[Recommendations of the Chilean Association for Digestive Endoscopy for the management of gastric pre-malignant lesions]. / Diagnóstico precoz de cáncer gástrico: Propuesta de detección y seguimiento de lesiones premalignas gástricas: protocolo ACHED.

An expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populations.

Treatment of common bile duct injuries after surgery.

The treatment of common biliary duct injuries after surgery is a permanent challenge for physicians, and management by a multidisciplinary team is often required. The endoscopic approach is a valuable tool because it is able to assess the problem and also provide a therapeutic option for both fistulas and stenosis of the biliary tree. This article discusses the endoscopic management of postsurgical injuries of the common bile duct and discusses the application of practical tools.

[Orange oily anal leakage: a new entity linked to dietary changes]. / Escurrimiento oleoso anaranjado o "keriorrea", ("orange oily anal leakage"): una nueva enfermedad ligada a cambios de hábito alimentario.

INTRODUCTION: Information is accumulating on exceptional cases of oily orange anal leakage, probably caused by certain foods and their form of consumption. The leakage is usually inadvertent and is worrisome for patients. METHOD: Clinical data was gathered on a case series presenting with massive and inadvertent orange oily anal leakage, without sphincter sensation, causing the patients to feel alarmed. This condition usually occurs after eating fish, especially Japanese cuisine. RESULTS: Eleven patients were included (four women and seven men). The mean age was 47.3 years. Colonoscopy had previously been performed in four patients, with normal results. The symptoms, described as keriorrhea, were probably produced by accumulation of indigestible "wax esters", es Mero present in some oily fish, recently incorporated in raw fish dishes (sashimi) or as Japanese Mero sea bass. These oils, which cannot be absorbed or digested, accumulate in the rectum and may also filter spontaneously and induce toxin-related sphincter dysfunction. The same symptoms are sometimes produced after consumption of cooked versions of these species. The diagnosis is given by clinical data, prior ingestion of these types of fish and the self-limiting nature of the symptoms, without the need for further investigations. CONCLUSION: We describe a case series of a recently described entity associated with dietary changes. This entity is benign and self-limiting. Clinicians should be familiar with the symptoms to inform patients correctly and avoid unnecessary laboratory studies.

[Colorectal cancer screening at Clínica Alemana, Santiago de Chile]. / Plan de tamizaje de cáncer colorrectal ("Mes del Colon") en la Clínica Alemana de Santiago de Chile.

INTRODUCTION: Colorectal cancer (CRC) incidence is rapidly increasing. It has been demonstrated that it can be prevented and cured when the diagnosis is made in early stages. OBJECTIVE: For this reason it is necessary to apply a screening program in asymptomatic patients. METHOD: Since 2003, we conducted a CRC screening plan called "Mes del Colon" at Clínica Alemana Santiago. A press and local diffusion campaign was designed. Open to the community CRC talks were scheduled. An ad hoc database was designed. An informed consent was available. Patients older than 50 years and high risk patients were included. Total colonoscopy and a medical interview after the procedure were included in the plan with favorable economic conditions. RESULTS: Since 2003, 1158 patients were included The 1.8% of them were excluded because of incomplete data or because they did not meet the inclusion criteria. The 54% of patients were women. Mean age was 58.4 years old and mean body mass index 25.5 kg/m2. Polipoid lesions were seen in 45% of the patients. Six (1%) of them were adenocarcinomas, 291 (57%) adenomas (98% tubular adenomas), 189 (37%) hyperplastic polyps and 25 (5%) miscellaneous lesions. In this series, the necessary number to investigate for 1 adenoma was 3.9. CONCLUSIONS: CRC prevention campaigns are needed due to the continuous increase of the incidence in our country. The detection of precursor or early lesions that are longstanding before becoming advanced cancer allows its treatment avoiding progression.

