ABSTRACT
Black esophagus (BE) or Acute esophageal necrosis (AEN) is rare clinical entity with an estimated incidence of 0.01-0.2% of patiens undergoing esophagogastroduodenoscopy (EGD). BE is characterized by circumferential blackish coloration of the mucosa, with abrupt interruption at the esophagogastric junction level, secondary to hypoperfusion and ischemia. Upper gastrointestinal hemorrhage is the most common presentation (70-90%), being a rare cause of it. We present 3 cases that were admitted in our center for hematemesis.
Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Mutation , Aged , Female , Humans , MRE11 Homologue Protein/genetics , Middle Aged , MutL Protein Homolog 1/genetics , Proto-Oncogene Proteins B-raf/genetics , Syndrome , Tumor Suppressor Proteins/genetics , Ubiquitin-Protein Ligases/geneticsABSTRACT
BACKGROUND: the Galician Health Service established indications and priority levels (I = fast track, II = preferential, III = normal) for colonoscopy, according to the risk of colorectal cancer and significant colonic lesions detection with access from primary health care. Our aim is to show the results of the implementation. METHODS: we included colonoscopies requested in symptomatic patients from June to October 2012 in a prospective observational cross sectional study. We collected health care level (primary, secondary), priority, appropriateness to the established criteria, wait times (from colonoscopy application and initial consultation) and diagnostic yield for colorectal cancer and/or significant colonic lesion. We compared health care levels in priorities I and II. RESULTS: 425 colonoscopies were included (I = 221, II = 141, III = 63). The appropriateness rate to the protocol was 67.5 %. Priority levels were significantly associated to wait times (days) from application (I = 8.7 ± 8.9, II = 50 + or - 20.3, III = 80.2 + or - 32.2; p < 0.001) and initial consultation (I = 32.2 + or - 38, II = 74.5 + or - 44.2, III = 128.5 + or - 47.4; p < 0.001), and with colorectal cancer (I = 20.1 %, II = 19.1 %, III = 4.8 %, p < 0.001) and significant colonic lesion (I = 35.3 %, II = 34 %, III = 19 %, p = 0.002) detection rates. In priority I and II, 21.8 % of colonoscopies were requested from primary health care. Referral form primary health care reduced wait times from initial consultation to colonoscopy (primary = 29.3 + or - 26, secondary = 55.2 + or - 48.6, p < 0.001). Instead, colorectal cancer (OR 2.41, 95 % CI 1.31-4.42) and significant colonic lesion (OR 1.88, 95 % CI 1.13- 3.15) detection rate was increased. CONCLUSIONS: Galician Health Service priority levels are significantly associated with colorectal cancer and significant colonic lesion detection. Referrals to colonoscopy from primary health care reduce waiting times and increase diagnostic yield.
Subject(s)
Colonoscopy/classification , Colonoscopy/statistics & numerical data , Colorectal Neoplasms/diagnosis , Aged , Cross-Sectional Studies , Female , Health Priorities , Humans , Male , Primary Health Care , Prospective Studies , SpainSubject(s)
Adenomatous Polyps/diagnosis , Colonic Neoplasms/diagnosis , Duodenal Neoplasms/diagnosis , Ganglioneuroma/diagnosis , Hamartoma Syndrome, Multiple/diagnosis , Intestinal Polyps/diagnosis , Adenoma/surgery , Adenomatous Polyps/genetics , Adenomatous Polyps/pathology , Adult , Colonic Neoplasms/genetics , Colonic Neoplasms/pathology , Colonoscopy , Diagnosis, Differential , Duodenal Neoplasms/genetics , Duodenal Neoplasms/pathology , Exons/genetics , Ganglioneuroma/genetics , Ganglioneuroma/pathology , Gastroscopy , Hamartoma Syndrome, Multiple/complications , Hamartoma Syndrome, Multiple/genetics , Hamartoma Syndrome, Multiple/pathology , Humans , Hyperpigmentation/etiology , Intestinal Polyps/genetics , Intestinal Polyps/pathology , Male , Megalencephaly/etiology , Multiple Endocrine Neoplasia Type 2a/diagnosis , Mutation, Missense , PTEN Phosphohydrolase/genetics , Penile Diseases/etiology , Point Mutation , Thyroid Neoplasms/surgery , ThyroidectomyABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Intestinal Polyposis/complications , Hamartoma Syndrome, Multiple/diagnosis , Colonic Polyps/diagnostic imaging , Colonic Polyps/surgery , Hamartoma Syndrome, Multiple/pathology , Colonoscopy/methods , Photomicrography/methods , Immunohistochemistry , Hyperplasia/complicationsSubject(s)
