[Clinical profile and results of acute pancreatitis in the Intensive and Intermediate Care Unit of a general hospital]. / Perfil clínico y resultados de la pancreatitis aguda en la Unidad de Cuidados Intensivos e Intermedios de un hospital genera.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that, according to the 2012 Atlanta classification, can be mild, moderate or severe. OBJECTIVE: Describe the epidemiological, clinical, therapeutic and outcomes of patients with AP admitted to the intensive care and intermediate care unit of a general hospital and compare them with those described in the national and international literature. MATERIALS AND METHODS: Observational study of patients with AP treated over a period of 3 years. RESULTS: 59 cases were included; the female sex prevailed (54.2%), the average age was 59.3 years, the most frequent etiology was biliary (84.7%). Average entry severity scores were APACHE II of 12.4 points, SOFA of 4.9 points and Marshall modified of 2.8 points; The most frequent organ failure was respiratory (47.5%). The average stay in care was 13.9 days and in the hospital it was 23.3 days. No patients with mild or moderate AP died during their hospital stay, 6 patients with severe AP died during their hospital stay (20% of cases of severe AP). CONCLUSION: The cases of our hospital had a clinical and therapeutic profile similar to that described in the world and Latin American literature. A hospital staying was greater than that described in recent works, but our mortality was lower.

Perfil clínico y análisis de sobrevida en pacientes con neoplasia mucinosa papilar intraductal diagnosticados por ecoendoscopía / Clinical profile and survival analysis in patients with intraductal papilar mucinous neoplasm by endoscopic ultrasound

RESUMEN Introducción. La neoplasia mucinosa papilar intraductal (IPMN) se diagnostica ahora con mayor frecuencia debido al mayor uso de los métodos de imágenes, y conlleva un desafío clínico su manejo y seguimiento por su probable transformación maligna. Objetivos. Conocer las características por ecoendoscopía (USE), evolución clínica y sobrevida de los pacientes diagnosticados de IPMN por USE. Materiales y métodos. Estudio de cohorte retrospectivo con análisis de sobrevida en pacientes diagnosticados de IPMN por USE entre 2013 y 2018 en el Hospital Nacional Edgardo Rebagliati Martins (HNERM). Se analizaron variables demográficas y ecoendoscópicas, además de seguimiento hasta el fallecimiento o 6 meses después del término del estudio. Se realizó el análisis de sobrevida con los métodos de Kaplan-Meyer y de regresión de Cox. Resultados. Se incluyeron 133 pacientes con IPMN. Edad media fue 68,6 años, 80 (60,2%) fueron mujeres. Según subtipos, 89 (66,9%) fueron de rama secundaria, 23 (17,3%) de ducto principal y 21 (15,8%) de tipo mixto. La principal localización fue cabeza de páncreas (41,4%). En el seguimiento, 22 (16,5%) fueron a cirugía, 22 (16,5%) fallecieron después de una mediana de seguimiento de 522 días. En 8 pacientes (6%) se detectó neoplasia maligna. La tasa de sobrevida global fue 86.8% (IC 95%, 79,6-91,6) al año y de 81.9% (IC95%, 73,3-88,0) a los 3 años. En análisis univariado los factores asociados a la sobrevida fueron los subtipos de IPMN-DP (p=0,02) y mixto (p=0,005), sexo masculino (p=0,004), tamaño de lesión ≥30 mm (p=0,000), nódulos (p=0,014) y Wirsung ≥10 mm (p=0,01). En el análisis multivariado, los factores predictores asociados con la sobrevida fueron: IPMN-DP (HR=6,3, p=0,005), IPMN mixto (HR=4,9, p=0,008) y tamaño de lesión ≥30 mm (HR=7,1, p=0,000). Conclusiones. El diagnostico de IPMN de ducto principal y mixto se asocian como factores predictores de sobrevida, al igual que el tamaño de la lesión ≥30 mm.