Anisakiasis, un atentado culinario prevenible contra el tracto gastrointestinal / Anisakiasis, a preventable culinary attempt for the gastrointestinal tract

Nuevos hábitos culinarios se han esparcido, desde las culturas originales, para convertirse en costumbres universales. El riesgo que esta globalización puede aparejar probablemente sea subestimado, a no ser que los gastroenterólogos estén conscientes de nuevas enfermedades relacionadas, por ejemplo, con la presencia de agentes infecciosos. Anisakiasis es una de tales enfermedades, relacionadas con la ingestión de pescado crudo o poco cocido, que se presenta en la cultura japonesa, (“el sushi”, “sashimi”), áreas en Sudamérica (“ceviche”), España (“anchoas de vinagre”) y Países Bajos (el pescado crudo). La prevención, está relacionada con la manipulación apropiada, la cocción adecuada y el almacenamiento en frío del pescado. Anisakiasis podría convertirse en un problema clínico serio, debido al compromiso gástrico con ulceraciones, dolor y raras veces pseudotumores en la pared digestiva. El compromiso del intestino delgado es también considerable, secundario a una reacción inflamatoria local severa con edema y estenosis intestinal que simula una obstrucción intestinal. El tratamiento esteroidal generalmente resuelve la crisis, de lo contrario la cirugía es requerida. La reacción alérgica a la presencia del parásito puede llegar a ser un grave problema. La presente revisión trata de aspectos clínicos patológicos, así como del ciclo del parásito, instrumentos diagnósticos y manejo terapéutico.

New culinary habits have been spread, from their original cultures, to become universally known today. They are probably not or insufficiently considered as risky, unless the gastroenterologists become aware of new diseases related for instance with the presence of infective agents. Anisakiasis is one of such diseases, related with the ingestion of raw or undercooked fish, with occurrence in the Japanese culture, (“Sushi”, “sashimi”), areas in South America (“Ceviche”), Spain (“vinegar anchovies”) and The Netherlands (Raw fish). Prevention is related with proper manipulation, cooking and fish frozen storage. Anisakiasis could become a severe clinical problem, because of gastric involvement with ulcerations, pain and rarely intramural pseudotumors. Small intestine involvement is also considerable due to severe inflammatory local reaction, with edema and intense narrowing of the intestinal lumen that mimics intestinal obstruction. Steroidal treatment often solves the crisis. Allergic and general reaction to the occurrence of the parasite is also sometimes a big problem. The present review deals with clinical pathological aspects, as well as parasite cycle, diagnostic tools and treatment.

[Inverted colonic diverticula: an uncommon endoscopic finding]. / Divertículo colónico invertido: un hallazgo endoscópico infrecuente.

BACKGROUND: The appearance of inverted colonic diverticula (ICD) is similar to that of elevated polypoid lesions. The aim of this study was to describe the endoscopic characteristics of ICD with a view to avoiding misdiagnosis, and to report the frequency of these lesions. MATERIAL AND METHOD: Using an endoscopic database, we retrospectively analyzed all patients who underwent colonoscopy at our institution between July 2001 and July 2004. Patients diagnosed with ICD were identified and both patient and ICD characteristics were recorded, including location, endoscopic characteristics, and the presence of synchronous colon polyps. RESULTS: Among the 4508 colonoscopies performed in the selected period, 33 patients (0.7%) were diagnosed with ICD. The mean age was 62.3 years, with a male-to-female ratio of 1:1.2. Most ICD (89%) were in an area of multiple colonic diverticula and 75% were located in the sigmoid colon. One patient had active bleeding directly from the inverted diverticulum and was treated with injection therapy. The endoscopic characteristics of ICDs were described. There were no complications in this series. CONCLUSIONS: ICD is a rare endoscopic finding that can be complicated by local bleeding. Misdiagnosis can be dangerous and biopsy or endoscopic resection could lead to serious complications. The endoscopic criteria described should be considered to avoid the complications associated with biopsy or resection.