Humans , Female , Middle Aged , Aged , Germ-Line Mutation , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Microsatellite Instability , DNA Repair Enzymes , Colorectal Neoplasms , Inpatients , Physical Examination , Symptom Assessment , Gastroenterology , Gastrointestinal DiseasesSubject(s)
Humans , Male , Aged , Aged, 80 and over , Gastrointestinal Hemorrhage , Esophagus/pathology , NecrosisABSTRACT
Introducción: el Servizo Galego de Saúde estableció indicaciones y niveles de prioridad de la colonoscopia (I-vía rápida, II-preferente, III-normal) acorde al riesgo de detectar cáncer colorrectal y lesiones colónicas significativas con acceso desde atención primaria. Nuestro objetivo es analizar los resultados de la implantación. Métodos: estudio prospectivo transversal y observacional. Se incluyeron las colonoscopias solicitadas entre julio y octubre de 2012 en pacientes sintomáticos. Se recogió el nivel asistencial solicitante (especializada o primaria), nivel de prioridad, adecuación a los criterios establecidos, tiempos de demora (solicitud y consulta inicial) y rendimiento diagnóstico para cáncer colorrectal y/o lesión colónica significativa. Se compararon los niveles asistenciales en las prioridades I y II. Resultados: se incluyeron 425 colonoscopias (I = 221, II = 141, III = 63) con una adecuación al protocolo del 67.5 %. Los niveles de prioridad se relacionaron significativamente con los tiempos de demora (días) desde la solicitud (I = 8,7 ± 8,9, II = 50 ± 20,3, III = 80,2 ± 32,2; p < 0,001) y la consulta inicial (I = 32,2 ± 38, II = 74,5 ± 44,2, III = 128,5 ± 47,4; p > 0,001); y con la tasa detección de cáncer colorrectal (I = 20,1 %, II = 19,1 %, III = 4,8 %; p < 0,001) y lesión colónica significativa (I = 35,3 %, II = 34 %, III = 19 %; p = 0,002). En las colonoscopias solicitadas con prioridad I y II desde primaria (21,8 %), la demora desde la consulta inicial fue inferior (primaria = 29,3 ± 26, especializada = 55,2 ± 48,6; p < 0,001) y se detectó más cáncer colorrectal (OR 2,41, IC 95 % 1,31-4,42) y lesión colónica significativa (OR 1,88, IC 95 % 1,13-3,15). Conclusiones: los niveles de prioridad se asocian significativamente con la detección de cáncer colorrectal y lesión colónica significativa. El acceso a la colonoscopia desde primaria reduce los tiempos de demora e incrementa el rendimiento diagnóstico (AU)
Background: the Galician Health Service established indications and priority levels (I = fast track, II = preferential, III = normal) for colonoscopy, according to the risk of colorectal cancer and significant colonic lesions detection with access from primary health care. Our aim is to show the results of the implementation. Methods: we included colonoscopies requested in symptomatic patients from June to October 2012 in a prospective observational cross sectional study. We collected health care level (primary, secondary),priority, appropriateness to the established criteria, wait times (from colonoscopy application and initial consultation) and diagnostic yield for colorectal cancer and/or significant colonic lesion. We compared health care levels in priorities I and II. Results: 425 colonoscopies were included (I = 221, II = 141, III = 63). The appropriateness rate to the protocol was 67.5 %. Priority levels were significantly associated to wait times (days) from application (I = 8.7 ± 8.9, II = 50 ± 20.3, III = 80.2 ± 32.2; p <0.001) and initial consultation (I = 32.2 ± 38, II = 74.5 ± 44.2, III = 128.5 ± 47.4; p < 0.001), and with colorectal cancer (I = 20.1 %, II = 19.1 %, III = 4.8 %, p < 0.001) and significant colonic lesion (I = 35.3 %, II = 34 %, III = 19 %, p = 0.002) detection rates. In priority I and II, 21.8 % of colonoscopies were requested from primary health care. Referral form primary health care reduced wait times from initial consultation to colonoscopy (primary = 29.3 ± 26, secondary = 55.2 ± 48.6, p < 0.001). Instead, colorectal cancer (OR 2.41, 95 % CI 1.31-4.42) and significant colonic lesion (OR 1.88, 95 % CI 1.13-3.15) detection rate was increased. Conclusions: Galician Health Service priority levels are significantly associated with colorectal cancer and significant colonic lesion detection. Referrals to colonoscopy from primary health care reduce waiting times and increase diagnostic yield (AU)