ABSTRACT Introduction: Intraductal papillary mucinous neoplasms (IPMN) are diagnosed more frequently because the higher use of radiologic exams, in that sense they are a great challenge to define its management and treatment in relation to its potential malignant transformation. Objective: To describe IPMN clinical profile, endoscopic ultrasound (EUS) characteristics and survival in all patients diagnosed with IPMN by EUS at HNERM. Materials and methods: Retrospective cohort of patients with IPMN diagnosed at HNERM by EUS from 2013 to 2018. Descriptive statistics was used for clinical profile and EUS characteristics. Kaplan Meir Method and Cox regression analysis was applied for survival analysis. Results: 133 patients with IPMN were included. Medium age was 68.6 years, 80 (60.2%) were female. According to IPMN subtypes, 89 (66.9%) originated from secondary branch, 23 (17.3%) from main duct (MD) and 21 (15.8%) were mixed type (MT). Head of pancreas was the main localization (41.4%). In follow-up, 22 (16.5%) were derived to surgery. Mortality occurred in 16.5% (22 cases) after a median follow-up of 522 days. Malignant transformation was diagnosed in 6% (8 cases). Survival was 86.8% (IC 95%, 79.6-91.6) at 1 year and 81.9% (IC95%, 73.3-88.0) at 3 years. Univariate analysis demonstrated that factors associated to survival were MD-IPMN (p=0.02) y MT-IPMN (p=0.005), male gender (p=004), nodule size ≥30 mm (p=0.000), presence of nodules (p=0.014) and Wirsung ≥10 mm (p=0.01). Multivariate analysis showed that predictive factors for survival were MD-IPMN (HR=6.3, p=0.005), MT-IPMN (HR=4.9, p=0.008) and nodule size ≥30 mm (HR=7.1, p=0.000). Conclusions: Diagnosis of MD-IPMN and MT-IPMN are predictive factors for survival as well as nodule size ≥ 30mm.

[Safety and efficacy of the use of self-expanding metal stents in the management ofunresectable malignant biliary stenosis]. / Seguridad y eficacia del uso de prótesis metálicas autoexpandibles en elmanejo de estenosis malignas de la vía biliar irresecables.

BACKGROUND: In recent years there has been an increase in the use of self-expanding metallic stents (SEMS) in patients with unresectable malignant stenosis of the bile duct. However, in Peru there are no reports on the safety and efficacy of this procedure. OBJECTIVE: To evaluate the safety and efficacy of the use of SEMS in the palliative management of malignant stenosis of the bile duct. MATERIALS AND METHODS: Retrospective cohort. All patients referred for placement of biliary SEMS as part of a palliative treatment between January 2016 and August 2018 were included. Rates of successful placement of SEMS, adequate palliation of the obstruction, and complications associated with the procedure were obtained. The patency of the prosthesis was evaluated during follow-up. Survival was determined after placement of the prosthesis. RESULTS: We included 32 patients with indication of palliative management due to an unresectable malignant stenosis of the bile duct. Pancreatic cancer (56.25%) followed by cholangiocarcinoma (31.25%) were the most frequent etiologies. A successful first-time placement rate of 96.97% was achieved. Adequate palliation of biliary obstruction was achieved in 100% of patients (p<0.05). Two SEMStc migrated during follow-up (6.25%) being managed with the placement of a new SEMSuc. CONCLUSIONS: The placement of SEMS is a safe and effective therapeutic strategy in the palliative management of patients with malignant obstruction of the biliary tract.

Seguridad y eficacia del uso de prótesis metálicas autoexpandibles en el manejo de estenosis malignas de la vía biliar irresecables / Safety and efficacy of the use of self-expanding metal stents in the management of unresectable malignant biliary stenosis

Antecedentes: En los últimos años se ha producido un incremento del uso de prótesis metálicas autoexpandibles (SEMS) en pacientes con estenosis malignas irresecables de la vía biliar. Sin embargo, en Perú no se cuentan con reportes sobre la seguridad y eficacia de este procedimiento. Objetivo: Evaluar la seguridad y eficacia del uso de las SEMS en el manejo paliativo de las estenosis malignas de la vía biliar. Materiales y métodos: Cohorte retrospectiva. Se incluyeron a todos los pacientes referidos para colocación de SEMS biliar como parte de un tratamiento paliativo entre enero del 2016 y agosto del 2018. Se obtuvieron las tasas de colocación exitosa de las SEMS, de paliación adecuada de la obstrucción y de complicaciones asociadas al procedimiento. Se evaluó la patencia de la prótesis durante el seguimiento. Se determinó la supervivencia luego de la colocación de la prótesis. Resultados: Se incluyeron 32 pacientes con indicación de manejo paliativo debido a una estenosis maligna irresecable de la vía biliar. El cáncer de páncreas (56,25%) seguido del colangiocarcinoma (31,25%) fueron las etiologías más frecuentes. Se alcanzó una tasa de colocación exitosa en primera intención de 96,97%. La paliación adecuada de la obstrucción biliar se alcanzó en el 100% de los pacientes (p<0,05). Dos SEMStc migraron durante el seguimiento (6,25%) siendo manejados con la colocación de una nueva SEMSnc. Conclusiones: La colocación de SEMS constituye una estrategia segura, con alta tasa de éxito terapéutico en el manejo paliativo de los pacientes con obstrucción maligna de la vía biliar.

