Endosonographic Characteristics of Subepithelial Lesions of the Upper Digestive Tract: Experience of a Referral Center in Colombia

Introduction: Subepithelial lesions (SELs), described as bulges or masses covered by healthy-looking mucosa, are usually found incidentally during endoscopic studies. They are typically asymptomatic and are estimated to be identified in 1% of esophagogastroduodenoscopies performed. Materials and methods: A descriptive study was conducted with retrospective data collection. We included all patients treated at the Unión de Cirujanos, a referral gastroenterology unit of the Coffee Region in Manizales, between January 2020 and January 2022, who underwent endoscopic ultrasonography to study subepithelial-looking lesions located in the esophagus, stomach, and duodenum. Results: 152 endoscopic ultrasounds were performed, finding 108 SELs; 66.6% of the patients were women, and the average age was 58. Most SELs were located in the stomach (78.7%), the antrum being the most frequent location. The average diameter of the gastric SELs was 14.6 mm, and 47% of the lesions depended on the fourth echolayer; the most frequent presumptive diagnoses were gastrointestinal stromal tumor (GIST; 65.8%) and lipoma (11.7%). Conclusions: SELs of the GI tract originate in the muscularis mucosae, submucosa, or muscularis propria. They are most frequently located in the stomach, and their characterization usually requires endoscopic ultrasonography and histopathology. Treatment of these lesions remains controversial due to their low frequency, histological variety, and low malignant potential.

Introducción: las lesiones subepiteliales (LSE), descritas como abultamientos o masas cubiertas por mucosa de aspecto sano, se encuentran usualmente de manera incidental durante estudios endoscópicos; suelen ser asintomáticas y se estima que se identifican en el 1% de las esofagogastroduodenoscopias realizadas. Métodos: se realizó un estudio descriptivo con recolección retrospectiva de la información. Se incluyeron todos los pacientes atendidos en Unión de Cirujanos, unidad de gastroenterología de referencia del Eje Cafetero ubicada en la ciudad de Manizales, entre enero de 2020 y enero de 2022, a quienes se les realizó ultrasonografía endoscópica como parte del estudio de lesiones de aspecto subepitelial localizadas en el esófago, estómago y duodeno. Resultados: se realizaron 152 endosonografías y se encontraron 108 lesiones subepiteliales, 66,6% de los pacientes eran mujeres y el promedio de edad fue 58 años. La mayoría de las LSE se localizaron en el estómago (78,7%) y, de estas, la localización más frecuente fue el antro; el diámetro promedio de las LSE gástricas fue de 14,6 mm y el 47% de las lesiones eran dependientes de la cuarta ecocapa; los diagnósticos presuntivos más frecuentes fueron el tumor del estroma gastrointestinal (GIST; 65,8%) y lipoma (11,7%). Conclusiones: las LSE del tracto gastrointestinal se originan en la muscular de la mucosa, submucosa o muscular propia, de manera más frecuente se localizan en el estómago y su caracterización suele requerir la realización de ultrasonografía endoscópica y estudio histopatológico. El tratamiento de estas lesiones sigue siendo controversial debido a su baja frecuencia, variedad histológica y bajo potencial maligno.

Improving Learning and Study Strategies in Undergraduate Medical Students: A Pre-Post Study.

We aimed to describe the impact of a structured interventional program to improve learning and study skills in undergraduate medical students from a Latin American medical school. The interventional program's design was based on diagnostic/prescriptive assessment test scores measuring ten scales. The program consisted of five tailored workshops. The cohort studied consisted of 81 third-year medical students. The outcome variable was the difference between "pre" and "post" test scores. The unadjusted score percentiles were used to compare improvement in learning and study skills. In addition, a sensitivity analysis was conducted to assess variation in the mean difference of the test scores by the number of workshops attended. The response rate was 100% (81/81) for the pre test and ~77% (62/81) for the post test. After the interventional program, nine out of ten scales showed statistical improvement, except for the scale of motivation. The scales with the highest and lowest percent change improvement were time management (66%, p-value: <0.001) and motivation (14.9%, p-value: 0.06). The students who attended more workshops obtained a higher percent change improvement in the post test. These findings suggest that through a well-designed interventional program, it is possible to improve learning and study skills among medical students.

The Impact of Strengthening Study Habits for Medical Students During COVID-19 Academic Transition: a Mixed-Methods Study.

PURPOSE: Assess the impact of learner-specific interventions on third-year medical students to cope with quarantine distance learning due to the COVID-19 pandemic. METHODS: We conducted a nested cross-sectional and mixed-methods study in a sample of 81 third-year medical students. Two face-to-face interventions were designed and conducted to offer tools to improve study habits, time management, and prioritizing skills. A nine-item structured questionnaire was administered. Descriptive statistics was performed for the quantitative section and thematic analysis for the qualitative section. RESULTS: Of the study population, 74.1% (60/81) completed the online questionnaire, 65.4% were female, and the mean age of the sample was 21.4±1.2 years old. Overall, ~50% of participants affirmed that the workshops were useful to improve time management, organize tasks and adapt to the new study modality imposed by the COVID-19 pandemic. More than 60% of the students found the application of the provided tools during the interventions (SMART and COMPASS) useful to determine personal values and set a proper mindset for coping with distance learning. Further, 93.3% of the respondents applied the SMART strategy learned to set goals at least once during the confinement time. These findings were also seen in the thematic analysis. CONCLUSIONS: Overall, most of the students found the workshops useful and were able to practice what they had learned during this pandemic lockdown. Medical schools and higher education institutions should evaluate the possibility of formally including study habit preparation for undergraduates' students in order to provide resilience and successful academic adaptation during an ever-changing world.

New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy.

BACKGROUND AND AIM: Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide nutrition to patients with a variety of gastrointestinal (GI) problems. The present study describes a new method of DPEJ using balloon-assisted-enteroscopy. METHODS: This observational, retrospective, single-arm case study conducted at a tertiary care hospital during a 15-month period included 25 patients (12 females, 13 males, mean age 54 years, age range 31-79 years) with necrotizing pancreatitis, n = 7; complex upper GI surgery, n = 6; complex fistula, n = 6; impossibility to place a gastrostomy tube, n = 5; and bowel obstruction, n = 1. The new DPEJ technique focused on three key components: (i) use of balloon-assisted overtube; (ii) use of fluoroscopy; (iii) leaving the overtube in place during the entire procedure (and also for DPEJ removal). RESULTS: Technical success was 96%. Mean time of the procedure was 30.5 min (range 24 to 45 min). Clinical success was 100% (24/24); all DPEJ could be used for their intended purpose. CONCLUSIONS: This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.