RESUMEN
El tamizaje por colonoscopia es un método efectivo para prevenir cáncer de colon a traves de la detección de pólipos sobre los cuales se desarrolla en un mayor porcentaje el cáncer de colon; sin embargo la detección de estas lesiones varía en los diferentes segmentos del colon y de ellos en colon derecho su tasa detección suele ser menor. Objetivo: El objetivo de este estudio es evaluar si la doble revisión endoscópica de colon derecho durante la colonoscopia es un mecanismo para mejorar su rendimiento en cuanto a la tasa de detección de pólipos (TDP) y la tasa de detección de adenomas (TDA). Materiales y métodos: Revisión sistemática y metaanálisis de la literatura de estudios clínicos aleatorizados que realizaron una doble revisión del colon derecho por colonoscopia comparado con una revisión simple para mejorar la detección de pólipos y adenomas. El protocolo de esta revisión se publicó en PROSPERO bajo el código CRD42022356509. Resultados: Se incluyeron 5 estudios que incluyeron 2729 participantes. Se informó la detección de pólipos en 585/1197 pacientes (48,87%) después de la segunda revisión, en comparación con 537/1206 (44,52%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,09 (IC 95%: 0,97-1,23) (I2 fue de 44%). Se informó la detección de adenomas en 830/1513 pacientes (54,75%) después de la segunda revisión, en comparación con 779/1509 (51,62%) de los pacientes que recibieron una única examinación (p < 0,05), para un RR combinado de 1,06 (IC 95%: 1,00-1,13) (I2 fue de 0%). Conclusión: La segunda examinación del colon derecho por colonoscopia puede tener una modesta mejoría en la detección de pólipos y adenomas.
Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. Objective: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). Materials and methods: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. Results: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). Conclusion: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.
RESUMEN
Colonoscopy screening is an effective method to prevent colon cancer through the detection of polyps on which colon cancer develops in a higher percentage; however, the detection of these lesions varies in the different segments of the colon and the detection rate of them in the right colon is usually lower. OBJECTIVE: The objective of this study is to evaluate whether double endoscopic revision of the right colon during colonoscopy is a mechanism to improve its performance in terms of polyp detection rate (TDP) and adenoma detection rate (ADR). MATERIALS AND METHODS: Systematic review and meta-analysis of the literature including randomized clinical trials that evaluated repeat right-sight examination by colonoscopy compared to standard view to improve detection of polyps and adenomas. The protocol for this decision was published in PROSPERO under the code CRD42022356509. RESULTS: Five studies involving 2729 participants were included. Polyp detection was reported in 585/1197 patients (48.87%) after the second review, compared with 537/1206 (44.52%) of patients who received a single examination (p< 0.05), for a combined RR of 1.09 (95% CI: 0.97-1.23) (I2 was 44%). Detection of adenomas was reported in 830/1513 patients (54.75%) after the second review, compared with 779/1509 (51.62%) of patients who received a single examination (p < 0.05), for a combined RR of 1.06 (95% CI: 1.00-1.13) (I2 was 0%). CONCLUSION: Second examination of the right colon by colonoscopy may have a modest improvement in the detection of polyps and adenomas.
