Impact of biliary stents in the performance of the EUS-guided tissue acquisition: A systematic review and meta-analysis / Impacto de los stents biliares en el rendimiento de la adquisición de biopsias guiadas por ecoendoscopia: una revisión sistemática y metanálisis

Introduction and aim: Pancreatobiliary tumours are challenging to diagnose exclusively by imaging methods. Although the optimum moment for carrying out the EUS is not well defined, it has been suggested that the presence of biliary stents may interfere with the proper staging of tumours and the acquisition of samples. We performed a meta-analysis to evaluate the impact of biliary stents on EUS-guided tissue acquisition yield. Material and methods: We conducted a systematic review in different databases, such as PubMed, Cochrane, Medline, and OVID Database. A search was made of all studies published up to February 2022. Results: Eight studies were analyzed. A total of 3185 patients were included. The mean age was 66.9±2.7 years; 55.4% were male gender. Overall, 1761 patients (55.3%) underwent EUS guided tissue acquisition (EUS-TA) with stents in situ, whereas 1424 patients (44.7%) underwent EUS-TA without stents. The technical success was similar in both groups (EUS-TA with stents: 88% vs EUS-TA without stents: 88%, OR=0.92 [95% CI 0.55–1.56]). The type of stent, the needle size and the number of the passes were similar in both groups. Conclusions: EUS-TA has similar diagnostic performance and technical success in patients with or without stents. The type of stent (SEMS or plastic) does not seem to influence the diagnostic performance of EUS-TA. Future prospectives and RCT studies are needed to strengthen these conclusions. (AU)

Introducción y objetivo: Los tumores pancreatobiliares son lesiones difíciles de diagnosticar exclusivamente por métodos de imagen. Aunque no está bien definido el momento óptimo para la realización de la ecoendoscopia (EUS), se ha demostrado que la presencia de stents biliares puede interferir en la correcta estadificación de los tumores y la toma de muestras. Realizamos un metanálisis para evaluar el impacto de los stents biliares en el rendimiento de la adquisición de tejido guiada por EUS. Material y métodos: Realizamos una revisión sistemática en diferentes bases de datos, como PubMed, Cochrane, Medline y OVID Database. Se realizó una búsqueda de todos los estudios publicados hasta febrero de 2022. Resultados: Se analizaron 8 estudios. Se incluyeron un total de 3.185 pacientes. La media de edad fue de 66,9±2,7 años; el 55,4% fueron pacientes de sexo masculino. En total, 1.761 pacientes (55,3%) se sometieron a biopsias guiadas por EUS con stents in situ, mientras que 1.424 pacientes (44,7%) se sometieron a dichas biopsias sin stents. El éxito técnico fue similar en ambos grupos (EUS con stents: 88% vs. EUS sin stents: 88%, OR=0,92 [IC 95% 0,55-1,56]). El tipo de stent, el tamaño de la aguja y el número de pases fueron similares en ambos grupos. Conclusiones: La biopsia por EUS tiene un rendimiento diagnóstico y un éxito técnico similares en pacientes con o sin stents. El tipo de stent (SEMS o plástico) no parece influir en el rendimiento diagnóstico de la adquisición de tejido guiada por EUS. Se necesitan futuros estudios prospectivos y estudios aleatorizados controlados para fortalecer estas conclusiones. (AU)

Impact of biliary stents in the performance of the EUS-guided tissue acquisition: A systematic review and meta-analysis.

INTRODUCTION AND AIM: Pancreatobiliary tumours are challenging to diagnose exclusively by imaging methods. Although the optimum moment for carrying out the EUS is not well defined, it has been suggested that the presence of biliary stents may interfere with the proper staging of tumours and the acquisition of samples. We performed a meta-analysis to evaluate the impact of biliary stents on EUS-guided tissue acquisition yield. MATERIAL AND METHODS: We conducted a systematic review in different databases, such as PubMed, Cochrane, Medline, and OVID Database. A search was made of all studies published up to February 2022. RESULTS: Eight studies were analyzed. A total of 3185 patients were included. The mean age was 66.9±2.7 years; 55.4% were male gender. Overall, 1761 patients (55.3%) underwent EUS guided tissue acquisition (EUS-TA) with stents in situ, whereas 1424 patients (44.7%) underwent EUS-TA without stents. The technical success was similar in both groups (EUS-TA with stents: 88% vs EUS-TA without stents: 88%, OR=0.92 [95% CI 0.55-1.56]). The type of stent, the needle size and the number of the passes were similar in both groups. CONCLUSIONS: EUS-TA has similar diagnostic performance and technical success in patients with or without stents. The type of stent (SEMS or plastic) does not seem to influence the diagnostic performance of EUS-TA. Future prospectives and RCT studies are needed to strengthen these conclusions.

