already been performed (endoscopic / radiological) without finding the cause. Currently, the gold standard is the videocapsule which has been described as a safe, useful and effective technique for the diagnosis and treatment of diseases of the small intestine. Objective: The objective was to describe demographic variables, indications, findings, explored segment, treatment and time of the surgical procedure of the intraoperative enteroscopy in 15 patients with a diagnosis of gastrointestinal bleeding of dark origin. Material and methods: 15 adult patients with the diagnosis of bleeding of dark origin with panendoscopy and negative colonoscopy to bleeding were included. All of these underwent exploratory laparotomy and intraoperative enteroscopy with a gastroduodenoscope. Results: 15 intraoperative enteroscopies were performed with a gastroduodenoscope; 10 women and 5 men with an average age of 67.2 years. Third and fourth portions of the duodenum, jejunum, and terminal ileum were explored. The diagnoses found were Crohn's disease 1 (6.66%), Adenomas 2 (13.3%), jejunal diverticulum 6 (40%) and angiectasias in 6 cases (40%). The location was in jejunum, 12 cases (80%) and ileum, 3 cases (20%). Conclusions: Intraoperative enteroscopy is a diagnostic alternative in bleeding of dark origin when there is no double balloon enteroscopy or endoscopic video capsule.


Subject(s)
Humans , Male , Female , Surgical Procedures, Operative , Crohn Disease , Colonoscopy , Endoscopes, Gastrointestinal , Mexico , Adenoma , Diverticulum , Gastrointestinal Tract , Duodenum , Endoscopy , Hemorrhage , Intestine, Small , Jejunum , Laparotomy
2.
Arq. gastroenterol ; 58(3): 384-389, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345308

ABSTRACT

ABSTRACT BACKGROUND: Recent studies have shown that endoscopy fellows can perform colonoscopy effectively and safely. However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques. OBJECTIVE: To assess whether quality indicators were met at an outpatient endoscopy center and whether surgical residents, without prior upper or lower endoscopy skills, could perform colonoscopy adequately. METHODS: A prospective non-randomized cohort study was undertaken. All exams were performed either by assistant physicians or by residents. Quality measures were compared between those groups. RESULTS: A total of 2720 colonoscopies were analyzed. In the resident group, we observed older patients (57.7±12.7 years vs 51.5±14.5 years, P<0.001), a higher prevalence of screening colonoscopies (52% vs 39.4%, P<0.001) and a higher prevalence of colorectal cancer (6.4% vs 1.8%, P<0.001). The cecal intubation rate was higher in the attending group (99.9% vs 89.3%; P<0.001). The polyp detection rate was 40.8%, and no differences were observed between the studied groups. The residents had a higher rate of perforation in all exams (0.4% vs 0%; P=0.02). Postpolypectomy bleeding and 7-day readmission rates were the same (0.2%). All readmissions in 7 days occurred due to low digestive bleeding, and none required intervention. CONCLUSION: Quality indicators were met at a university outpatient endoscopy center; however, medical residents achieved lower rates of cecal intubation and higher rates of perforation than the attending physicians.


RESUMO CONTEXTO: Estudos recentes mostraram que médicos em treinamento podem realizar a colonoscopia de maneira eficaz e segura. No entanto, pouco se sabe sobre a performance dos médicos residentes de cirurgia sem o conhecimento prévio das técnicas endoscópicas. OBJETIVO: Avaliar se os indicadores de qualidade foram atendidos em um centro de endoscopia ambulatorial e se os residentes de cirurgia, sem habilidades anteriores em endoscopia alta ou baixa, realizaram a colonoscopia de forma adequada. MÉTODOS: Foi realizado um estudo de coorte prospectivo não randomizado. Todos os exames foram realizados por médicos assistentes ou residentes. Os indicadores de qualidade foram comparados entre esses grupos. RESULTADOS: Um total de 2.720 colonoscopias foram analisadas. No grupo de médicos residentes, observamos pacientes mais velhos (57,7±12,7 anos vs 51,5±14,5 anos, P<0,001), maior prevalência de colonoscopias de rastreamento (52% vs 39,4%, P<0,001) e maior prevalência de câncer colorretal (6,4% vs 1,8%, P<0,001). A taxa de intubação cecal foi maior no grupo de médicos assistentes (99,9% vs 89,3%; P<0,001). A taxa de detecção de pólipos foi de 40,8% e não foram observadas diferenças entre os grupos estudados. Os médicos residentes tiveram maior índice de perfuração (0,4% vs 0%; P=0,02). O sangramento pós-polipectomia e as taxas de readmissão em 7 dias foram iguais (0,2%). Todas as readmissões em 7 dias ocorreram devido a hemorragia digestiva baixa e nenhuma intervenção foi necessária. CONCLUSÃO: Os indicadores de qualidade foram alcançados em um centro de endoscopia universitário; no entanto, os médicos residentes alcançaram taxas mais baixas de intubação cecal e taxas mais altas de perfuração do que os médicos assistentes.


Subject(s)
Humans , Outpatients , Cecum , Universities , Prospective Studies , Cohort Studies , Colonoscopy , Clinical Competence
3.
Arq. gastroenterol ; 58(3): 390-393, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345305

ABSTRACT

ABSTRACT BACKGROUND: Since 2012, a new technique for resection of large polyps has been described, the underwater endoscopic mucosal resection (UEMR). Some advantages that emerge from it is the needless of injection in submucosal layer and a greater chance of complete capture of the polyp. OBJECTIVE: There are few studies of UEMR in Brazil. The aim of this study is to evaluate the safety and efficacy of this technique in one Brazilian center. METHODS: This case series was conducted from February to December of 2020. Colorectal polyps greater than 9 mm without features of deep submucosal invasion were resected using UEMR. RESULTS: Twenty-four large polyps were resected with the UEMR approach from 24 patients. The mean size of the polys was 19 mm, ranging from 12 to 35 mm. All lesions were successful resected and 66% (16/24) were resected en bloc. In histologic analyses, most of them were adenomas (70.8%) and only one had deep submucosal invasion. There were no cases of acute complications, such perforation or acute bleeding. CONCLUSION: The UEMR is a safe and feasible procedure. With the emerging data on the procedure, it seems to be a wonderful tool in preventing colorectal cancer and its applicability and scope should be encourage to surpass reference centers.