Asunto(s)
Adenoma , Neoplasias del Colon , Pólipos del Colon , Humanos , Pólipos del Colon/diagnóstico , Pólipos del Colon/patología , Colonoscopía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/patología , Adenoma/diagnóstico , Adenoma/patologíaRESUMEN
RESUMEN Introducción: Los pacientes con diarrea crónica con frecuencia se someten a la evaluación con colonoscopia, sin embargo, la realización de biopsias o ileoscopia permanece controversial. Objetivo: Evaluar la utilidad de la colonoscopia más biopsias en el estudio de pacientes con diarrea crónica. Materiales y métodos: Retrospectivamente revisamos pacientes con diarrea crónica que fueron llevados a colonoscopia entre 2015 a 2019. Se excluyeron pacientes con datos incompletos, infección por VIH, hallazgos endoscópicos anormales, colonoscopia sin valoración del ciego, estar en tratamiento empírico para la diarrea y mala preparación. Se realizó análisis descriptivo de las características de los pacientes, hallazgos histopatológicos y comparación de signos y síntomas según hallazgo histopatológico. Resultados: Se evaluaron 535 pacientes con diarrea crónica, de estos, a 283 (52,8%) se les realizó biopsias. En el 55,1% (n=156) de las biopsias se obtuvo algún diagnóstico histopatológico final. Los diagnósticos histopatológicos correspondieron a colitis ulcerativa (n=3), enfermedad de Crohn (n=5), colitis linfocítica (n=6), colitis colágena (n=12), colitis eosinofílica (n=13), colitis infecciosa (n=13), Melanosis coli (n=15), colitis inespecífica (n=57) y otros cambios histológicos (n=32). La enfermedad de Crohn solo se documentó en biopsias de íleon (p<0,001), la colitis ulcerativa solo se diagnosticó en biopsias del recto sigmoide (p=0,007), la colitis infecciosa en su mayor proporción (30,7%) se documentó en biopsias del colon derecho (p=0,028). Conclusión: La colonoscopia y las biopsias son útiles en la investigación de pacientes con diarrea crónica, obteniendo un diagnóstico histológico en el 55% de los pacientes. La ileoscopia complementó los hallazgos de la colonoscopia en menor proporción.
ABSTRACT Introduction: Patients with chronic diarrhea often undergo colonoscopy evaluation, however, the performance of biopsies or ileoscopy remains controversial. Objective: To evaluate the usefulness of colonoscopy plus biopsies in the study of patients with chronic diarrhea. Materials and methods: We retrospectively reviewed patients with chronic diarrhea who underwent colonoscopy between 2015 and 2019. Patients with incomplete data, HIV infection, abnormal endoscopic findings, colonoscopy without blind assessment, being on empiric treatment for diarrhea, and poor diagnosis were excluded. preparation. A descriptive analysis of the characteristics of the patients, histopathological findings and comparison of signs and symptoms according to histopathological finding was performed. Results: 535 patients with chronic diarrhea were evaluated, of these, 283 (52.8%) underwent biopsies. In 55.1% (n=156) of the biopsies some final histopathological diagnosis was obtained. Histopathological diagnoses corresponded to ulcerative colitis (n=3), Crohn's disease (n=5), lymphocytic colitis (n=6), collagenous colitis (n=12), eosinophilic colitis (n=13), infectious colitis (n=13), Melanosis coli (n=15), nonspecific colitis (n=57) and other histological changes (n=32). Crohn's disease was only documented in biopsies of the ileum (p<0.001), ulcerative colitis was only diagnosed in biopsies of the sigmoid rectum (p=0.007), infectious colitis in its highest proportion (30.7%) was documented in biopsies of the right colon (p=0.028). Conclusion: Colonoscopy and biopsies are useful in the investigation of patients with chronic diarrhea, obtaining a histological diagnosis in 55% of patients. Ileoscopy complemented colonoscopy findings to a lesser extent.
RESUMEN
INTRODUCTION: Patients with chronic diarrhea often undergo colonoscopy evaluation, however, the performance of biopsies or ileoscopy remains controversial. OBJECTIVE: To evaluate the usefulness of colonoscopy plus biopsies in the study of patients with chronic diarrhea. MATERIALS AND METHODS: We retrospectively reviewed patients with chronic diarrhea who underwent colonoscopy between 2015 and 2019. Patients with incomplete data, HIV infection, abnormal endoscopic findings, colonoscopy without blind assessment, being on empiric treatment for diarrhea, and poor diagnosis were excluded. preparation. A descriptive analysis of the characteristics of the patients, histopathological findings and comparison of signs and symptoms according to histopathological finding was performed. RESULTS: 535 patients with chronic diarrhea were evaluated, of these, 283 (52.8%) underwent biopsies. In 55.1% (n=156) of the biopsies some final histopathological diagnosis was obtained. Histopathological diagnoses corresponded to ulcerative colitis (n=3), Crohn's disease (n=5), lymphocytic colitis (n=6), collagenous colitis (n=12), eosinophilic colitis (n=13), infectious colitis (n=13), Melanosis coli (n=15), nonspecific colitis (n=57) and other histological changes (n=32). Crohn's disease was only documented in biopsies of the ileum (p<0.001), ulcerative colitis was only diagnosed in biopsies of the sigmoid rectum (p=0.007), infectious colitis in its highest proportion (30.7%) was documented in biopsies of the right colon (p=0.028). CONCLUSION: Colonoscopy and biopsies are useful in the investigation of patients with chronic diarrhea, obtaining a histological diagnosis in 55% of patients. Ileoscopy complemented colonoscopy findings to a lesser extent.
