Seguimiento a largo plazo tras disección submucosa endoscópica de lesiones colorrectales en una cohorte española / No disponible

INTRODUCCIÓN: la disección submucosa endoscópica (DSE) en colon es una técnica en expansión en países occidentales. Existen pocos estudios con seguimiento a largo plazo. OBJETIVO: analizar supervivencia libre de enfermedad a largo plazo tras DSE y comparar las tasas de recidiva en función de diferentes factores. MATERIAL Y MÉTODOS: cohorte prospectiva de pacientes con DSE planeada entre septiembre de 2008 y diciembre de 2015. Cuando no fue posible técnicamente completar DSE se realizó disección híbrida en bloque o fragmentada. Se analizó la tasa de recurrencia a cinco años mediante curvas de Kaplan-Meier y se compararon en función de diferentes factores usando test de log-rank. RESULTADOS: se incluyó una cohorte inicial de 89 pacientes en los que se consiguió seguimiento en 69. De los 69 pacientes, en 31 (45 %) se realizó DSE; en once (16 %), DSE híbrida; y en 27 (39 %), DSE híbrida fragmentada. La mediana de seguimiento fue de 27 meses. La supervivencia libre de enfermedad a cinco años fue del 81 %. La media de endoscopias para eliminar la recurrencia fueron dos (rango 1-7) y ninguna requirió cirugía. La tasa de recidiva fue significativamente menor tras DSE "en bloque" respecto a fragmentada (15 % vs. 27 %, p = 0,036) y en resecciones R0 respecto a R1 (0 % vs. 26 %, p = 0,034). Las resecciones con márgenes laterales negativos en lesiones resecadas en bloque presentaron menor tasa de recidiva respecto a aquellas con márgenes afectos/desconocidos, que no alcanzaron la significación estadística (0 % vs. 28 %, p = 0,09). CONCLUSIONES: en nuestro estudio, la supervivencia libre de enfermedad a cinco años fue del 81 % y ningún paciente requirió cirugía durante el seguimiento. Las resecciones fragmentadas y R1 se asociaron de forma significativa con mayor tasa de recurrencia

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Disección submucosa endoscópica en lesiones gástricas epiteliales: resultados a largo plazo en una cohorte española / No disponible

INTRODUCCIÓN: la disección submucosa endoscópica sobre lesiones gástricas (DSE-G) es una técnica que permite la resección de tumores gástricos precoces en bloque, con una tasa de curación similar a la cirugía y una morbimortalidad menor. OBJETIVO: analizar la supervivencia total, la supervivencia libre de enfermedad y la tasa de recidiva en pacientes sometidos a DSE-G en una cohorte española a lo largo de su evolución clínica. MATERIAL Y MÉTODOS: estudio observacional prospectivo. Inclusión de pacientes sometidos a DSE-G de 2008 a 2015, con seguimiento entre seis y 60 meses. Se analizó la recurrencia a cinco años mediante curvas de Kaplan-Meier y los resultados fueron comparados entre diferentes factores (en bloque vs. resección fragmentada, resecciones curativas R0 vs. margen lateral afecto ML+) usando test log-rank. RESULTADOS: se analizaron 35 pacientes sometidos a DSE-G, con una mediana de seguimiento de 33,62 meses. Se identificaron cuatro recidivas en este periodo (11,4%), tres de ellas tratadas mediante nueva DSE-G. La presencia de ML+ en la pieza histológica se relacionó con mayor tasa de recidiva local durante el seguimiento (p = 0,06). Las resecciones fragmentadas presentaron un mayor riesgo de recidiva pero sin detectarse diferencias estadísticamente significativas (p = 0,49). No se registraron fallecimientos por neoplasia gástrica ni gastrectomía por persistencia de enfermedad en este periodo. La tasa de supervivencia global en nuestra serie fue de 94,3%. CONCLUSIONES: la DSE-G realizada en nuestro medio permite una tasa elevada de curación a largo plazo evitando la cirugía. Estos resultados se asemejan a las series europeas publicadas y aún se encuentran lejos de las tasas de curación y recidiva de las cohortes asiáticas. Los casos de recidiva local pueden ser controlados mediante endoscopia

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Long-term follow-up after endoscopic submucosal dissection of colorectal lesions in a Spanish cohort.