RESUMO CONTEXTO: Desde 2012, uma nova técnica para ressecção de pólipos grandes tem sido descrita, a ressecção da mucosa endoscópica sob imersão d'água (REMS). Algumas vantagens que surgem desta técnica são evitar a injeção na camada submucosa e a maior chance de captura completa do pólipo. Objetivo - Há poucos estudos com REMS no Brasil. Nosso objetivo é avaliar a segurança e a eficácia da técnica em um centro brasileiro. MÉTODOS: Esta série de casos foi conduzida de fevereiro a dezembro de 2020. Pólipos colorretais maiores que 9 mm sem sinais endoscópicos de invasão de submucosa foram ressecados utilizando RMES. RESULTADOS: Vinte e quatro pólipos foram ressecados com RMES em 24 pacientes diferentes. O tamanho médio dos pólipos era de 19 mm, variando de 12 a 35 mm. Todas as lesões foram ressecadas e 66% (16/24) foram ressecadas em monobloco. Na análise histológica, a maioria era adenoma (70.8%) e apenas uma havia invasão profunda da submucosa. CONCLUSÃO: O uso de REMS é um procedimento seguro e factível. Com o aumento de dados relativos ao procedimento, esta parece ser uma excelente ferramenta na prevenção do câncer colorretal e sua aplicabilidade deve ser encorajada para fora dos centros de referência.


Subject(s)
Humans , Colorectal Neoplasms/surgery , Colorectal Neoplasms/pathology , Colonic Polyps/surgery , Colonic Polyps/pathology , Endoscopic Mucosal Resection , Brazil , Colonoscopy , Ambulatory Care , Intestinal Mucosa , Intestinal Mucosa/surgery
4.
Arq. gastroenterol ; 58(3): 359-363, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345304

ABSTRACT

ABSTRACT BACKGROUND: The gold standard test for colorectal cancer screening the colonoscopy. Although this is the test of choice, colonoscopy misses a significant number of lesions, mainly in the proximal colon. With the purpose of reducing the number of lesions missed, new techniques have been studied, amongst them, retroflexed view in the right side of the colon and the second direct forward view. OBJECTIVE: Assessing the safety of the retroview in the proximal colon (cecum and ascending colon), its impact on the detection of lesions in the proximal colon and its advantage over the double right forward view using adenoma detection rate and adenoma miss rate. METHODS: Three hundred and ninety-three patients who came to Hospital Mater Dei to undergo colonoscopy from March to July 2017, prospectively. Out of these, 372 were included in the study based on the following exclusion criteria: being under 18 years of age, inadequate bowel preparations (Boston scale <7), history of colectomy, inflammatory bowel disease or polypoid diseases. First, an endoscopist inserted the colonoscope into the cecum and examine the cecum and the ascending colon with a forward view twice. In the third insertion into the cecum, retroflexed view was performed, cecal mucosa was examined until the hepatic flexure in search of polyps missed on forward view. All lesions found were resected and sent for histological analysis. RESULTS: In 334 (89.8%) patients, retroflexed view was performed successfully, 65.8% of failures were attributed to the loops of the device which prevented the maneuver. The direct view identified 175 polyps in the proximal colon in 102 people. Retroflexed view detected 26 polyps missed by the direct view in 24 (6.5%) people, with a missing rate of 12.9% in the test with only the forward view. Out of the 26 polyps found in retroview, 21 (80.76%) were adenomas, one of them with a high-grade dysplasia. Eleven patients had polyps seen only in retroflexed view. Retroview has increased the polyp detection rate from 27.41% to 31.72% and the adenoma detection rate from 21.77% to 25%. The adenoma miss rate by the double direct view was 12.8%. Without the retroview, one polyp in every 13.91 colonoscopies would be missed (number needed to treat - NNT=13.91). There was no adverse event. CONCLUSION: The retroflexed view technique in the proximal colon was shown to be safe, fast and feasible in most cases. It increased the adenoma detection rate and was shown to be advantageous in this study wit benefit beyond the double direct view.


RESUMO CONTEXTO: O exame padrão ouro para rastreamento de câncer colorretal é a colonoscopia. Apesar de ser o exame de escolha, a colonoscopia perde um número não desprezível de lesões, principalmente no cólon proximal. Com a intenção de reduzir a perda de lesões, novas técnicas são estudadas, dentre elas, a retroflexão em cólon direito e a segunda visão frontal direta. OBJETIVO: Avaliar a segurança da retrovisão no cólon proximal (ceco e cólon ascendente), o seu impacto na detecção de lesões em cólon proximal e sua superioridade sobre a dupla visão frontal direta usando taxa de detecção de adenoma e taxa de adenoma perdido. MÉTODOS: Foram avaliados 393 pacientes de forma prospectiva que procuraram o Hospital Mater Dei para realizar colonoscopia entre março e julho de 2017. Desses, 372 foram incluídos baseados nos critérios de exclusão: menores de 18 anos, preparos intestinais inadequados (escala de Boston <7), com antecedente de colectomia, doença inflamatória intestinal ou síndromes polipoides. Primeiramente um endoscopista realizou a inserção do colonoscópio até o ceco e examinou o ceco e o cólon ascendente em visão frontal por duas vezes. Na terceira reinserção até o ceco era realizada a retroflexão e inspeção da mucosa do ceco até a flexura hepática em busca de pólipos perdidos à visão frontal. Todas lesões encontradas foram ressecadas e enviadas para análise histológica. RESULTADOS: Em 334 (89,8%) pacientes a retroflexão foi realizada com sucesso, 65,8% dos insucessos foram atribuídos a alças no aparelho que impediram a manobra. A visão direta identificou 175 pólipos no cólon proximal em 102 pessoas. A retroflexão detectou 26 pólipos perdidos pela visão direta em 24 (6,5%) pessoas, com uma taxa de perda de 12,9% no exame apenas em visão frontal. Dos 26 pólipos encontrados em retrovisão, 21 (80,76%) eram adenomas, um deles com displasia de alto grau. Onze pacientes tinham pólipos vistos apenas em retroflexão. A realização da retrovisão aumentou a taxa de detecção de pólipo de 27,41% para 31,72% e a taxa de detecção e adenomas de 21,77% para 25%. A taxa de adenoma perdido pela dupla visão direta foi de 12,8%. Se a retrovisão não fosse realizada, um pólipo a cada 13,91 colonoscopias seria perdido (NNT=13,91). Não houve nenhum evento adverso. CONCLUSÃO: A técnica de retroflexão em cólon proximal mostrou-se segura, rápida e factível na maioria dos casos. Ela aumentou a taxa de detecção de adenomas e mostrou-se soberana neste estudo com benfeitorias além da dupla visão direta.


