Revisão sistemática e meta-análise sobre técnicas de polipectomia de pólipos colorretais pequenos e diminutos / Best polypectomy technique for small and diminutive colorectal polyps: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Polypectomy of colorectal polyps is the mainstay of colorectal cancer prevention. Identification of the best polypectomy technique is imperative. OBJECTIVE: This review aims at comparing efficacy of nine different resection methods for small colorectal polyps (<10 mm). METHODS: We searched and selected only randomized controlled trials. Primary outcome was complete resection rates of small polyps by histological eradication. Secondary outcomes were: adverse events, retrieval tissue failures rates and duration of procedure. RESULTS: Eighteen trials including 3215 patients and 5223 polyps were analysed. Overall, cold polypectomy had a significantly shorter time of procedure than hot polypectomy (RD -5.92, 95%CI -9.90 to -1.94, P<0.05), with no statistical difference on complete histological eradication (RD 0.08, 95%CI -0.03 to 0.19, P>0.05). Regarding cold polypectomy techniques, cold snare was found superior to cold forceps on complete and en-bloc resection rates and less time consuming. When comparing endoscopic mucosal resection (EMR) with hot-snare and cold-snare, the latter showed no-inferiority on histological eradication, adverse events or retrieval tissue failure rates. CONCLUSION: Cold polypectomy is the best technique for resection of small colorectal polyps. Among cold methods, dedicated cold snare was found superior on histological eradication. Cold snare endoscopic mucosal resection might be considered an option for polyps from 5 to 9 mm.

RESUMO CONTEXTO: A polipectomia de pólipos colorretais é a base da prevenção do câncer colorretal. A identificação da melhor técnica de polipectomia é imperativa. OBJETIVO: Esta revisão tem como objetivo comparar a eficácia de nove diferentes métodos de ressecção para pólipos colorretais pequenos (<10 mm). MÉTODOS: Pesquisamos e selecionamos apenas ensaios clínicos randomizados. O desfecho primário foi taxas de ressecção completa de pólipos pequenos por confirmação histológica. Os desfechos secundários foram: eventos adversos, taxas de falha de recuperação do espécime e duração do procedimento. RESULTADOS: Dezoito estudos, incluindo 3215 pacientes e 5223 pólipos foram analisados. No geral, a polipectomia a frio teve um tempo de procedimento significativamente menor do que a polipectomia a quente (RD -5,92; IC 95% -9,90 a -1,94; P<0,05), sem diferença estatística na erradicação histológica (RD 0,08; IC 95% -0,03 a 0,19; P>0,05). Em relação às técnicas de polipectomia a frio, a alça fria foi considerada superior ao uso de pinça fria nas taxas de ressecção completa e em bloco, além de um menor tempo de procedimento. Ao comparar a ressecção endoscópica da mucosa utilizando alça quente ou alça fria, esta última mostrou não-inferioridade na erradicação histológica, eventos adversos ou taxas de falha do tecido de recuperação. CONCLUSÃO: A polipectomia a frio mostrou ser a melhor técnica para ressecção de pequenos pólipos colorretais. Entre os métodos frios, a alça fria dedicada foi considerada superior na erradicação histológica. ressecção endoscópica da mucosa com alça fria pode ser considerado uma opção para pólipos de 5 a 9 mm.

Calprotectina fecal para diagnóstico de patología orgánica de colon / Fecal Calprotectin for the diagnosis of colon organic pathology

OBJETIVO: determinar la sensibilidad y especificidad de la calprotectina fecal (CPF) y la prueba de sangre oculta en heces (SOH) para el diagnóstico de patología orgánica de colon. MÉTODOS: se realizó un estudio observacional que, incluyó de manera intencionada, 246 pacientes de ambos sexos atendidos en el Instituto Gastroenterológico Boliviano Japonés de Cochabamba, por dolor abdominal, diarrea crónica y pérdida de peso. Se les realizó laboratorios de calprotectina fecal y sangre oculta en heces, además de colonoscopia como estudio de control. RESULTADOS: se determinó que la calprotectina fecal tiene una sensibilidad de 86 %, y especificidad de 98 %, con una asociación de 0,54 y relación de 0,75 según los coeficientes de Pearson y Spearman respectivamente, en relación con la colonoscopía y el diagnóstico de patología orgánica de colon. La prueba de sangre oculta en heces presentó una sensibilidad de 79% pero una especificidad de 58%, la asociación y relación con el estudio de control fue mínima: 0,21 y 0,22 según los coeficientes de Pearson y Spearman. CONCLUSIONES: los resultados muestran que la calprotectina fecal presenta alta sensibilidad y especificidad para el diagnóstico de patología orgánica de colon. Los valores más altos se relacionaron con mayor lesión en la mucosa colónica.