Background: In recent years there has been an increase in the use of self-expanding metallic stents (SEMS) in patients with unresectable malignant stenosis of the bile duct. However, in Peru there are no reports on the safety and efficacy of this procedure. Objective: To evaluate the safety and efficacy of the use of SEMS in the palliative management of malignant stenosis of the bile duct. Materials and methods: Retrospective cohort. All patients referred for placement of biliary SEMS as part of a palliative treatment between January 2016 and August 2018 were included. Rates of successful placement of SEMS, adequate palliation of the obstruction, and complications associated with the procedure were obtained. The patency of the prosthesis was evaluated during follow-up. Survival was determined after placement of the prosthesis. Results: We included 32 patients with indication of palliative management due to an unresectable malignant stenosis of the bile duct. Pancreatic cancer (56.25%) followed by cholangiocarcinoma (31.25%) were the most frequent etiologies. A successful first-time placement rate of 96.97% was achieved. Adequate palliation of biliary obstruction was achieved in 100% of patients (p<0.05). Two SEMStc migrated during follow-up (6.25%) being managed with the placement of a new SEMSuc. Conclusions: The placement of SEMS is a safe and effective therapeutic strategy in the palliative management of patients with malignant obstruction of the biliary tract.

Fasciola hepatica in the common bile duct: spyglass visualization and endoscopic extraction

We report the case of a 60-year-old Peruvian female who was admitted with abdominal pain and jaundice. Cholangioscopy revealed a leaf-like trematode, Fasciola hepatica. This trematode was extracted with a Dormia's basket via endoscopic retrograde cholangiopancreatography (ERCP)

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Factors associated with complications during endoscopic esophageal dilation.

BACKGROUND: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. OBJECTIVE: to assess the safety of esophageal dilation and the factors associated with the development of complications. MATERIALS AND METHODS: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. RESULTS: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. CONCLUSIONS: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.

Factores asociados a complicaciones en las dilataciones esofágicas endoscópicas / Factors associated with complications during endoscopic esophageal dilation

Antecedentes: las dilataciones endoscópicas se consideran el tratamiento de elección para las estenosis esofágicas, sin embargo, no se cuenta en nuestra región con estudios en los que se evalúe la seguridad de este procedimiento. Objetivo: evaluar la seguridad de las dilataciones esofágicas y los factores asociados a las complicaciones. Material y métodos: cohorte retrospectiva. Se incluyeron todos los pacientes referidos para dilatación esofágica entre enero de 2015 y junio de 2017. Se obtuvo la tasa de complicaciones y se determinó la asociación entre la no adherencia a la "regla de los tres" y el desarrollo de complicaciones. Se analizaron otros factores predictivos asociados al desarrollo de complicaciones. Resultados: se incluyeron 164 pacientes en los que se realizaron 474 dilataciones. La etiología más prevalente fue la estenosis de anastomosis quirúrgica. Se presentaron seis complicaciones: tres perforaciones (0,63%), dos sangrados (0,42%) y un episodio de dolor significativo que requirió observación posprocedimiento (0,21%). La dilatación endoscópica esofágica fuera de la "regla de los tres" no se encontró asociada a un mayor riesgo de complicaciones. La dilatación con balón fue el único factor predictivo para el desarrollo de complicaciones. Conclusiones: la dilatación esofágica es un procedimiento seguro. La no adherencia a la "regla de los tres" no parece estar asociada a un mayor riesgo de complicaciones, incluyendo la perforación esofágica

Background: endoscopic dilation is considered as the treatment of choice for esophageal strictures. However, there are no studies in our region that have assessed the safety of the procedure. Objective: to assess the safety of esophageal dilation and the factors associated with the development of complications. Materials and methods: a retrospective cohort was studied. All patients referred for esophageal dilation between January 2015 and June 2017 were included in the study. A complication rate was obtained and the association between nonadherence to the "rule of 3" and the development of complications was determined. Other predictive factors associated with complication development were also analyzed. Results: a total of 164 patients that underwent 474 dilations were included in the study. Surgical anastomosis stricture was the most prevalent etiology. A total of six complications occurred, including three perforations (0.63%), two bleeding events (0.42%) and one episode of significant pain that required post-procedure observation (0.21%). Endoscopic esophageal dilation without adherence to the "rule of 3" was not associated with a higher risk of complications. Balloon dilation was the only predictive factor for complications. Conclusions: esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation

Fasciola hepatica in the common bile duct: spyglass visualization and endoscopic extraction.