Subject(s)
Humans , Adolescent , Colonic Polyps/diagnostic imaging , Colonic Neoplasms/diagnostic imaging , Colonoscopy , Tertiary Care Centers
5.
J. coloproctol. (Rio J., Impr.) ; 41(3): 301-307, July-Sept. 2021.
Article in English | LILACS | ID: biblio-1346416

ABSTRACT

Over the past decade, there has been a great interest in postcolonoscopy colorectal cancer (PCCRC). Its etiology is complex and multifactorial. Monitoring for PCCRC is even more complex. The strategies to decrease the incidence of PCCRC start by defining the problem, identifying the factors contributing to its development, followed by an attempt to define methods to decrease its incidence.We believe that the quality of the colonoscopy and the endoscopist's expertise are the key factors in decreasing the incidence of PCCRC. (AU)


Subject(s)
Humans , Colorectal Neoplasms/diagnosis , Colonoscopy , Colitis, Ulcerative/complications , Colorectal Neoplasms, Hereditary Nonpolyposis/complications , Clinical Competence , Early Detection of Cancer
6.
J. coloproctol. (Rio J., Impr.) ; 41(3): 228-233, July-Sept. 2021. tab, ilus
Article in English | LILACS | ID: biblio-1346421

ABSTRACT

Objectives: To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods: This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by themedical team. All polyps identified were removed and sent to the same pathologist for analysis. Results: A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions: The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams. (AU)


Subject(s)
Humans , Male , Female , Colonoscopy , Colon/injuries , Colorectal Neoplasms/etiology , Smoking/adverse effects , Colonic Polyps/diagnosis , Endoscopy
7.
Arq. gastroenterol ; 58(2): 175-179, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285324

ABSTRACT

ABSTRACT BACKGROUND: Ileitis is defined as ileal inflammation, with several etiologies, including inflammatory bowel disease (IBD), and can be evaluated during the colonoscopy exam, but its mandatory evaluation is discussed, because of few diagnosis and procedure time. OBJECTIVE: This study aims to evaluate the correlation of colonoscopic ileitis with the clinical presentation, in order to identify the cases where ileal examination is mandatory. METHODS: A retrospective, cross-sectional study was conducted between 2013 and 2017. The examination report, indications for colonoscopy, and medical records were evaluated in order to identify whether the colonoscopic findings were clinically significant. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age, those with previous intestinal resections, and repeated examinations of the same patient in the study period were excluded. The estimated association measure was the odds ratio with 95% confidence intervals. P-values <0.05 indicated statistical significance. RESULTS: A total of 3382 cases were included. Among these participants, 64.5% were females and the average age was 56.9±13.1 years (18-89 years). Ileal alterations were observed in 5.3% of the patients, with 2.69% being clinically significant between all patients, and 0.96% excluding those with IBD. There was a positive correlation between the ileitis findings and IBD control examinations and a negative correlation in screening and change in bowel habit indications. Among the indications with ileitis clinically significant, IBD control still had a positive correlation, 'diarrhea' and 'others' did not show a statistical significance, and all other indications presented a negative correlation for ileal assessment. CONCLUSION: Ileal evaluation in only mandatory in IBD control. When the main colonoscopy objective is detecting colonic neoplasms, ileoscopy is unnecessary.


RESUMO CONTEXTO: Ileíte é definida como inflamação ileal, com diversas etiologias, incluindo doença inflamatória intestinal (DII), e pode ser avaliada durante o exame de colonoscopia, mas sua avaliação obrigatória é discutida, devido aos poucos diagnósticos e tempo de procedimento. OBJETIVO: O objetivo deste estudo é avaliar a correlação da ileíte colonoscópica com a apresentação clínica, a fim de identificar os casos em que o exame ileal é obrigatório. MÉTODOS: Foi realizado um estudo transversal retrospectivo entre 2013 e 2017. O laudo do exame, as indicações para colonoscopia e os prontuários médicos foram avaliados para identificar se os achados colonoscópicos eram clinicamente significativos. Pacientes maiores de 18 anos submetidos à ileoscopia foram incluídos, enquanto pacientes menores de 18 anos, aqueles com ressecções intestinais prévias e exames repetidos do mesmo paciente no período de estudo foram excluídos. A medida de associação estimada foi o odds ratio com intervalos de confiança de 95%. Valores de P <0,05 indicaram significância estatística. RESULTADOS: Foram incluídos 3382 casos. Desses, 64,5% eram mulheres e a média de idade foi de 56,9±13,1 anos (18-89 anos). Alterações ileais foram observadas em 5,3% dos pacientes, sendo 2,69% clinicamente significativos entre todos os pacientes e 0,96% excluindo aqueles com DII. Houve uma correlação positiva entre os achados de ileíte e exames de controle de DII e uma correlação negativa no rastreamento e alteração de hábito intestinal. Entre as indicações com ileíte clinicamente significativa, o controle de DII ainda teve uma correlação positiva, 'diarreia' e 'outros' não apresentaram significância estatística, e todas as outras indicações apresentaram correlação negativa para avaliação ileal. CONCLUSÃO: A avaliação ileal é obrigatória apenas no controle de DII. Quando o objetivo principal da colonoscopia é detectar neoplasias colônicas, a ileoscopia é desnecessária.


