Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas / Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales (AU)

This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions (AU)

Guía clínica para la resección mucosa endoscópica de lesiones colorrectales no pediculadas / Clinical guidelines for endoscopic mucosal resection of non-pedunculated colorectal lesions

Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales (AU)

This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions (AU)

Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country / Estudio experimental sobre disección submucosa endoscópica con bisturí híbrido frente a la ESD estándar en un país occidental

Background: Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise. Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with highpressure water jet and to compare with standard ESD. Material and methods: We performed a prospective nonsurvival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed atotal of 50 gastric ESD (30 hybrid-knife and 20 standard). Results: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04).Hybrid-knife ESD was faster than standard (time: 44.6 ± 21.4 minutes vs. 68.7 ± 33.5 minutes; p = 0.009 and velocity: 20.8 ± 9.2 mm2/ min vs. 14.3 ± 9.3 mm2/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 ± 15.68 to 28.18 ± 20.07 mm2/min; p= 0.615 and standard: From 6.4 ± 0.3 to 19.48 ± 19.21 mm2/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %). Conclusion: despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybridknife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results (AU)

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Disección submucosa endoscópica. Guía de práctica clínica de la SEED / Endoscopic submucosal dissection. Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline

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Esofagitis herpética en paciente inmunocompetente / Herpes esophagitis in an immunocompetent patient

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Comparación de las estenosis esofágicas producidas por escleroterapia o ligadura de varices / Comparison of esophageal stenoses produced by endoscopic sclerotherapy versus variceal ligation

Introducción: La ligadura de varices (LV) erradica las varices esofágicas más rápidamente que la escleroterapia (ES), con menos tasa de recidiva hemorrágica y de complicaciones. Sin embargo, la mayoría de los estudios son a corto plazo y algunas complicaciones tardías pueden pasar desapercibidas. Pacientes y métodos: Analizamos la base de datos de 253 pacientes cirróticos, tratados endoscópicamente tras una hemorragia por varices esofágicas desde 1988 hasta 2004 en nuestro hospital, en busca de incidencia y características de estenosis esofágicas. La esclerosis se realizó con etanolamina al 5% intravariz, y polidocanol al 1,5% perivariz. Las sesiones de tratamiento endoscópico se realizaron cada 15 días hasta la erradicación y, posteriormente, a los 3, 6 y 12 meses, repitiendo el mismo tratamiento inicial si reaparecían las varices. La estenosis se consideró leve cuando tenía una luz superior a 10 mm y grave si no permitía el paso del endoscopio. Resultados: Encontramos 7 estenosis en 105 pacientes tratados con esclerosis (6,7%) y en 10 de 148 tratados con ligadura (6,7%). Las características clínicas de los pacientes y el número previo de sesiones endoscópicas fueron similares en ambos grupos. Cuatro de los 7 pacientes del grupo ES presentaron la estenosis durante el primer proceso de erradicación (media 11, meses; rango, 1-60), pero el desarrollo temprano de estenosis sólo se observó en uno de 10 pacientes del grupo LV (media, 20 meses; rango, 1-72). La estenosis fue grave en 3 de 7 (43%) pacientes del grupo ES, pero sólo en 2 de 10 (20%) pacientes del grupo LV (sin diferencias significativas). Conclusiones: La incidencia de estenosis fue similar tras el tratamiento endoscópico de las varices esofágicas con ES y LV, aunque se observó una tendencia al desarrollo de estenosis mas tardío tras LV

Introduction: Variceal ligation (VL) eradicates esophageal varices faster than endoscopic sclerotherapy (ES) with a lower rebleeding rate and fewer secondary effects. However, most studies have evaluated the short-term effects of these treatments and some late complications may be overlooked. Patients and methods: To determine the incidence and the characteristics of stenosis, we included 253 cirrhotic patients treated endoscopically for variceal bleeding from 1988 to 2004 in our hospital. ES was carried out with ethanolamine 5% and polidocanol 1.5%. ES and VL were carried out every 15 days until varices were eradicated and then at 3-, 6- and 12-month intervals; if varices reappeared, the initial treatment was repeated. Stenosis was considered mild when esophageal size was more than 10 mm and severe when the endoscope could not be passed through the stricture. Results: We found stenosis in seven out of 105 (6.7%) ES-treated patients and in 10 out of 148 (6.7%) VL-treated patients. The clinical characteristics of the patients and the previous number of endoscopic sessions were similar in both groups. Four out of seven ES patients developed stenosis during the first eradication process (mean: 11 months, 1-60), but this early stenosis was observed in one out of 10 VL patients (mean: 20 months, 1-72). Stenosis was severe in three out of seven ES patients (43%) but in only two out of ten VL patients (20%) (NS). Conclusions: The incidence of esophageal stenosis was similar after treatment of esophageal varices with ES and VL, although VL had a tendency to produce later stenosis