OBJECTIVE: to determine the sensitivity and specificity of fecal calprotectin and fecal occult blood test (FOBT) for the diagnosis of organic colon pathology. METHODS: an observational study was made, which intentionally included 246 patients of both sexes seen at the Japanese Bolivian Gastroenterological Institute of Cochabamba, due to abdominal pain, chronic diarrhea and weight loss. We performed fecal calprotectin and fecal occult blood laboratories, as well as colonoscopy as a control study. RESULTS: it was determined that the fecal calprotectin has a sensitivity of 86%, and specificity of 98%, with an association of 0,54 and a ratio of 0,75 according to the Pearson and Spearman coefficients respectively, in relation to colonoscopy and the diagnosis of organic pathology of colon. The fecal occult blood test showed a sensitivity of 79% but a specificity of 58%, according to the association and relationship with the control minimum of 0,21 and 0,22 according to the Pearson and Spearman coefficients. CONCLUSIONS: The results show that fecal calprotectin presents high sensitivity and specificity for the diagnosis of organic colon pathology. Higher values were associated with greater lesion in the colonic mucosa.

Development of a Robotic Colonoscopic Manipulation System, Using Haptic Feedback Algorithm

PURPOSE: Colonoscopy is one of the most effective diagnostic and therapeutic tools for colorectal diseases. We aim to propose a master-slave robotic colonoscopy that is controllable in remote site using conventional colonoscopy. MATERIALS AND METHODS: The master and slave robot were developed to use conventional flexible colonoscopy. The robotic colonoscopic procedure was performed using a colonoscope training model by one expert endoscopist and two unexperienced engineers. To provide the haptic sensation, the insertion force and the rotating torque were measured and sent to the master robot. RESULTS: A slave robot was developed to hold the colonoscopy and its knob, and perform insertion, rotation, and two tilting motions of colonoscope. A master robot was designed to teach motions of the slave robot. These measured force and torque were scaled down by one tenth to provide the operator with some reflection force and torque at the haptic device. The haptic sensation and feedback system was successful and helpful to feel the constrained force or torque in colon. The insertion time using robotic system decreased with repeated procedures. CONCLUSION: This work proposed a robotic approach for colonoscopy using haptic feedback algorithm, and this robotic device would effectively perform colonoscopy with reduced burden and comparable safety for patients in remote site.

A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Colitis ulcerosa inespecífica como causa de hemorragia digestiva baja: caso pediátrico a propósito de diagnóstico diferencial y manejo / Nonspecific ulcerative colitis as a cause of lower gastrointestinal bleeding: a pediatric case purpose differential diagnosis and management

Se describe el caso clínico de una niña, de dos años y cuatro meses de edad, que consulta por rectorragia severa, luego de una disentería. La colonoscopía realizada a las tres horas del sangrado, reveló úlceras en todo el colon y el estudio histopatológico describe una colitis ulcerativa crónica en fase activa; es manejada solo condieta, probióticos y ceftriaxona, con mejoría del cuadro clínico. Dos colonoscopías de control muestran rectosigmoiditis inespecifica, con franca remisión de las úlceras. La estadística de colitis ulcerosa(CU) registrada en el Instituto Gastroenterológico Boliviano Japonés de La Paz, donde también se realizan todos los estudios endoscópicos del Hospital del Niño, muestra que el caso expuesto corresponde a la niña de menor edad reportada en nuestro medio hasta la fecha de la presente divulgación, aun que está descrita en laliteratura internacional la CU en lactantes de meses de edad (2). Esta circunstancia, junto a la remisión sin el uso de drogas específicas para la CU de la enfermedad inflamatoria intestinal (EII), obligan aplantear el diagnóstico diferencial con otras entidades que originan hemorragia digestiva baja con úlceras colónicas. Lo anterior, junto a los hallazgos endoscópico e histopatológico que inicialmente sugerían una CU como parte de la EII, la remisión progresiva consolo medidas dietéticas a perfilado el diagnóstico fi nal de una colitis ulcerosa inespecífica que amerita diagnósticos diferenciales por su evolución y por la rectorragia importante que ocasionó, por lo que el autor considera la justificación de esta publicación.