Subject(s)
Humans , Female , Adolescent , Adult , Aged , Colonoscopy , Ileum , Cross-Sectional Studies , Retrospective Studies , Endoscopy, Gastrointestinal , Middle Aged
8.
Arq. gastroenterol ; 58(2): 145-149, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285314

ABSTRACT

ABSTRACT BACKGROUND: Ileitis is defined as an inflammation of the ileum, which is evaluated during colonoscopy. Biopsies should be performed on altered ileus, aiding to the diagnosis. OBJECTIVE: Evaluate the correlation of anatomopathological findings on ileitis between pathologists and endoscopists. METHODS: A retrospective, cross-sectional study, between 2013 and 2017. Examination report, indications for colonoscopy, and medical records were evaluated to identify whether the colonoscopic findings were clinically significant. Anatomopathological samples were reviewed by a pathologist expert in gastrointestinal tract. Patients over 18 years of age who had undergone ileoscopy were included, whereas patients below 18 years of age and those with previous intestinal resections were excluded. The correlation was assessed using the kappa coefficient index. RESULTS: A total of 5833 colonoscopies were conducted in the study period and 3880 cases were included. Ileal alterations were observed in 206 cases, with 2.94% being clinically significant. A hundred and sixty three biopsies were evaluated using the kappa index, resulting in agreement among pathologists of 0.067 and among pathologist and endoscopist of 0.141. CONCLUSION: It was observed that despite the low concordance between pathologists and endoscopists, there was no change in patient outcomes. This study confirms the importance of knowledge of the main anatomopathological changes related to ileitis by pathologists and endoscopists, making the best diagnosis and follow-up.


RESUMO CONTEXTO: Ileíte é definida como uma inflamação ileal, que pode ser avaliada durante a colonoscopia. Biópsias devem ser realizadas em íleos alterados, acrescentando na definição diagnóstica. OBJETIVO: Avaliar a correlação de achados anatomopatológicos das ileítes entre patologistas e endoscopistas. MÉTODOS: Estudo retrospectivo, transversal, entre os anos de 2013 e 2017. Foram avaliados laudos de exames, indicações e prontuários para identificar quando os achados colonoscópicos foram significativos. As amostras de anatomopatologia foram revisadas por um patologista especialista em trato gastrointestinal. Foram incluídos pacientes acima de 18 anos, com ileoscopia, e excluídos pacientes menores de 18 anos e os com ressecções intestinais prévias. A correlação foi avaliada utilizando-se o coeficiente kappa. RESULTADOS: Durante o período do estudo foram realizadas 5833 colonoscopias, das quais 3880 foram incluídas. Alterações ileais foram observadas em 206 casos, com 2,94% sendo clinicamente significativo. Cento e sessenta e três biópsias foram avaliadas, resultando em coeficiente kappa entre patologistas de 0,067 e entre patologista e endoscopista de 0,141. CONCLUSÃO: Foi observado que a despeito da baixa concordância entre patologistas e endoscopistas, não houve mudança no desfecho clínico do paciente. Esse estudo confirma a importância do conhecimento dos achados anatomopatológicos principais das ileítes entre patologistas e endoscopias, fazendo o melhor diagnóstico e seguimento.


Subject(s)
Humans , Adolescent , Adult , Pathologists , Ileitis , Cross-Sectional Studies , Retrospective Studies , Colonoscopy , Language
9.
Säo Paulo med. j ; 139(3): 218-225, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1252250

ABSTRACT

ABSTRACT BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.


Subject(s)
Humans , Colonic Polyps/surgery , Fibrinolytic Agents/adverse effects , Turkey , Retrospective Studies , Colonoscopy , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/epidemiology
10.
Rev. colomb. gastroenterol ; 36(supl.1): 30-36, abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1251543

ABSTRACT

Resumen La tuberculosis es una enfermedad de importancia en la salud pública a nivel mundial, con una alta incidencia a nivel del territorio colombiano. Principalmente, afecta el parénquima pulmonar; sin embargo, en un porcentaje elevado de casos se diagnostica en su forma extrapulmonar y el tracto gastrointestinal es uno de los sitios más frecuentes. Así mismo, la región ileocecal y el íleon terminal son las regiones con más predilección por la bacteria Mycobaterium tuberculosis. Las manifestaciones en esta rara presentación de la enfermedad están dadas por dolor abdominal y sensación de masa principalmente, lesiones ulcerosas en la mucosa intestinal y hallazgos histológicos correspondientes a granulomas caseificantes de gran tamaño y de morfología confluente, que se diferencian de otras entidades como la enfermedad de Crohn. La búsqueda de la enfermedad dentro del tracto gastrointestinal se realiza con ayuda de métodos invasivos como la colonoscopia y de ayudas diagnósticas de laboratorio como cultivos, tinciones o reacción en cadena de la polimerasa (PCR). Dada la complejidad en el diagnóstico de esta forma de tuberculosis, el conocimiento y la manera en que se aborda un paciente con un cuadro sugestivo de esta enfermedad son factores importantes para establecer el manejo terapéutico oportuno. Se comparte un caso inusual de tuberculosis ileocecal como manifestación de síndrome febril prolongado con desenlace fatal.


Abstract Tuberculosis is a disease of public health importance worldwide with a high incidence in Colombia. It mainly affects the lung parenchyma. However, in a large number of cases, it is diagnosed in its extrapulmonary form, with the gastrointestinal tract being one of the most frequent sites. Mycobacterium tuberculosis has a strong predilection for the ileocecal region and the terminal ileum. Manifestations of this rare form of the disease are abdominal pain and mass sensation mainly, as well as ulcerative lesions in the intestinal mucosa and histological findings corresponding to large caseating granulomas of confluent morphology, which distinguish it from other entities such as Crohn's disease. Invasive procedures, such as colonoscopy, and diagnostic laboratory aids, such as cultures, stains, and PCR, are used to find the disease in the gastrointestinal tract. Given the difficulty of diagnosing this type of tuberculosis, knowledge and how a patient with symptoms suggestive of the disease is approached are critical factors for establishing timely treatment. The following is an unusual case of ileocecal TB as a manifestation of prolonged febrile illness with a fatal outcome.


