Gastric endoscopic submucosal dissection: from animal model to patient.

AIM: To assess whether the use of porcine models is useful for learning endoscopic submucosal dissection (ESD), thus contributing to its subsequent application in human patients. METHODS: This study/learning process was carried out in 3 phases: Phase I: Ex vivo animal; Phase II: In vivo animal; Phase III: Humans. One endoscopist performed 30 gastric ESDs in porcine models, and later 5 gastric ESDs in 5 patients. The ESD was done following the method practiced at the National Cancer Center in Tokyo, Japan. Technical aspects, size, time and speed of ESD, as well as complications were registered. In patients, their clinical, endoscopic and histologic evolution was additionally added. RESULTS: Thirty en bloc ESDs were carried out in animal models. The mean ± SD size of the pieces was of 28.4 ± 1.2 mm, and the time of ESD was 41.7 ± 2.4 min. The time of ESD in the first 15 procedures was 43.0 ± 3.0 min whereas in the next 15 procedures, the time was 40.3 ± 3.9 min, P = 0.588. The speed in the first 15 ESDs was 1.25 ± 0.11 cm(2)/min vs 2.12 ± 0.36 cm(2)/min in the remaining 15, P = 0.028. There were no complications. In patients, 5 lesions were resected en bloc. The size of the pieces was 25.2 ± 5.1 mm and the time was 85.0 ± 25.6 min. Endoscopic and histological controls did not show evidence of residual neoplastic tissue. CONCLUSION: A sequential ESD training program of a unique endoscopist, based on the practice in porcine models, contributed to learning ESD for its subsequent application in humans, yielding good results in efficacy and safety.

Prevalencia de la enfermedad por reflujo gastroesofágico en Uruguay / Prevalence of gastroesophageal reflux disease in Uruguay

Antecedente La enfermedad por reflujo gastroesofágico (ERGE) es una condición frecuente, con grandes diferencias geográficas en todo el mundo. Uruguay carece de datos epidemiológicos sobre esta enfermedad. Objetivo Estimar la prevalencia de la ERGE en 2 poblaciones adultas de Uruguay, urbana y hospitalaria, mediante el Gastroesophageal reflux disease Questionnaire (GerdQ) e interrogatorio de síntomas típicos. Material y método Se realizó un estudio descriptivo de corte transversal mediante el uso de 2 métodos diagnósticos administrados a 2 niveles: urbano y hospitalario. Uno de ellos fue el cuestionario GerdQ, estandarizado, de respuesta estructurada y el otro consistió en evaluar síntomas característicos de ERGE. Se incluyeron 1.141 personas procedentes de población urbana, con edad promedio de 52 (± 18 años) y 163 pacientes de una policlínica de gastroenterología, con edad promedio de 53 años (± 16 años).Resultados La prevalencia de ERGE en Uruguay utilizando el cuestionario GerdQ fue 4,69%, (IC 95% 2,92-6,46%), mientras que al considerar solo los síntomas típicos ascendió a 14,14% (IC 95% 12,57-15,71). En la muestra hospitalaria la prevalencia fue de 11,66% (IC 95% 6,42-16,89%) y 20,25% (IC 95% 14,01-26,48), respectivamente. Conclusión La prevalencia obtenida en la población urbana de Uruguay con el cuestionario GerdQ en la población sintomática (hospitalaria) fue más del doble respecto de la población general, 11,66 y 4,69%, respectivamente. La evaluación de síntomas, pirosis y/o regurgitación conduce sistemáticamente a un resultado de mayor prevalencia. El consenso en la definición de la ERGE y la herramienta utilizada son claves para interpretar y comparar los estudios epidemiológicos (AU)

