Peroral endoscopic septotomy for Zenker's diverticulum with additional cut of mucosal flap: step by step.

Video 1Peroral endoscopic septotomy for Zenker's diverticulum with additional cut of mucosal flap: step by step.

An unusual case of extensive polypoid high-grade dysplasia in Barrett's esophagus

Barrett's esophagus (BE) is a known precursor of dysplasia and adenocarcinoma. Endoscopic resection and surgery are the techniques used to treat these kinds of lesions. However, endoscopic resection is considered the first choice for the management of superficial lesions. Dysplasia in BE most commonly appears like a flat lesion but here we describe an unusual case of dysplasia and superficial adenocarcinoma looking like an extensive polypoid lesion.

El esófago de Barrett (EB) es un precursor conocido de displasia y adenocarcinoma. La resección endoscópica y la cirugía son las técnicas utilizadas para tratar este tipo de lesiones. Sin embargo, la resección endoscópica se considera la primera opción para el manejo de las lesiones superficiales. La displasia en EB aparece más comúnmente como una lesión plana, pero aquí describimos un caso inusual de displasia y adenocarcinoma superficial que parece una lesión polipoide extensa.

Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC. METHODS: We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure. RESULTS: The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively. CONCLUSION: Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series.

An unusual case of extensive polypoid high-grade dysplasia in Barrett's esophagus.

Barrett's esophagus (BE) is a known precursor of dysplasia and adenocarcinoma. Endoscopic resection and surgery are the techniques used to treat these kinds of lesions. However, endoscopic resection is considered the first choice for the management of superficial lesions. Dysplasia in BE most commonly appears like a flat lesion but here we describe an unusual case of dysplasia and superficial adenocarcinoma looking like an extensive polypoid lesion.

Peroral endoscopic myotomy in a pediatric patient with refractory achalasia: a case report and review of the literature.

A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic "bird-beak" termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly-equipped health care delivery centers and could be used as a rescue treatment in refractory achalasia. We present the youngest patient with achalasia in our region who had a successful response to rescue POEM.

Peroral endoscopic myotomy in a pediatric patient with refractory achalasia: a case report and review of the literature

A 15-year-old male patient presented with dysphagia, regurgitation, weight loss and retrosternal pain. The diagnosis of achalasia was made 4 years before. The esophagogram revealed severe esophagus dilatation and the classic "bird-beak" termination. A Heller myotomy plus fundoplication and endoscopic balloon dilatation were conducted four months previously. Nevertheless, the symptoms persisted and the last high-resolution manometry study still showed achalasia type II. The patient underwent a peroral endoscopic esophageal myotomy (POEM). POEM is a feasible and safe procedure for experienced and properly- equipped health care delivery centers and could be used as a rescue treatment in refractory achalasia. We present the youngest patient with achalasia in our region who had a successful response to rescue POEM.

Un paciente varón de 15 años, con el diagnóstico de acalasia realizado 4 años antes, acudió a evaluación por presentar disfagia, regurgitación, pérdida de peso y dolor restroesternal. El esofagograma baritado evidenció una dilatación severa del esófago y la terminación clásica en "pico de pájaro". El paciente había sido sometido a una miotomía de Heller más fundoplicatura y posteriormente a una dilatación esofágica con balón 4 meses atrás. Sin embargo, los síntomas persistían y la última manometría de alta resolución reveló acalasia tipo II. Finalmente, se realizó una miotomía endoscópica por vía oral (POEM); el cual es un procedimiento seguro y accesible en centros experimentados y debidamente equipados, pudiendo ser una adecuada opción de tratamiento en casos de acalasia refractaria. Presentamos el caso del paciente más joven en nuestra región con acalasia con una respuesta exitosa a un POEM de rescate.