Subject(s)
Humans , Male , Aged , Tuberculosis, Gastrointestinal , Mycobacterium tuberculosis , Bacteria , Colonoscopy , Fatal Outcome , Laboratories
11.
J. coloproctol. (Rio J., Impr.) ; 41(1): 23-29, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1286969

ABSTRACT

Abstract Background Colorectal cancer (CRC) is the third most common cancer among men, and the second among women worldwide. In Brazil, the incidence andmortality of CRC continues to increase. In colonoscopies, adenoma detection rates (ADRs) higher than 25% are associated linearly with better outcomes and lower rates of interval cancer. Objective To assess the colonoscopy quality indexes. Methods This is a cross-sectional retrospective study in which anatomopathological data and data regarding the colonoscopies were collected from the patient records of Hospital Moinhos de Vento, in Southern Brazil. The exams were performed by doctors from the Colorectal Service from June to August 2015. Results A total of 430 exams were included. Most patients were women (60.9% [262]), with a mean age of 56.96 years. The cecal intubation rate was of 96.7% (416). The quality of the bowel preparation was excellent or good in 92.95% (396) of the cases. The average time of removal of the colonoscope in normal exams was of 6.15 minutes. Polyps were detected in 201 patients (46.7%), and adenomas, in 125 patients (29.1%); 12 patients (2.8%) had advanced adenomas, and 6 (2.3%) had malignant neoplasms. The proximal serrated lesion detection rate (PSLDR) was of 6.7% (29). The prevalence ratio (PR) of adenomas among men was 1.78 times greater than in women (95% confidence interval [95%CI]: 1.16-2.75). The PR of adenomas among people aged 50 years or older was 2.41 times that of those under 50 years of age (95%CI: 1.43-4.06). Conclusion The data obtained are in line with international quality criteria in colonoscopy. More studies are needed to assess the ADR in the Brazilian population.


Resumo Introdução O câncer colorretal (CCR) é o terceiro mais comum em homens e o segundo mais comum em mulheres em todo o mundo. A incidência e mortalidade do CRC continuam a aumentar no Brasil. Taxas de detecção de adenoma superiores a 25% em colonoscopias estão associadas linearmente a melhores resultados emenores taxas de câncer de intervalo. Objetivo Avaliar a qualidade das colonoscopias analisadas. Métodos Este é um estudo transversal e retrospectivo no qual dados anatomopatológicos e relacionados às colonoscopias foram coletados de registros dos pacientes do Hospital Moinhos de Vento, no Sul do Brasil. Os exames foram realizados por médicos do Serviço de Coloproctologia de junho a agosto de 2015. Resultados Foram incluídos 430 exames. A maioria dos pacientes era do sexo feminino (60,9% [262]), com idade média de 56,96 anos. A taxa de intubação cecal foi de 96,7% (416). A qualidade do preparo intestinal foi excelente ou boaem92,95% (396) dos casos.O tempomédio de retirada do colonoscópio emexames normais foi de 6,15 minutos. Pólipos foram detectados em 201 pacientes (46,7%), e adenomas, em 125 (29.1%); 12 pacientes (2,8%) tinhamadenomas avançados, e 6 (2,3%), neoplasias malignas. A taxa de detecção de lesões serrilhadas foi de 6,7% (29). A razão prevalência (RP) de adenomas emhomens foi de 1,78 vezes emrelação amulheres (intervalo de confiança de 95% [IC95%]: 1,16-2,75). A RP de adenomas entre pacientes com 50 anos ou mais foi 2,41 vezes maior do que a daqueles com mais de 50 anos (IC95%: 1,43-4,06). Conclusão Os dados obtidos estão de acordo com os critérios internacionais de qualidade em colonoscopia. Mais estudos são necessários para avaliar as taxas de detecção de adenoma na população brasileira.


Subject(s)
Humans , Male , Female , Middle Aged , Colorectal Neoplasms/diagnosis , Adenocarcinoma/diagnosis , Colonic Polyps/diagnosis , Colonoscopy/statistics & numerical data
12.
Rev. colomb. gastroenterol ; 36(1): 24-29, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1251518

ABSTRACT

Resumen Introducción: la hiperplasia nodular linfoide del colon se define como > 10 nódulos linfoides visibles en colonoscopia. No existen estudios de su validez al compararlo con la histopatología. Objetivos: determinar la validez del hallazgo de nódulos en colonoscopia para el diagnóstico de hiperplasia nodular linfoide. Material y métodos: estudio prospectivo de prueba diagnóstica. Se incluyeron colonoscopias realizadas consecutivamente de 2014 al 2018 con equipos Olympus PCFQ150AI y GIFXP150N con obtención de biopsias. El criterio endoscópico fue la presencia de > 10 nódulos de 2 a 10 mm y el criterio histológico fue hiperplasia de folículos linfoides y mantos de linfocitos en lámina propia o submucosa. Los datos se analizaron en Epidat3.1. Se obtuvo la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y negativo (VPN), y coeficientes de probabilidad positivo (LR+) y negativo (LR-) con sus intervalos de confianza. Resultados: se incluyeron 327 colonoscopias, la mediana de edad fue de 84 meses. La principal indicación para la colonoscopia fue sangrado digestivo bajo (38,8%). El hallazgo de nódulos se encontró en el 21% y el sitio de mayor frecuencia fue el colon total (46%), mientras que por histopatología se encontró hiperplasia nodular linfoide en el 38%. El hallazgo de nódulos obtuvo una S de 32% (intervalo de confianza [IC] del 95%: 24-140), E de 84% (IC 95%: 79-89), VPP de 56% (IC 95%: 44-68), VPN de 67% (IC 95%: 61-72), LR+ de 2,04 (IC 95%: 1,4-3) y LR- de 0,8 (IC 95%: 0,8-0,9). Conclusiones: la validez diagnóstica del hallazgo de nódulos en colonoscopia para hiperplasia nodular linfoide es pobre, por lo que la toma de biopsia debe recomendarse siempre.