Asunto(s)
Colitis Colagenosa , Colitis Microscópica , Colitis Ulcerosa , Enfermedad de Crohn , Infecciones por VIH , Biopsia , Colitis Microscópica/complicaciones , Colitis Microscópica/diagnóstico , Colitis Microscópica/patología , Colonoscopía , Diarrea/diagnóstico , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND AND AIMS: Ulcerative Colitis (UC) and Crohn's Disease (CD) have a major impact on quality of life and medical costs. The aim of the study was to estimate the prevalence, incidence and clinical phenotypes of Inflammatory Bowel Disease (IBD) cases in Mexico and Colombia. METHODS: We analyzed official administrative and health databases, used mathematical modelling to estimate the incidence and complete prevalence, and performed a case-series of IBD patients at a referral center both in Mexico and Colombia. RESULTS: The age-adjusted complete prevalence of UC per 100,000 inhabitants for 2015/2016 ranged from 15.65 to 71.19 in Mexico and from 27.40 to 69.97 in Colombia depending on the model considered. The prevalence of CD per 100,000 inhabitants in Mexico ranged from 15.45 to 18.08 and from 16.75 to 18.43 in Colombia. In Mexico, the age-adjusted incidence of UC per 100,000 inhabitants per year ranged from 0.90 to 2.30, and from 0.55 to 2.33 in Colombia. The incidence for CD in Mexico ranged from 0.35 to 0.66 whereas in Colombia, the age-adjusted incidence of CD ranged from 0.30 to 0.57. The case-series included 200 IBD patients from Mexico and 204 patients from Colombia. The UC/CD prevalence ratio in Mexico and Colombia was 1.50:1 and 4.5:1 respectively. In Mexico, the female/male prevalence ratio for UC was 1.50:1 and 1.28:1 for CD, while in Colombia this ratio was 0.68:1 for UC and 0.8:1 for CD. In Mexico the relapse rate for UC was 63.3% and 72.5% for CD, while those rates in Colombia were 58.2% for UC and 58.3% for CD. CONCLUSIONS: The estimated burden of disease of IBD in Mexico and Colombia is not negligible. Although these findings need to be confirmed by population-based studies, they are useful for decision-makers, practitioners and patients with this condition.
Asunto(s)
Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Bases de Datos Factuales , Modelos Teóricos , Adulto , Anciano , Colombia/epidemiología , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana EdadRESUMEN
El dolor torácico es uno de los motivos de consulta más frecuentes en los servicios de urgencias; por lo que consideramos importante revisar aspectos como su clasificación, causas y perfiles clínicos. Se debe realizar una adecuada evaluación inicial con una excelente historia clínica que incluya una muy buena anamnesis y examen físico. Esto nos llevará a un diagnóstico certero ayudados en la óptima interpretación de los exámenes paraclínicos, pertinentes según los diagnósticos sospechados. Destacamos los diferentes síntomas, signos, hallazgos en EKG, Rx tórax, biomarcadores cardíacos, gases arteriales y tomografía axial computarizada. Se evalúan puntajes de severidad y pronóstico como el TIMI. De un adecuado al abordaje inicial dependerá el óptimo tratamiento de las diferentes patologías que puedan producir este tipo de dolor.