Closure of colonic deep mural injury and perforation with endoclips

INTRODUCTION: colorectal perforations are one of the most feared complications after performing an endoscopic resection. The use of endoclips is considered for the management of these complications. OBJECTIVES: to evaluate the efficacy and safety of the use of endoclips in the management of perforations and deep mural injuries that occur after an endoscopic colorectal resection. METHODS: a prospective cohort of consecutively included patients was used with a diagnosis of perforation or deep mural injury after an endoscopic colorectal resection treated with endoclips in our institution. The rates of perforation and deep mural injury were obtained. The factors associated with an unfavorable evolution after the placement of the endoclips were analyzed. RESULTS: after 342 endoscopic mucosal resections (EMR) and 42 endoscopic submucosal dissections (ESD), there were 25 cases with perforation or deep mural injury. The deep mural injury rate was 3.22 % and 7.14 % in the case of EMR and ESD, respectively. The perforation rate was 1.46 % and 14.29 % in the case of EMR and ESD, respectively. Successful closure with endoclips was achieved in 24 cases (96 %). Only one patient presented an unfavorable evolution (10 %) after successful closure. The factors associated with an unfavorable evolution were the presence of diffuse peritoneal symptoms and a perforation size greater than or equal to 10 mm. CONCLUSION: endoscopic closure with endoclips is effective to avoid surgery in cases of deep mural injury or perforation after an endoscopic resection

No disponible

[Adherence to institutional clinical practice guideline on managing upper gastrointestinal bleeding, in a hospital in Lima - Peru]. / Adherencia a la guía de práctica clínica institucional sobre hemorragia digestiva alta, en un hospital de Lima - Perú.

INTRODUCTION: In 2018, the Clinical Practice Guideline (CPG) for the Evaluation and Management of upper gastrointestinal bleeding (UGB) was published by the Social Security of Peru (EsSalud). It provides evidence-based statements to optimize the management of these patients. OBJECTIVE: To evaluate the adherence to the statements of the CPG at the Edgardo Rebagliati Martins National Hospital (HNERM) of EsSalud (Lima, Peru). MATERIALS AND METHODS: Retrospective study, which analyzed the database of all patients who came to the HNERM emergency service with suspected UGB and were scheduled for endoscopy between October 19, 2019 and April 15, 2020. We included those with ≥ 18 years of age. This database contains the main characteristics of the standardized medical history for patients with UGB. Compliance with 13 of the 34 statements of the EsSalud CPG was evaluated. The results were presented descriptively, and the factors associated with compliance with the statements with insufficient adherence (<80%) and with more than 100 evaluated participants were evaluated. RESULTS: Data were obtained from 184 patients who met the inclusion criteria (men: 59.8%, median age: 70 years). The range of adherence to the 13 statements was from 63.2% to 99.5%. Only two statements had insufficient adherence (<80%). The statement with the least adherence was the recommendation to perform a restrictive transfusion. Noncompliance with this recommendation was found to be lower in those who had a higher score on the Glasgow-Blatchford index, a urea creatinine ratio > 60, and a lower hemoglobin on admission. CONCLUSION: Of the 13 statements evaluated, 11 had satisfactory adherence. It is important to explore the reasons why adherence is not adequate for some statements, and to evaluate methods to increase this adherence.

Closure of colonic deep mural injury and perforation with endoclips.

INTRODUCTION: colorectal perforations are one of the most feared complications after performing an endoscopic resection. The use of endoclips is considered for the management of these complications. OBJECTIVES: to evaluate the efficacy and safety of the use of endoclips in the management of perforations and deep mural injuries that occur after an endoscopic colorectal resection. METHODS: a prospective cohort of consecutively included patients was used with a diagnosis of perforation or deep mural injury after an endoscopic colorectal resection treated with endoclips in our institution. The rates of perforation and deep mural injury were obtained. The factors associated with an unfavorable evolution after the placement of the endoclips were analyzed. RESULTS: after 342 endoscopic mucosal resections (EMR) and 42 endoscopic submucosal dissections (ESD), there were 25 cases with perforation or deep mural injury. The deep mural injury rate was 3.22 % and 7.14 % in the case of EMR and ESD, respectively. The perforation rate was 1.46 % and 14.29 % in the case of EMR and ESD, respectively. Successful closure with endoclips was achieved in 24 cases (96 %). Only one patient presented an unfavorable evolution (10 %) after successful closure. The factors associated with an unfavorable evolution were the presence of diffuse peritoneal symptoms and a perforation size greater than or equal to 10 mm. CONCLUSION: endoscopic closure with endoclips is effective to avoid surgery in cases of deep mural injury or perforation after an endoscopic resection.