Abstract Introduction: Nodular lymphoid hyperplasia of the colon is characterized by the presence of >10 lymphoid nodules visible in colonoscopy. There are no studies that confirm their validity when compared with histopathology. Objective: To determine the validity of nodules detected at colonoscopy for the diagnosis of nodular lymphoid hyperplasia in children. Materials and methods: Prospective study of diagnostic test accuracy. Colonoscopies performed consecutively from 2014 to 2018 using Olympus PCFQ150AI and GIFXP150N biopsy machines were included. The endoscopic criterion was the presence of >10 nodules from 2 to 10mm of diameter, while the histological criterion was presence of follicular lymphoid hyperplasia and lymphocyte mantles in lamina propia or submucosa. Data were analyzed in Epidat3.1. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were obtained with their corresponding confidence intervals. Results: 327 colonoscopies were included; the median age was 84 months. The main indication for colonoscopy was lower gastrointestinal bleeding (38.8%). Nodules were found in 21% of the patients, predominantly throughout the whole colon (46%), whereas histopathology found nodular lymphoid hyperplasia in 38%. SE for the finding of nodules was 32% (95% confidence interval [CI]: 24-140), SP was 84% (95% CI: 79-89), PPV was 56% (95% CI: 44-68), NPV was 67% (95% CI: 61-72), LR+ was 2.04 (95% CI: 1.4-3) and LR- was 0.8 (95% CI: 0.8-0.9). Conclusions: The validity of the presence of nodules on colonoscopy for the diagnosis of nodular lymphoid hyperplasia is poor, so biopsy should always be performed.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Colonoscopy , Diagnosis , Hyperplasia , Biopsy , Confidence Intervals , Predictive Value of Tests , Sensitivity and Specificity , Colon , Methods
13.
Rev. colomb. gastroenterol ; 36(1): 93-97, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251527

ABSTRACT

Resumen El hemangioma cavernoso de colon es una neoplasia vascular benigna, muy poco frecuente. Se realiza una breve descripción del cuadro clínico, diagnóstico y tratamiento de un paciente joven con un hemangioma cavernoso en el sigmoides. Se trata de un paciente de 18 años de edad quien consultó al servicio de urgencias por un cuadro clínico consistente en sangrado rectal indoloro asociado con disnea, astenia y adinamia; el paciente ingresó con signos vitales estables, posteriormente, se realizaron estudios complementarios, entre ellos un hemograma, que reportó un síndrome anémico grave que lleva al estudio de su causa. Se realizó una colonoscopia que reportó una lesión a nivel del sigmoides compatible con hemangioma colónico. El paciente es llevado a cirugía (laparotomía), se realizó una hemicolectomía y se confirmó el diagnostico por estudio de patología.


Abstract Cavernous hemangioma of the colon is a very rare benign vascular neoplasm. The following is a brief description of the symptoms, diagnosis, and treatment of a young patient with a cavernous hemangioma of the sigmoid colon. An 18-year-old man consulted the emergency department due to painless rectal bleeding associated with dyspnea, asthenia, and adynamia. The patient was admitted with stable vital signs, and complementary studies, including a blood count, reported severe anemic syndrome leading to the study of the cause of the disease. A colonoscopy was performed, finding a sigmoid lesion compatible with colon hemangioma. The patient was taken to surgery (laparotomy), a hemicolectomy was performed, and the diagnosis was confirmed by pathology study.


Subject(s)
Humans , Male , Adolescent , Colon, Sigmoid , Hemangioma, Cavernous , Colonoscopy , Laparotomy
14.
Rev. argent. salud publica ; 13: 1-5, 5/02/2021.
Article in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1151563

ABSTRACT

INTRODUCCIÓN: El Programa de Prevención de Tumores de la Provincia del Neuquén recomienda la Sangre Oculta en Materia Fecal Inmunológica (SOMFi) como intervención de rastreo, con posterior confirmación por videocolonoscopía (VCC) en pacientes con resultado positivo. El objetivo del estudio fue conocer los resultados de la utilización de SOMFi, la realización de VCC confirmatoria y sus hallazgos. MÉTODOS: Se realizó un estudio retrospectivo, que analizó los resultados de SOMFi obtenidos en personas de 50 a 75 años en todos los efectores del Sistema de Salud Pública de Neuquén en el período 2015-2019 sobre la base de registros informáticos provinciales y de cada centro de endoscopía. Se determinó la frecuencia de resultados de SOMFi, de VCC en los pacientes con SOMFi positiva y sus hallazgos. RESULTADOS: De 9909 muestras analizadas, 23,1% fueron positivas. Se realizó VCC confirmatoria en 24,1% de los pacientes con SOMFi positiva; presentaron cáncer el 3,7% de los casos, pólipos el 35% y estudio normal el 61,3%. Los tipos histológicos de los pólipos fueron: tubular (49%), hiperplásico (21,3%), tubulovelloso (20%), aserrado (7,2%) y otros tipos (2,5%). DISCUSIÓN: La frecuencia de SOMFi positiva fue mayor a la publicada. Solo el 20% de los pacientes realizó VCC confirmatoria. La frecuencia de cáncer y pólipos encontrados fue similar a la de otros estudios publicados. Debe incrementarse la realización de VCC confirmatoria


Subject(s)
Argentina , Colorectal Neoplasms , Mass Screening , Colonoscopy , Occult Blood
15.
Rev. argent. salud publica ; 13: 1-5, 5/02/2021.
Article in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1253977

ABSTRACT

INTRODUCCIÓN: El Programa de Prevención de Tumores de la Provincia del Neuquén recomienda la Sangre Oculta en Materia Fecal Inmunológica (SOMFi) como intervención de rastreo, con posterior confirmación por videocolonoscopía (VCC) en pacientes con resultado positivo. El objetivo del estudio fue conocer los resultados de la utilización de SOMFi, la realización de VCC confirmatoria y sus hallazgos. MÉTODOS: Se realizó un estudio retrospectivo, que analizó los resultados de SOMFi obtenidos en personas de 50 a 75 años en todos los efectores del Sistema de Salud Pública de Neuquén en el período 2015-2019 sobre la base de registros informáticos provinciales y de cada centro de endoscopía. Se determinó la frecuencia de resultados de SOMFi, de VCC en los pacientes con SOMFi positiva y sus hallazgos. RESULTADOS: De 9909 muestras analizadas, 23,1% fueron positivas. Se realizó VCC confirmatoria en 24,1% de los pacientes con SOMFi positiva; presentaron cáncer el 3,7% de los casos, pólipos el 35% y estudio normal el 61,3%. Los tipos histológicos de los pólipos fueron: tubular (49%), hiperplásico (21,3%), tubulovelloso (20%), aserrado (7,2%) y otros tipos (2,5%). DISCUSIÓN: La frecuencia de SOMFi positiva fue mayor a la publicada. Solo el 20% de los pacientes realizó VCC confirmatoria. La frecuencia de cáncer y pólipos encontrados fue similar a la de otros estudios publicados. Debe incrementarse la realización de VCC confirmatoria.