We report the case of a 60-year-old Peruvian female who was admitted with abdominal pain and jaundice. Cholangioscopy revealed a leaf-like trematode, Fasciola hepatica. This trematode was extracted with a Dormia's basket via endoscopic retrograde cholangiopancreatography (ERCP).

[Lower prevalence of Helicobacter pylori infection observed in patients with erosive esophagitis]. / Menor prevalencia de infecciónpor Helicobacter pylori observada en pacientes con esofagitis erosiva.

OBJECTIVES: To investigate the prevalence of helicobacter pylori infection and the histological type of gastritis in patients with erosive esophagitis and compare these findings with a control group without esophagitis. MATERIALS AND METHODS: Prospective study in the settings of a private clinic in Lima, Peru. Each esophagitis and control patient had two biopsies taken from the antrum, two from the corpus as well as two additional samples for the ureasa (CLO) test. If any of the samples was positive for helicobacter, the patient was considered infected. The histological type of gastritis was assessed in the biopsies. RESULTS: 140 adult patients (69% males, mean age 48 years) with endoscopically proven esophagitis and 140 control cases, matched by age and sex, were included. A lower prevalence of helicobacter infection was found in the esophagitis group (27 vs. 44% p= 0.004).The risk for esophagitis was also lower in the patients with helicobacter OR: 0.48 IC95% (0.28 - 0.82. A higher percentage of normal gastric histology was found in the patients with esophagitis (44 vs. 31% p= 0.036). In 16 patients the erosive esophagitis was developed "de novo", after the eradication of helicobacter. CONCLUSIONS: A lower prevalence of helicobacter infection and a higher percentage of normal gastric mucosa were found in patients with endoscopic proven erosive esophagitis.

Menor prevalencia de infección por Helicobacter pylori observada en pacientes con esofagitis erosiva / Lower prevalence of Helicobacter pylori infection observed in patients with erosive esophagitis

Objetivos: Investigar la prevalencia de infección por Helicobacter pylori y el tipo histológico de gastritis que presentan los pacientes con esofagitis erosiva confirmada por endoscopía. Contrastar estos resultados con los de un grupo control sin esofagitis. Materiales y métodos: Estudio realizado con recolección prospectiva de datos en una clínica privada de Lima, Perú. En cada paciente y control se tomaron 2 biopsias del antro gástrico, 2 del cuerpo y 2 muestras para el test de la ureasa. Si alguna de estas pruebas era positiva para helicobacter se consideraba al paciente infectado. Se determinó el tipo de gastritis en las biopsias. Resultados: Ingresaron al estudio 140 pacientes adultos con esofagitis, edad promedio 48 años, 69% varones y 140 controles pareados por edad y sexo. La prevalencia de infección por helicobacter fue menor en los pacientes con esofagitis (27 vs 44% p=0,004). Los pacientes infectados mostraron menor riesgo de presentar esofagitis: OR: 0,48 IC95% (0,28 - 0,82) No se demostró diferencias en el tipo histológico de gastritis, pero si hubo una mayor proporción de pacientes con histología gástrica normal en el grupo con esofagitis (44 vs 31% p= 0,036). En 16 pacientes la esofagitis erosiva se desarrolló “de novo” luego de la erradicación del helicobacter. Conclusiones: Se demostró una menor prevalencia de infección por helicobacter y una mayor proporción de biopsias gástricas normales en los pacientes con esofagitis erosiva.

Objectives: To investigate the prevalence of helicobacter pylori infection and the histological type of gastritis in patients with erosive esophagitis and compare these findings with a control group without esophagitis. Materials and methods: Prospective study in the settings of a private clinic in Lima, Peru. Each esophagitis and control patient had two biopsies taken from the antrum, two from the corpus as well as two additional samples for the ureasa (CLO) test. If any of the samples was positive for helicobacter, the patient was considered infected. The histological type of gastritis was assessed in the biopsies. Results: 140 adult patients (69% males, mean age 48 years) with endoscopically proven esophagitis and 140 control cases, matched by age and sex, were included. A lower prevalence of helicobacter infection was found in the esophagitis group (27 vs. 44% p= 0.004). The risk for esophagitis was also lower in the patients with helicobacter OR: 0.48 IC95% (0.28 - 0.82. A higher percentage of normal gastric histology was found in the patients with esophagitis (44 vs. 31% p= 0.036). In 16 patients the erosive esophagitis was developed “de novo”, after the eradication of helicobacter. Conclusions: A lower prevalence of helicobacter infection and a higher percentage of normal gastric mucosa were found in patients with endoscopic proven erosive esophagitis.

