[Cecal tuberculosis: the importance of a high diagnostic suspicion]. / Tuberculosis cecal: la importancia de una alta sospecha diagnóstica.

Intestinal tuberculosis is less common than pulmonary tuberculosis. Its clinical and endoscopic features are nonspe-cific, so diagnostic suspicion must be high in order to make an early diagnosis and prevent iatrogenia. Pharmacotherapy is often effective, with an excellent clinical and endoscopic evolution. Surgical treatment is reserved for complications. We present the case of cecal tuberculosis diagnosed endoscopically; this is the second case diagnosed in a few months in our center. In this case there were no risk factors, such as recent travel, risk of contacts or inmunosupression.

Ultrasonography is an accurate technique for the diagnosis of gastrointestinal tumors in patients without localizing symptoms.

INTRODUCTION AND OBJECTIVES: This study compared the accuracy of ultrasonography in the diagnosis of gastrointestinal tumors in patients with several degrees of clinical suspicion. MATERIAL AND METHODS: We recruited patients that were suspect for gastrointestinal neoplasia but with no evidence of localizing symptoms (group A), and patients that were suspect for colon cancer (group B) or for gastric cancer (group C). Accuracy in the diagnosis was compared for: gastric cancer in groups A and C, and for colon cancer in groups A and B. The comparison was made by using the contingency coefficient, which quantifies coincidence of endoscopic and ultrasonographic diagnoses. RESULTS: Seventy-nine patients were included in group A (48 males), wherein 12 colon and 5 gastric neoplasms were detected. Group B was comprised of 153 patients (78 males) and included 66 patients with colorectal cancer (CCR). Group C contained 58 patients (35 males), 31 of whom were diagnosed with gastric cancer. The accuracy of sonography for diagnosing colon cancer was 95.5% for group A and 87.5% for group B. The contingency coefficient for endoscopy vs. ultrasonography was greater for group A: 0.658 than for group B: 0.549. The diagnostic accuracy for gastric cancer was 97.4% for group A and 86.2% for group C. The contingency coefficient between endoscopic and ultrasonographic diagnoses was also greater in group A (0.618) than in group C (0.588). CONCLUSIONS: The accuracy of ultrasonography in diagnosing colon and gastric cancer is not lower in patients without localizing symptoms.

La ecografía es una técnica sensible en el diagnóstico de las neoplasias gastrointestinales en pacientes sin síntomas localizadores / Ultrasonography is an accurate technique for the diagnosis of gastrointestinal tumors in patients without localizing symptoms

Introducción y objetivos: en todos los estudios publicadoshasta la fecha se ha evaluado la precisión de la ecografía en eldiagnóstico del cáncer de colon y del cáncer gástrico en pacientesen los que esta era la sospecha diagnóstica o ya con un diagnósticoestablecido de esta patología. Nosotros, en este estudio, comparamosla sensibilidad de la ecografía en pacientes con diferentesgrados de sospecha clínica.Material y método: reclutamos pacientes con sospecha deneoplasia digestiva, sin evidencia de síntomas localizadores (grupoA), pacientes con sospecha de cáncer de colon (grupo B) y pacientescon sospecha de cáncer gástrico (grupo C). Comparamosla precisión de la ecografía en el diagnóstico del cáncer gástricoen los grupos A y C, y la precisión en el diagnóstico del cáncer decolon en los grupos A y B. El parámetro usado en la comparaciónes el coeficiente de contigencia que cuantifica la coincidencia dediagnóstico endoscópico y ecográfico.Resultados: se han incluido 79 pacientes en el grupo A (48varones y 31 mujeres, con una edad media de 69,3 años), en losque se han diagnosticado 12 neoplasias colónicas y 5 gástricas. Elgrupo B se compone de 153 pacientes (78 varones y 75 mujeres,con una edad media de 66,5 años) e incluye 66 pacientes conCCR. Finalmente, el grupo C está formado por 58 pacientes (35varones y 23 mujeres, con una edad media de 67,4 años), siendodiagnosticados de cáncer gástrico 31 pacientes. La precisión de laecografía en el diagnóstico del cáncer de colon fue del 95,5% enel grupo A y del 87,5% en el grupo B. El coeficiente de contingenciaentre los diagnósticos endoscópico y ecográfico tambiénfue superior en el grupo A: 0,658 frente a 0,549. La precisión dela ecografía en el diagnóstico del cáncer gástrico fue del 97,4% enel grupo A y del 86,2% en el grupo C...(AU)