Subject(s)
Argentina , Colorectal Neoplasms , Mass Screening , Colonoscopy , Occult Blood
16.
Pesqui. vet. bras ; 41: e06741, 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1250489

ABSTRACT

Colonoscopy is a minimally invasive technique used to assess the large intestine through direct inspection of the intestinal mucosa. When associated with histopathological examination of fragments collected from the intestine, the definitive diagnosis can be obtained. This retrospective study evaluated colonoscopy and histopathological exams of the large intestine and ileum of dogs with gastrointestinal disorders admitted at the Veterinary Hospital of the Federal University of Minas Gerais (UFMG) and the Veterinary Hospital São Francisco de Assis to determine the frequency of injuries, their distribution in the intestinal segments, and the relationship of the findings observed in these two analyzes. The colonoscopy and histopathological findings of the case series were described using absolute and relative frequencies, as well as nature and intensity classification of the findings. Cohen's Kappa coefficient was obtained to assess the concordance of nature and intensity classifications between colonoscopy and histopathology, and its 95% confidence interval constructed. The analyses were performed using the Software SAS University Edition. It was observed a moderate agreement between the classification of the nature of the findings by endoscopy and histopathology (Kappa coefficient = 0.39, CI = 0.20-0.59). This can also be observed when assessing the frequency of similar diagnoses between the methods, since only 39 (72.22%) were consistent, i.e., 15 (22.78%) diagnoses differed depending on the nature of the finding, which could have a great influence on the final diagnosis if histopathology was disregarded. For the intensity of the injuries, little agreement was observed between the methods (Kappa coefficient = 0.1243, C = -0.05-0.30). This was even more evident in the frequency of similar diagnoses in terms of intensity, of which 20 (37.04%) were similar and 34 (62.96%) were different. Inflammatory affections are the most frequently observed alterations in the large intestine and ileum of dogs. The most common finding that reveals inflammatory changes is the lymphoplasmacytic infiltrate. As for the proliferative and neoplastic lesions, adenomatous polyps and lymphoma were common. The most affected sites of the large intestine were the descending colon and the rectum. Findings such as edema and reddening of the mucosa were frequent by macroscopy. Although the changes observed by colonoscopy and histopathology may not be similar, these techniques are complementary, which makes biopsies mandatory for a diagnostic conclusion.(AU)


A colonoscopia é uma técnica pouco invasiva utilizada para avaliação do intestino grosso por meio de inspeção direta da mucosa intestinal. Quando associada ao exame histopatológico, com a coleta de fragmentos do intestino, o diagnóstico definitivo pode ser obtido. O objetivo desse estudo retrospectivo foi associar os achados de exames de colonoscopia e histopatologia do intestino grosso e íleo em 54 cães com distúrbios gastrointestinais dos Hospitais Veterinários da Universidade Federal de Minas Gerais (UFMG) e São Francisco de Assis. Na colonoscopia, as alterações mais frequentemente observadas foram edema, friabilidade e avermelhamento de mucosa. Quanto à distribuição de lesões por segmento intestinal, houve maior incidência de alterações inflamatórias, das quais foram as mais frequentes, com o infiltrado linfoplasmocitário sendo o mais comum em todos segmentos analisados (i.e. reto, cólon, ceco e íleo). O cólon ascendente e o reto foram os locais de alterações mais frequentes na colonoscopia e na histopatologia. Os pólipos hiperplásicos e o linfoma foram as lesões proliferativas de ocorrência mais comum. Houve baixa concordância entre as classificações por natureza e intensidade dos achados na colonoscopia e histopatologia. Assim, não foi possível associar alterações descritas nos exames histopatológicos quanto à natureza e intensidade das lesões utilizando a colonoscopia, o que leva à conclusão de que é essencial a realização de biópsias em todos os exames para conclusão diagnóstica.(AU)


Subject(s)
Animals , Dogs , Colonoscopy , Dogs/anatomy & histology , Endoscopy , Intestine, Large , Hospitals, Animal , Intestinal Mucosa
17.
Chinese Medical Journal ; (24): 1335-1344, 2021.
Article in English | WPRIM | ID: wpr-878176

ABSTRACT

BACKGROUND@#Fecal immunochemical tests (FITs) are the most widely used non-invasive tests in colorectal cancer (CRC) screening. However, evidence about the direct comparison of the test performance of the self-administered qualitative a laboratory-based quantitative FITs in a CRC screening setting is sparse.@*METHODS@#Based on a CRC screening trial (TARGET-C), we included 3144 pre-colonoscopy fecal samples, including 24 CRCs, 230 advanced adenomas, 622 non-advanced adenomas, and 2268 participants without significant findings at colonoscopy. Three self-administered qualitative FITs (Pupu tube) with positivity thresholds of 8.0, 14.4, or 20.8 μg hemoglobin (Hb)/g preset by the manufacturer and one laboratory-based quantitative FIT (OC-Sensor) with a positivity threshold of 20 μg Hb/g recommended by the manufacturer were tested by trained staff in the central laboratory. The diagnostic performance of the FITs for detecting colorectal neoplasms was compared in the different scenarios using the preset and adjusted thresholds (for the quantitative FIT).@*RESULTS@#At the thresholds preset by the manufacturers, apart from the qualitative FIT-3, significantly higher sensitivities for detecting advanced adenoma were observed for the qualitative FIT-1 (33.9% [95% CI: 28.7-39.4%]) and qualitative FIT-2 (22.2% [95% CI: 17.7-27.2%]) compared to the quantitative FIT (11.7% [95% CI: 8.4-15.8%]), while at a cost of significantly lower specificities. However, such difference was not observed for detecting CRC. For scenarios of adjusting the positivity thresholds of the quantitative FIT to yield comparable specificity or comparable positivity rate to the three qualitative FITs accordingly, there were no significant differences in terms of sensitivity, specificity, positive/negative predictive values and positive/negative likelihood ratios for detecting CRC or advanced adenoma between the two types of FITs, which was further evidenced in ROC analysis.@*CONCLUSIONS@#Although the self-administered qualitative and the laboratory-based quantitative FITs had varied test performance at the positivity thresholds preset by the manufacturer, such heterogeneity could be overcome by adjusting thresholds to yield comparable specificities or positivity rates. Future CRC screening programs should select appropriate types of FITs and define the thresholds based on the targeted specificities and manageable positivity rates.