Background Gastroesophageal reflux disease (GERD) is a common condition, with wide geographical differences worldwide. There are no epidemiological data on this disease for Uruguay. Objective To estimate the prevalence of GERD in two adult populations in Uruguay (urban and hospital) through the Gastroesophageal reflux disease Questionnaire (GerdQ) questionnaire and evaluation of typical symptoms. Material and method A descriptive, cross-sectional study was carried out through the use of two diagnostic methods administered in two settings: an urban and a hospital setting. The first method consisted of administration of the standardized GerdQ structured questionnaire and the other consisted of evaluating the typical symptoms of GERD. A total of 1141 persons from the urban population, with a mean age of 52 years (± 18 years), and 163 persons from a gastroenterology polyclinic, with a mean age of 53 years (± 16 years), were included. Results The prevalence of GERD in Uruguay was 4.69%, (95% CI 2.92-6.46%) when the GerdQ questionnaire was used, but increased to 14.14% (95% CI 12.57-15.71) when only typical symptoms were considered. In the hospital sample, the prevalence was 11.66% (95% CI 6.42-16.89%) and 20.25% (95% CI 14.01-26.48), respectively. Conclusion The prevalence obtained in the urban population of Uruguay with the GerdQ questionnaire in the symptomatic (hospital) population was more than double that in the general population, 11.66% and 4.69%, respectively. Evaluation of symptoms, pyrosis and/or regurgitation systematically yields a higher prevalence. Consensus on the definition of GERD and on the instrument used for its diagnosis are essential to interpret and compare epidemiological studies (AU)

[Prevalence of gastroesophageal reflux disease in Uruguay]. / Prevalencia de la enfermedad por reflujo gastroesofágico en Uruguay.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common condition, with wide geographical differences worldwide. There are no epidemiological data on this disease for Uruguay. OBJECTIVE: To estimate the prevalence of GERD in two adult populations in Uruguay (urban and hospital) through the Gastroesophageal reflux disease Questionnaire (GerdQ) questionnaire and evaluation of typical symptoms. MATERIAL AND METHOD: A descriptive, cross-sectional study was carried out through the use of two diagnostic methods administered in two settings: an urban and a hospital setting. The first method consisted of administration of the standardized GerdQ structured questionnaire and the other consisted of evaluating the typical symptoms of GERD. A total of 1141 persons from the urban population, with a mean age of 52 years (± 18 years), and 163 persons from a gastroenterology polyclinic, with a mean age of 53 years (± 16 years), were included. RESULTS: The prevalence of GERD in Uruguay was 4.69%, (95% CI 2.92-6.46%) when the GerdQ questionnaire was used, but increased to 14.14% (95% CI 12.57-15.71) when only typical symptoms were considered. In the hospital sample, the prevalence was 11.66% (95% CI 6.42-16.89%) and 20.25% (95% CI 14.01-26.48), respectively. CONCLUSION: The prevalence obtained in the urban population of Uruguay with the GerdQ questionnaire in the symptomatic (hospital) population was more than double that in the general population, 11.66% and 4.69%, respectively. Evaluation of symptoms, pyrosis and/or regurgitation systematically yields a higher prevalence. Consensus on the definition of GERD and on the instrument used for its diagnosis are essential to interpret and compare epidemiological studies.

Hallazgos colonoscópicos en una población de pacientes con test de sangre oculta en heces positivos / Colonoscopic findings in a population of patients with positive fecal occult blood test

Los test inmunológicos de sangre oculta en heces (SOH-I) constituyen actualmente una de las estrategias más extendidas para el cribado de cáncer colorrectal(CCR) y lesiones precancerosas avanzadas. Objetivos: Describir los hallazgos colonoscópicos en una población de pacientes con test de SOH-I positivos y conocer además la relación con la presencia de CCR. Métodos: Se recabaron de manera retrospectiva los datos de pacientes con test de SOH positivos, prueba inmunocromatográfica, en el período 2007-2008 que tenían colonoscopia. Se excluyeron aquellos pacientes con colonoscopia previa, enfermedad inflamatoria intestinal, colectomizados o hemicolectomizados,y aquellos con colonoscopia parcial y/o con mala preparación. Resultados:Se incluyeron 89 pacientes, 49 (55%) correspondieron al sexo femenino y 40(45%) al masculino. Respecto a los hallazgos colonoscópicos: 2 (2,2%) presentaronCCR, 33 (37%) tenían pólipos (8 pacientes con pólipos >= 10 mm), y hemorroides internas 54 (60,6%) pacientes. Conclusiones: La verdadera precisión de los test de SOH en términos de sensibilidad y especificidad para la detección de neoplasia colorrectal es difícil de conocer. Según estos hallazgos,la especificidad del test de SOH para el diagnóstico de CCR fue baja.