INTRODUCTION: ESD in the colon is an increasingly important technique in Western countries. There are few studies that include long term follow-up. AIM: to analyze the long term recurrence free survival rate after ESD and to compare recurrence rates according to different variables. METHODS: this was a prospective observational study of patients with a planned ESD from September 2008 to December 2015. When it was not possible to achieve an ESD, hybrid ESD was performed, either en bloc or piecemeal. Kaplan-Meier survival curves were used to assess the five year local recurrence free survival rate and the recurrence rate. The results were compared according to different factors. RESULTS: of the 89 patients scheduled for ESD who were initially enrolled in the study, 69 were finally included for follow-up. ESD was performed in 31 (45%) patients, KAR in eleven (16%) and pKAR in 27 (39%). The median follow-up was 27 months (range 6-60). The five year disease free survival rate was 81%. The average number of endoscopies needed to eliminate recurrence was two (range 2-7) and no patient required surgery for this reason. The recurrence rate was significantly higher in piecemeal resections vs en bloc resections (27% vs 15%, p = 0.036) and R1 resections vs R0 resections (26% vs 0%, p = 0.034). The presence of affected or unknown lateral margins in en bloc resections without other poor prognosis factors had higher recurrence rates but the difference was not statistically significant (28% vs 0%, p = 0.09). CONCLUSIONS: in our study, the five year disease free survival rate was 81% and no patient required surgery during follow-up. Piecemeal and R1 resections had significantly higher recurrence rates, as well as LM involvement, although this was not statistically significant.

Endoscopic submucosal dissection for gastric epithelial lesions: long-term results in a Spanish cohort.

INTRODUCTION: endoscopic submucosal dissection for gastric lesions (ESD-G) is a technique that allows en-bloc resection of early gastric tumors, with a cure rate similar to that of surgery but lower morbidity and mortality rates. OBJECTIVE: to assess total survival, disease-free survival and relapse rate during the course of disease in a Spanish cohort of patients undergoing ESD-G. MATERIAL AND METHODS: this was a prospective observational study of patients undergoing ESD-G from 2008 to 2015, with a follow-up ranging from six to 60 months. Recurrence at five years was analyzed using Kaplan-Meier curves and the results were compared according to several factors using the log-rank test. These included en-bloc versus piecemeal resection and R0 curative resection versus resection with affected lateral margins (LM+). RESULTS: a total of 35 patients undergoing ESD-G were assessed, with a median follow-up of 33.62 months. Four relapses were identified (11.4%) during this period, of which three were managed with repeat ESD-G. A histological specimen with LM+ was associated with a higher local relapse rate during follow-up (p = 0.06). Piecemeal resections had a higher relapse risk, although no statistically significant differences were identified (p = 0.49). No deaths from gastric cancer occurred and no gastrectomies due to persistent disease were performed during this period. The overall survival rate in our series was 94.3%. CONCLUSIONS: ESD-G in our setting provides high long-term cure rates, while avoiding surgery. These results are similar to those reported by the European series and remain far removed from the cure and relapse rates obtained in Asian cohorts. Local relapse cases may be monitored with endoscopy.

Complete resolution of dysphagia after sequential Polyflex(TM) stenting in a case of recurrent anastomotic stenosis in an adult with congenital esophageal atresia

We present a case of intractable dysphagia in a 23-year-old female with type 1 esophageal atresia (EA) and subsequent postsurgical refractory esophageal strictures. The patient was referred due to increasing symptomatology and a slight response to balloon dilations. A biodegradable polydioxanone stent (ELLA) was placed, but this did not relieve the dysphagia. After the sequential placement of two siliconated polypropylene stents (Polyflex(TM), Boston Scientifics), the dysphagia was definitively relieved. To our knowledge, this is the first published case with a full resolution of dysphagia using this strategy in an adult patient

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Complete resolution of dysphagia after sequential Polyflex™ stenting in a case of recurrent anastomotic stenosis in an adult with congenital esophageal atresia.

We present a case of intractable dysphagia in a 23-year-old female with type 1 esophageal atresia (EA) and subsequent postsurgical refractory esophageal strictures. The patient was referred due to increasing symptomatology and a slight response to balloon dilations. A biodegradable polydioxanone stent (ELLA) was placed, but this did not relieve the dysphagia. After the sequential placement of two siliconated polypropylene stents (Polyflex™, Boston Scientifics), the dysphagia was definitively relieved. To our knowledge, this is the first published case with a full resolution of dysphagia using this strategy in an adult patient.

Metástasis esplénica solitaria en una paciente con adenocarcinoma colorrectal / Splenic metastases secondary to colorrectal carcinoma

Introduction: Splenic metastases are unusual, arising in less than 1 percent of all metastases. Splenic metastases from colorrectal carcinoma is considered excepcional. If present, they generally occur in concert with disseminated disease. Case report: We present a case of 78 year old man operated of colon tumor by right hemicolectomy. Nine months after first surgical, CT scan showed metastases in spleen, splenectomy was performed.

Introducción: Las metástasis esplénicas son inusuales, representando menos del 1 por ciento de todas las metástasis. Que este tipo de localización secundaria sea ocasionado por carcinomas colorrectales puede considerarse como algo excepcional. Cuando se presentan generalmente lo hacen en el contexto de una enfermedad diseminada. Caso clínico: Presentamos el caso de un varón de 78 años de edad que fue intervenido de un carcinoma colorrectal mediante hemicolectomía derecha. nueve meses después de la primera cirugía el escáner muestra metástasis en el bazo, por lo que se realizó una esplenectomía.