Subject(s)
Colonoscopy , Colorectal Neoplasms/diagnosis , Early Detection of Cancer , Feces , Hemoglobins/analysis , Humans , Laboratories , Occult Blood , Sensitivity and Specificity
19.
Evid. actual. práct. ambul ; 24(1): e002102, 2021. tab
Article in Spanish | LILACS | ID: biblio-1222362

ABSTRACT

El cáncer colorrectal presenta un problema para la salud pública a nivel mundial. En Argentina, se diagnostican aproximadamente 13.500 casos cada año. El tamizaje como medida de prevención secundaria es una medida beneficiosa para lograr un abordaje temprano con mejores resultados. Los dos métodos más utilizados para el tamizaje son la videocolonoscopía y la prueba de sangre oculta en materia fecal, sobre todo la de tipo inmunoquímico que con el paso de los años fue reemplazando a la prueba de guayaco por su mayor practicidad. El primero es un método invasivo y que requiere anestesia, mientras que el segundo no tiene un efecto adverso directo pero debe realizarse con una cadencia mayor. El objetivo de los autores de este artículo fue evaluar la evidencia sobre la sensibilidad y especificidad de ambos métodos, como también sus beneficios y daños a partir de la consulta de un paciente a su médico de familia. Ninguna prueba parecería ser inferior para el tamizaje de cáncer colorrectal en una población de riesgo promedio, y ambas pueden usarse en programas de rastreo. Sin embargo, no existen estudios que comparen ambos métodos de manera directa, y toda prueba inmunoquímica fecal positiva debe ser seguida de una colonoscopía. La elección de la prueba puede depender de los valores y preferencias de los pacientes. (AU)


Colorectal cancer presents a public health problem worldwide. In Argentina, approximately 13,500 cases appear each year. Screening as a secondary prevention measure is a beneficial measure to achieve an early approach with better results. The two most used methods for screening are video colonoscopy and faecal immunochemical test, the former being invasiveand requiring anaesthesia, while the latter does not have a direct adverse effect but must be performed at a higher rate. The objective of this article was to evaluate the evidence for the sensitivity and specificity of both methods, as well as their benefits and harms. No test would appear to be inferior for colorectal cancer screening in an average-risk population, and both can be used in screening programs. However, there are no studies comparing both methods directly, and any positive faecal immunochemical test should be evaluated with a colonoscopy. The choice of the test may depend on the values and preferences of the patients. (AU)


Subject(s)
Humans , Male , Middle Aged , Colonic Neoplasms/prevention & control , Early Detection of Cancer/methods , Patient Participation , Mass Screening/methods , Meta-Analysis as Topic , Public Health , Sensitivity and Specificity , Colonoscopy/statistics & numerical data , Early Detection of Cancer/adverse effects , Secondary Prevention/methods , Patient Preference , Systematic Reviews as Topic , Occult Blood
20.
J. coloproctol. (Rio J., Impr.) ; 40(4): 368-375, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1143177

ABSTRACT

ABSTRACT Objective: Comparison of post-anesthesia recovery time in sedated patients for colonoscopy using two drug combinations: midazolam and propofol or fentanyl and propofol. Method: Fifty patients ASA I and II, from 18 to 65 years of age, candidates for elective colonoscopy under sedation administered by an anesthesiologist, were randomized in two groups: Group A (midazolam and propofol) and Group B (fentanyl and propofol). Each patient was evaluated as for the length of the exam (Exam length), length of stay in the post-anesthesia care unit 1 and 2 (LSPACU1 and LSPACU2) and hospital discharge. Episodes of awakening, and of movement, drop in SpO2 < 90%, need for mechanical ventilation, propofol consumption, heart rate (HR) and mean blood pressure (MBP) were also evaluated. Results: Patients of group B had a recovery time in LSPACU1 statistically shorter than that for those in group A. In both groups, LSPACU1 was considered inversely proportional to LSPACU2. Hospital discharge time was similar between groups. Patients of group B had a significant decrease in MBP during and at the end of the exam, when compared to the initial measurement and that during sedation. Nevertheless, this variation was lower than 20%. No adverse event was observed. All patients were discharged on the same day, with no unexpected hospitalization. Conclusions: The combined use of fentanyl and propofol for colonoscopy sedation had a post-anesthesia recovery time in LSPACU1 shorter than that with the combination of midazolam and propofol. Nevertheless hospital discharge time was similar between groups.


RESUMO Objetivo: Comparar o tempo de recuperação pós-anestésica de pacientes sedados para colonoscopia usando duas combinações de fármacos: midazolam e propofol ou fentanil e propofol. Método: Cinquenta pacientes ASA I e II, entre 18 e 65 anos, candidatos a colonoscopia eletiva sob sedação administrada por anestesiologista, foram randomizados em dois grupos: Grupo A (midazolam e propofol) e Grupo B (fentanil e propofol). Cada paciente foi avaliado quanto ao tempo de realização do exame (TExame), tempo de permanência na sala de recuperação pós-anestésica 1 e 2 (TSRPA 1 e TSRPA2) e a alta domiciliar. Episódios de despertar, movimentação, queda de SpO2 < 90%, necessidade de assistência ventilatória, consumo de propofol, frequência cardíaca (FC) e pressão arterial média (PAM) também foram avaliados. Resultados: Pacientes do grupo B apresentaram tempo de recuperação na SRPA1 inferior estatisticamente ao grupo A. Em ambos os grupos o TSRPA1 foi considerado inversamente proporcional ao TSRPA2. O tempo de alta domiciliar foi semelhante entre os grupos. Pacientes do grupo B apresentaram redução significativa na PAM no tempos exame e final, em relação ao inicial e sedação. Entretanto, essa variação foi inferior a 20%. Não foram observados eventos adversos. Todos os pacientes evoluíram com alta domiciliar no mesmo dia, sem ocorrência de internação não prevista. Conclusões: O uso combinado de fentanil e propofol para sedação em colonoscopia produziu tempo de recuperação pós-anestésica na SRPA1 inferior a combinação midazolam e propofol. No entanto, o tempo de alta domiciliar foi semelhante entre os grupos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Colonoscopy/methods , Anesthesia/statistics & numerical data , Midazolam/administration & dosage , Anesthesia Recovery Period , Propofol/administration & dosage , Fentanyl/administration & dosage
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