EUS-Guided gallbladder drainage vs percutaneous transhepatic drainage in patients with acute cholecystitis: a systematic review and meta-analysis

Occasionally, cholecystectomy is not possible because the patient is not suitable for surgery, and non-operative management should be performed. In these patients, the non-operative management can be through the percutaneous transhepatic gallbladder drainage (PTGBD) or the endoscopic gallbladder drainage. We decided to compare the efficacy and safety of PTGBD and EUS-GBD in the non-operative management of patients with acute cholecystitis. We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta-analysis considers studies published until September 2021. Six studies were selected (2 RCTs). These studies included 749 patients. The mean age was 72.81 ±7.41 years, and males represented 57.4%. EUS-GBD technical success was lower than PTGBD (RR, 0.97; 95% CI, 0.95-0.99), whereas clinical success and adverse events rates were similar in both groups. Twenty-one deaths were reported in all six studies. The global mortality rate was 2.80%, without differences in both groups (2.84% and 2.77% in the EUS-GBD group and the PTGBD groups, respectively). EUS-GBD and PTGBD were successful techniques for gallbladder drainage in patients with acute cholecystitis who are non-tributary for surgery. EUS-GBD has a similar clinical success rate and a similar adverse events rate in comparison to PTGBD. The high technical success and the low adverse events rate of the EUS approach to gallbladder make this technique an excellent alternative for patients with acute cholecystitis who cannot be undergoing surgery.

En ocasiones, no es posible realizar una colecistectomía debido a que el paciente no es apto para la cirugía, y se debe optar por un manejo no quirúrgico. En estos pacientes, el manejo no quirúrgico puede ser a través del drenaje transhepático percutáneo de la vesícula o bien el drenaje ecoendoscópico de la misma. En el presente trabajo decidimos comparar la eficacia y seguridad de ambas técnicas en el manejo no quirúrgico de pacientes con colecistitis aguda. Métodos: Se realizó una revisión sistemática en diferentes bases de datos, como PubMed, OVID, Medline y Cochrane Databases. Este metanálisis considera estudios publicados hasta septiembre de 2021. Se seleccionaron seis estudios (2 estudios aleatorizados controlados). Estos estudios incluyeron 749 pacientes. La edad media fue de 72,81 ± 7,41 años, y los varones representaron el 57,4%. El éxito técnico del drenaje ecoendoscópico fue menor que el del drenaje percutáneo (RR, 0,97; IC del 95 %, 0,95-0,99), mientras que las tasas de éxito clínico y de eventos adversos fueron similares en ambos grupos. Se reportaron 21 muertes en los seis estudios. La tasa de mortalidad global fue del 2,80%, sin diferencias en ambos grupos (2,84% y 2,77% en el grupo ecoendoscópico y en el percutáneo, respectivamente). El drenaje ecoendoscópico y el drenaje percutáneo fueron técnicas exitosas para el drenaje de la vesícula biliar en pacientes con colecistitis aguda que no son tributarios de cirugía. El drenaje ecoendoscópico tiene una tasa de éxito clínico similar y una tasa de eventos adversos similar al drenaje percutáneo. El alto éxito técnico y la baja tasa de eventos adversos del abordaje ecoendoscópico de la vesícula biliar hacen de esta técnica una excelente alternativa para pacientes con colecistitis aguda que no pueden ser intervenidos quirúrgicamente.

EUS-Guided gallbladder drainage vs percutaneous transhepatic drainage in patients with acute cholecystitis: a systematic review and meta-analysis.