We describe the case of a 2 years and 4 months old girl who was admitted to the hospital for severe bleeding from the rectum after dysentery. Colonoscopy made three hours after the bleeding showed ulcers throughout the colon and the histopathologic exam described an active phase of chronic ulcerative colitis. The treatment is only diet, probiotics and ceftriaxone and the child’s state improves. Two control colonoscopies show an unspecific rectosigmoiditis with a clear remission of the ulcers. Statistics of ulcerative colitis (CU)recorded in the Instituto Gastroenterológico Boliviano Japonés of La Paz, where all the endoscopic studies of the Children’s Hospital are carried out, shows that the present case corresponds to the youngest girl ever reported until now, even though in the international literature, CU is described in babies of only months of age (2). This fact together with the remission of the infl ammatory intestinal disease (EII) without use of CU specifi c drugs, make it necessary to think of differential diagnoses with other diseases with colon ulcers that cause bleedings of the lower gastrointestinal tract. The above together with the endoscopic and histopathologic fi ndings that initially suggested a CU as part of the EII, the progressive remission with only dietetic measures, has drawn the fi nal diagnose of an unspecifi c ulcerative colitis that needs differential diagnosis due to its evolution and the important bleeding that it caused. For these reasons, the author considers this publication justifi ed.

Comparative study between botulinium toxin injection and partial division of puborectalis for treating anismus

To compare the results of partial division of puborectalis [PDPR] versus local botulinium toxin [BTX-A] injection in treating patients with anismus. This prospective randomized study included 30 male patients with a mean age 38.93 +/- 12.39 years and a mean duration of 5.80 +/- 3.96 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into: Group [I]: included 15 patients injected with BTX-A, and Group [II]: included 15 patients who underwent bilateral PDPR. Follow up was conducted for one year. Both BTX-A and PDPR significantly reduced the preoperative constipation scores. The initial and long term success rates were 86.7% and 40% in BTX-A group versus 100% and 66.6% in PDPR group. Recurrence was observed in 7 patients [53.8%] and 5 patients [33.4%] following BTX-A and PDPR respectively. Minor incontinence had occurred in 2 patients [13.3%] following PDPR. BTX-A injection seems to be successful for temporary treatment of anismus. However, PDPR has been found to be a promising method for treatment of anismus with a relatively lower morbidity in relation to its higher success rate

Tratamiento de várices rectales a través de ligadura elástica endoscópica / Treatment of rectal varices using endoscopic elastic ligation

Las várices rectales sangrantes son raras y cuando aparecen representan un riesgo muy alto para estos pacientes. Relatamos el caso de un paciente de 50 años con cirrosis, que presentó sangrado por várices rectales y fue tratado con ligadura elástica endoscópica con excelente resultado

Colonoscopía: su rol actual en el dignóstico de enfermedades del colon / Colonoscopy: today role in diagnosis of colonic diseases

The preparation, medication, indications, methods, complications and results of colonoscopy for the diagnosis of colonic disease is presented

Cateter óptico para aplicaçöes espectroscópicas / Optic catheter for spectroscopic applications

Neste trabalho é apresentada a caracterização de cateteres utilizando fibras ópticas para aplicações de espectroscopia in vivo. Estes cateteres apresentam a configuração de seis fibras em torno de uma fibra central de mesmo diâmetro, sendo estas fibras do tipo multimodo com diâmetro de núcleo de 100 mum. A eficiência de coleta de radiação para este tipo de cateter é da ordem de 0,05 por cento, variando em função da distância ao tecido e da distribuição de intensidade de sinal retroespalhado na superfície do mesmo.

ln this work we describe the characterization of fiber optic catheters for in vivo spectroscopy applications. This type of catheters have the geometry of one central fiber sun-ounded by six 100 µm diameter multimode fibers. The collection efficiency of these type of catheter is about 0.05% and it changes with the distance to the tissue surface and the signal intensity distribution on it.

Colonoscopia: metodo diagnostico e terapeutico / Colonoscopy: diagnostic and therapeutic method

O autor aborda o desenvolvimento historico e tecnico do metodo da colonoscopia, as vantagens proporcionadas pelo emprego do metodo, pricipalmente com os novos recursos adquiridos pelos equipamentos ora empregados. Discorrem sobre as diferentes maneiras da realizacao do preparo do intestino grosso para exame e preconizou o emprego do manitol a 10 por cento. Discutiu-se os aspectos quando a sedacao e analgesia para a realizacao do procedimento com seguranca, a descricao do metodo, as indicacoes e contra-indicacoes.

Limpieza y desinfección de los equipos fibroendoscópicos: papel de la enfermera / Cleanness and desinfection of fibroendoscopic equipments: nurse's role

Se realizaron 80 estudios bacteriológicos con las muestras tomadas al colonoscopio, después de realizada la exploración endoscópica del colon a cada paciente. Se dividieron en grupos de 20, se le aplicaron al equipo distintas técnicas de desinfección antes de la toma de la muestra, y se determinó por cultivo bacteriológico la flora existente en el tubo de inserción. Se exponen en tablas los resultados de este estudio y se resalta la importancia del papel de la enfermera en este proceder, así como los métodos de desinfección más útiles