Introduction and objectives: this study compared the accuracyof ultrasonography in the diagnosis of gastrointestinal tumorsin patients with several degrees of clinical suspicion.Material and methods: we recruited patients that were suspectfor gastrointestinal neoplasia but with no evidence of localizingsymptoms (group A), and patients that were suspect for coloncancer (group B) or for gastric cancer (group C). Accuracy in thediagnosis was compared for: gastric cancer in groups A and C,and for colon cancer in groups A and B. The comparison wasmade by using the contingency coefficient, which quantifies coincidenceof endoscopic and ultrasonographic diagnoses.Results: seventy-nine patients were included in group A (48males), wherein 12 colon and 5 gastric neoplasms were detected.Group B was comprised of 153 patients (78 males) and included66 patients with colorectal cancer (CCR). Group C contained 58patients (35 males), 31 of whom were diagnosed with gastric cancer.The accuracy of sonography for diagnosing colon cancer was95.5% for group A and 87.5% for group B. The contingency coefficientfor endoscopy vs. ultrasonography was greater for groupA: 0.658 than for group B: 0.549. The diagnostic accuracy forgastric cancer was 97.4% for group A and 86.2% for group C.The contingency coefficient between endoscopic and ultrasonographicdiagnoses was also greater in group A (0.618) than ingroup C (0.588).Conclusions: the accuracy of ultrasonography in diagnosingcolon and gastric cancer is not lower in patients without localizingsymptoms(AU)

[Usefulness of ultrasonography in diagnosing patients suspect for digestive tract neoplasms]. / Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo.

BACKGROUND: The Positive Predictive Value (PPV) of signs and symptoms for the diagnosis of colon and gastric cancer is low. Furthermore, many patients are referred to us to discard a digestive tract neoplasm with no symptoms suggestive of its whereabouts, in whom clinical PPV is even lower. This study evaluates the usefulness of ultrasonography as a first approach to diagnosis. MATERIAL AND METHODS: Seventy-nine patients were recruited into the study (48 males with an average age of 69.3 years). Ultrasonography was performed on all patients prior to endoscopy. Parameters studied included diagnostic accuracy for colon and gastric cancer, ultrasonographic diagnoses, and number of endoscopies that can be avoided. Predictive factors for neoplasm location were also studied. RESULTS: Five gastric cancers (6.3%), 12 colon cancers (15,1%), 3 pancreatic cancers (3.8%), 2 uterine neoplasms (2.5%), and 2 hypernephromas (2.5%) were diagnosed. The figures for sensitivity, specificity, PPV, Negative Predictive Value (NPV) and global accuracy of ultrasonography were 80%, 98.6%, 80%, 98.6%, and 97.4%, respectively, for gastric cancer, while these figures were 100%, 94.5%, 80%, 100%, and 95.5%, respectively, for colon cancer. Ultrasonography enabled to avoid 10% of endoscopic explorations. The only parameter that helps locate a neoplasm is the presence of anemia, which is more frequently associated with a diagnosis of colon cancer: 30.4 versus 4.3% (p = 0.033). CONCLUSIONS: In patients without specific symptoms who were sent to us for discarding digestive tract neoplasm, "extra-digestive" neoplasms were frequently diagnosed. If we further take into account the high diagnostic accuracy of ultrasonography, then this procedure could be a very good first approach towards such diagnosis.

Utilidad de la ecografía en el diagnóstico de los pacientes con sospecha de neoplasias del tubo digestivo / No disponible

Introducción: el valor predictivo positivo de síntomas y signosen el diagnóstico del cáncer de colon y gástrico es bajo. Además,muchos pacientes son remitidos para descartar una neoplasiadigestiva, sin síntomas que sugieran su localización, siendo elVPP de la clínica aún menor. En este trabajo evaluamos la utilidadde la ecografía como primera aproximación diagnóstica.Material y método: se han reclutado 79 pacientes (48 varones,edad media 69,3 años). En todos ellos se realiza una ecografíaantes de la endoscopia. Se evalúa la precisión en el diagnósticodel cáncer de colon y gástrico, los diagnósticos ecográficos y elnúmero de endoscopias que se evitarían. También se buscan factorespredictivos de la localización de la neoplasia.Resultados: se han diagnosticado 5 neoplasias gástricas(6,3%) y 12 de colon (19%), 3 cáncer de páncreas (3,8%), 2 neoplasiasuterinas (2,5%) y 2 hipernefromas (2,5%). Las cifras desensibilidad, especificidad, VPP, VPN y precisión de la ecografíafueron 80%, 98,6%; 80%; 98,6%; y 97,4% respectivamente enel diagnóstico del cáncer gástrico, y del 100%, 94,5%; 80%;100% y 95,5% respectivamente en el diagnóstico del cáncer decolon. La ecografía permitió evitar el 10% de las endoscopias. Elúnico dato que orienta la localización de la neoplasia es la presenciade anemia, que se asocia con mayor frecuencia al diagnósticode cáncer de colon: 30,4 versus 4,3% (p = 0,033).Conclusiones: en los pacientes remitidos para descartar unaneoplasia digestiva, con síntomas inespecíficos, se diagnostica confrecuencia de patología neoplásica ajena al tubo digestivo. Si consideramos,además, la elevada precisión diagnóstica de la ecografía,esta podría ser una muy buena primera aproximación diagnóstica