Etiología de la diarrea crónica en el adulto mayor del Hospital Edgardo Rebagliati - Lima-Perú: estudio retrospectivo 2005-2011 / Etiology of chronic diarrhea in the elderly in Hospital Edgardo Rebagliati, Lima-Peru

INTRODUCCION: El impacto de la diarrea crónica en el adulto mayor es desproporcionado por diversos factores provocando mayor morbilidad y mortalidad. OBJETIVO: Describir las principales características acerca de la diarrea crónica en los pacientes ancianos del hospital Nacional Edgardo Rebagliati (Lima-Perú) durante el periodo enero del 2005 a diciembre del 2011, METODO: Estudio descriptivo y retrospectivo en la cual se revisaron las historias clínicas de los pacientes adultos mayores con el diagnostico de diarrea crónica, vertiéndose los datos en una ficha de recolección. RESULTADOS: Se revisaron las historias clínicas de 202 pacientes. La edad media fue de 73,5±6,7 años, siendo la mayoría mujeres (57.43%). Las principales comorbilidades fueron las cardiovasculares (60,4%) y endocrinas (27,2%). El tiempo de enfermedad medio fue de 21.6 ± 13.6 semanas. Los exámenes más solicitados fueron hemograma, bioquímica (glucosa, urea y creatinina), albumina, coprofuncional, parasitologico y colonoscopia. El tipo de diarrea más frecuente fue organica (84,16%). Dentro de las principales causas se encontró a la colitis microscópica (35,15%), parasitosis (15,84%), síndrome de intestino irritable (14,85%) y sobrecrecimiento bacteriano (8,42%). CONCLUSIONES: Las causas más frecuentes de diarrea crónica en el anciano son colitis microscópica, parasitosis, síndrome de intestino irritable y sobrecrecimiento bacteriano.

INTRODUCTION: The impact of chronic diarrhea in the elderly is disproportionate by several factors causing increased morbidity and mortality. OBJECTIVE: To describe the main features about the chronic diarrhea in elderly patients from Edgardo Rebagliati Hospital (Lima-Peru) during the period January 2005 to December 2011, METHOD: A descriptive and retrospective study in which we reviewed the medical records of elderly patients with the diagnosis of chronic diarrhea, pouring in a data collection sheet. RESULTS: We reviewed the medical records of 202 patients. The mean age was 73.5 ± 6.7 years, with most women (57.43%). Major comorbidities were cardiovascular (60.4%) and endocrine (27.2%). The half time of illness was 21.6 ± 13.6 weeks. The most requested tests were CBC, biochemistry, albumin, coprofuncional, parasitological and colonoscopy. The most common type of diarrhea was the organic (84.16%). Among the main causes were found microscopic colitis (35.15%), parasites (15.84%), irritable bowel syndrome (14.85%) and bacterial overgrowth (8.42%). CONCLUSIONS: The most common causes of chronic diarrhea in the elderly are microscopic colitis, parasites, irritable bowel syndrome and bacterial overgrowth.

[Etiology of chronic diarrhea in the elderly in Hospital Edgardo Rebagliati, Lima-Peru]. / "Etiología de la diarrea crónica en el adulto mayor del Hospital Edgardo Rebagliati-Lima-Perú: estudio retrospectivo 2005-2011".

INTRODUCTION: The impact of chronic diarrhea in the elderly is disproportionate by several factors causing increased morbidity and mortality. OBJECTIVE: To describe the main features about the chronic diarrhea in elderly patients from Edgardo Rebagliati Hospital (Lima-Peru) during the period January 2005 to December 2011, METHOD: A descriptive and retrospective study in which we reviewed the medical records of elderly patients with the diagnosis of chronic diarrhea, pouring in a data collection sheet. RESULTS: We reviewed the medical records of 202 patients. The mean age was 73.5 ± 6.7 years, with most women (57.43%). Major comorbidities were cardiovascular (60.4%) and endocrine (27.2%). The half time of illness was 21.6 ± 13.6 weeks. The most requested tests were CBC, biochemistry, albumin, coprofuncional, parasitological and colonoscopy. The most common type of diarrhea was the organic (84.16%). Among the main causes were found microscopic colitis (35.15%), parasites (15.84%), irritable bowel syndrome (14.85%) and bacterial overgrowth (8.42%). CONCLUSIONS: The most common causes of chronic diarrhea in the elderly are microscopic colitis, parasites, irritable bowel syndrome and bacterial overgrowth.