Adherencia a la guía de práctica clínica institucional sobre hemorragia digestiva alta, en un hospital de Lima - Perú / Adherence to institutional clinical practice guideline on managing upper gastrointestinal bleeding, in a hospital in Lima - Peru

RESUMEN Introducción : El año 2018 se publicó la Guía de práctica clínica (GPC) para la evaluación y el manejo de la hemorragia digestiva alta (HDA) del Seguro Social de Salud del Perú (EsSalud). Esta emite enunciados basados en evidencias, que buscan optimizar el manejo de estos pacientes. Objetivo : Evaluar la adherencia a los enunciados de dicha GPC en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) de EsSalud (Lima, Perú). Materiales y métodos : Estudio retrospectivo, que analizó la base de datos de todos los pacientes que acudieron al servicio de emergencia del HNERM con sospecha de HDA y fueron programados para endoscopía entre el 19 de octubre del 2019 y el 15 de abril del 2020. Se incluyó a aquellos con ≥ 18 años de edad. Esta base contiene las principales características de la historia clínica estandarizada para pacientes con HDA. Se evaluó el cumplimiento de 13 de los 34 enunciados de la GPC de EsSalud. Los resultados se presentaron descriptivamente, y se evaluaron los factores asociados al cumplimiento de los enunciados con inadecuada adherencia (< 80%) y con más de 100 participantes evaluados. Resultados : Se obtuvieron datos de 184 pacientes que cumplieron con los criterios de inclusión (varones: 59,8%, mediana de edad: 70 años). El rango de adherencia a los 13 enunciados fue de 63,2% a 99,5%. Sólo dos enunciados tuvieron adherencia inadecuada (<80%). El enunciado con menor adherencia fue la recomendación de realizar transfusión restrictiva. Se encontró que el cumplimiento de esta recomendación fue menor en quienes tuvieron mayor puntaje en el índice de Glasgow-Blatchford, relación urea creatinina > 60, y menor hemoglobina al ingreso. Conclusión : De los 13 enunciados evaluados, 11 tuvieron una adherencia adecuada. Resulta importante profundizar en los motivos por los cuales la adherencia no es adecuada para algunos enunciados, y valorar estrategias para aumentar esta adherencia.

ABSTRACT Introduction : In 2018, the Clinical Practice Guideline (CPG) for the Evaluation and Management of upper gastrointestinal bleeding (UGB) was published by the Social Security of Peru (EsSalud). It provides evidence-based statements to optimize the management of these patients. Objective : To evaluate the adherence to the statements of the CPG at the Edgardo Rebagliati Martins National Hospital (HNERM) of EsSalud (Lima, Peru). Materials and methods : Retrospective study, which analyzed the database of all patients who came to the HNERM emergency service with suspected UGB and were scheduled for endoscopy between October 19, 2019 and April 15, 2020. We included those with ≥ 18 years of age. This database contains the main characteristics of the standardized medical history for patients with UGB. Compliance with 13 of the 34 statements of the EsSalud CPG was evaluated. The results were presented descriptively, and the factors associated with compliance with the statements with insufficient adherence (<80%) and with more than 100 evaluated participants were evaluated. Results : Data were obtained from 184 patients who met the inclusion criteria (men: 59.8%, median age: 70 years). The range of adherence to the 13 statements was from 63.2% to 99.5%. Only two statements had insufficient adherence (<80%). The statement with the least adherence was the recommendation to perform a restrictive transfusion. Noncompliance with this recommendation was found to be lower in those who had a higher score on the Glasgow-Blatchford index, a urea creatinine ratio > 60, and a lower hemoglobin on admission. Conclusion : Of the 13 statements evaluated, 11 had satisfactory adherence. It is important to explore the reasons why adherence is not adequate for some statements, and to evaluate methods to increase this adherence.