Background: the Positive Predictive Value (PPV) of signs andsymptoms for the diagnosis of colon and gastric cancer is low. Furthermore,many patients are referred to us to discard a digestive tractneoplasm with no symptoms suggestive of its whereabouts, in whomclinical PPV is even lower. This study evaluates the usefulness of ultrasonographyas a first approach to diagnosis.Material and methods: seventy-nine patients were recruitedinto the study (48 males with an average age of 69.3 years). Ultrasonographywas performed on all patients prior to endoscopy. Parametersstudied included diagnostic accuracy for colon and gastriccancer, ultrasonographic diagnoses, and number of endoscopies thatcan be avoided. Predictive factors for neoplasm location were alsostudied.Results: five gastric cancers (6.3%), 12 colon cancers (15,1%), 3pancreatic cancers (3.8%), 2 uterine neoplasms (2.5%), and 2 hypernephromas(2.5%) were diagnosed. The figures for sensitivity, specificity,PPV, Negative Predictive Value (NPV) and global accuracy ofultrasonography were 80%, 98.6%, 80%, 98.6%, and 97.4%, respectively,for gastric cancer, while these figures were 100%,94.5%, 80%, 100%, and 95.5%, respectively, for colon cancer. Ultrasonographyenabled to avoid 10% of endoscopic explorations.The only parameter that helps locate a neoplasm is the presence ofanemia, which is more frequently associated with a diagnosis ofcolon cancer: 30.4 versus 4.3% (p = 0.033).Conclusions: in patients without specific symptoms who weresent to us for discarding digestive tract neoplasm, “extra-digestive”neoplasms were frequently diagnosed. If we further take into accountthe high diagnostic accuracy of ultrasonography, then this procedurecould be a very good first approach towards such diagnosis

[Perforation risk in esophageal endoscopic mucosal resection with ligation: an experimental study with two ligator models]. / Riesgo de perforación en la mucosectomía esofágica con banda: estudio experimental con dos modelos de ligadores.

OBJECTIVE: endoscopic mucosal resection with ligation (EMRL) is considered an efficient, safe method for the treatment of some esophageal, gastric and colorectal tumors. We conducted this study using a porcine model in order to compare the safety of esophageal EMRL with two multiband ligation systems, since many centers only use these ligator models in EMRL (commercialized for varix ligation). METHODS: eight pigs were used, which were submitted to 23 esophageal resections without previous injection. Ten resections were conducted using the Six Shooter Saeed model, and 13 resections used the Speedband Superview Super 7 model. The technique was also compared by making random cuts either above or below the band. RESULTS: five perforations occurred, all of them using the Speedband model. This represents 38.5% of total in the Speedband model group. No perforation occurred when using the Six Shooter model (p = 0.046). On the contrary, no significant differences were found regarding frequency of perforation when cutting above or below the band. CONCLUSIONS: esophageal EMRL using the Speedband model without previous injection leads to perforation in a high percentage of cases in an experimental animal model. Further studies are required to find out whether a previous injection may increase the safety of this technique with this ligator model.

Endoscopic ultrasound-assisted endoscopic resection of carcinoid tumors of the gastrointestinal tract.

INTRODUCTION: Usually found in the gastrointestinal tract, carcinoids are the most frequent neuroendocrine tumors. Most of these lesions are located in areas that are difficult to access using conventional endoscopy (small intestine and appendix); carcinoid tumors found in the gastroduodenal tract and in the large intestine can be studied endoscopically; in these cases, if localized disease is confirmed, local treatment by endoscopic resection may be the treatment of choice. Since endoscopic ultrasonography has been shown to be the technique of choice for the study of tumors exhibiting submucosal growth, the selection of patients who are candidates for a safe and effective local resection should be based on this technique. PATIENTS AND METHOD: We selected patients with gastrointestinal carcinoid tumors who were endoscopically treated between 1997 and 2002. Those patients with tumors measuring less than 10 mm, which had not penetrated the muscularis propria, and those with localized disease were considered candidates for endoscopic resection. The endpoints of this study were to assess the effectiveness (complete resection) and safety (complications) of the technique. Follow-up consisted of eschar biopsies performed one month and twelve months after the resection. RESULTS: During the aforementioned period, we resected endoscopically 24 tumors in 21 patients (mean age: 51.7 years; 71.5% males). Most lesions were incidental discoveries made during examinations indicated for other reasons. Resection was indicated in most cases as a result of the suspected presence of a carcinoid tumor after endoscopic ultrasonography. Endoscopic ultrasonography also enabled us to clearly identify the layer where the lesion had originated, as well as the size of the lesion. The carcinoid tumor was removed in 13 cases (54.2%) by using the conventional snare polypectomy technique, in 9 cases (37.5%) assisted by a submucosal injection of saline solution and/or adrenaline, and in 2 cases (8.3%) after ligating the lesion with elastic bands. In all cases the resection was complete, with no recurrence during the follow-up period, and no major complications, except for a single case in which a post-polypectomy hemorrhage occurred that was endoscopically solved. CONCLUSIONS: In properly selected patients, the endoscopic resection of carcinoid tumors is a safe and effective technique that permits a complete resection in all cases with few complications. Endoscopic ultrasonography is the technique of choice for selecting the patients who are candidates for endoscopic resection.

Test de IBP y endoscopia en la ERGE / PPI test and endoscopy in GERD

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Cuerpos extraños colorrectales: un problema médico complicado / Colorectal foreign bodies: a complex medical problem

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