Occasionally, cholecystectomy is not possible because the patient is not suitable for surgery, and non-operative management should be performed. In these patients, the non-operative management can be through the percutaneous transhepatic gallbladder drainage (PTGBD) or the endoscopic gallbladder drainage. We decided to compare the efficacy and safety of PTGBD and EUS-GBD in the non-operative management of patients with acute cholecystitis. We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta-analysis considers studies published until September 2021. Six studies were selected (2 RCTs). These studies included 749 patients. The mean age was 72.81 ±7.41 years, and males represented 57.4%. EUS-GBD technical success was lower than PTGBD (RR, 0.97; 95% CI, 0.95-0.99), whereas clinical success and adverse events rates were similar in both groups. Twenty-one deaths were reported in all six studies. The global mortality rate was 2.80%, without differences in both groups (2.84% and 2.77% in the EUS-GBD group and the PTGBD groups, respectively). EUS-GBD and PTGBD were successful techniques for gallbladder drainage in patients with acute cholecystitis who are non-tributary for surgery. EUS-GBD has a similar clinical success rate and a similar adverse events rate in comparison to PTGBD. The high technical success and the low adverse events rate of the EUS approach to gallbladder make this technique an excellent alternative for patients with acute cholecystitis who cannot be undergoing surgery.

Head-to-head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta-analysis.

BACKGROUND/AIMS: Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options for drainage or debridement of pancreatic pseudocysts and walled-off necrosis (WON). The traditional procedure is drainage by placing double pigtail plastic stents (DPPS); lumen-apposing metal stent (LAMS) has a biflanged design with a wide lumen that avoids occlusion with necrotic tissue, which is more common with DPPS and reduces the possibility of migration. We performed a systematic review and meta-analyses head-to-head, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. METHODS: We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta-analysis considers studies published from 2014 to 2020, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS. RESULTS: Thirteen studies were included in the meta-analyses. Only one of all studies was a randomized controlled trial. These studies comprise 1584 patients; 68.2% were male, and 31.8% were female. Six hundred sixty-three patients (41.9%) were treated with LAMS, and 921 (58.1%) were treated with DPPS. Six studies included only WON in their analysis, two included only pancreatic pseudocysts, and five studies included both pancreatic pseudocysts and WON. The technical success was similar in patients treated with LAMS and DPPS (97.6% vs 97.5%, respectively, P = .986, RR = 1.00 [95% CI 0.93-1.08]). The clinical success was similar in both groups (LAMS: 90.1% vs DPPS: 84.2%, P = .139, RR = 1.063 [95% CI 0.98-1.15]). Patients treated with LAMS had a lower complication rate than the DPPS groups, with a significant statistical difference (LAMS: 16.0% vs DPPS: 20.2%, P = .009, RR = 0.746 [95% CI 0.60-0.93]). Bleeding was the most common complication in the LAMS group (33 patients, [5.0%]), whereas infection was the most common complication in the DPPS group (56 patients, [6.1%]). The LAMS migration rate was lower than in the DPPS (0.9% vs 2.2%, respectively, P = .05). The mortality rate was similar in both groups, 0.6% in the LAMS group (four patients) and 0.4% in the DPPS group (four patients; P = .640). CONCLUSION: The PFCs drainage is an indication when persistent symptoms or PFCs-related complications exist. EUS guided drainage with LAMS has similar technical and clinical success to DPPS drainage for the management of PFCs. The technical and clinical success rates are high in both groups. However, LAMS drainage has a lower adverse events rate than DPPS drainage. More randomized controlled trials are needed to confirm the real advantage of LAMS drainage over DPPS drainage.

Estudio de validación diagnóstica de la escala de Glasgow-Blatchford para la predicción de mortalidad en pacientes con hemorragia digestiva alta en un hospital de Lima, Perú (junio 2012-diciembre 2013) / Validation of the Glasgow-Blatchford Scoring System to predict mortality in patients with upper gastrointestinal bleeding in a hospital of Lima, Peru (June 2012-December 2013)

ANTECEDENTES Y PROPÓSITO DEL ESTUDIO: la hemorragia digestiva alta es una causa importante de ingreso hospitalario y constituye la principal emergencia gastroenterológica, con una tasa de mortalidad de hasta el 14%. En el Perú no existen estudios sobre el uso de la escala de Glasgow-Blatchford para predecir mortalidad por hemorragia digestiva alta. El objetivo de este estudio es realizar la validación externa de la escala de Glasgow-Blatchford y establecer su mejor punto de corte para predecir mortalidad por hemorragia digestiva alta en un hospital de Lima, Perú. Métodos: estudio de validación diagnóstica, analítico, longitudinal, de tipo retrospectivo, con datos de pacientes con diagnóstico clínico y endoscópico de hemorragia digestiva alta atendidos en la Unidad de Hemorragia Digestiva del Hospital Nacional Edgardo Rebagliati Martins, entre junio de 2012 y diciembre de 2013. Calculamos el área bajo la curva ROC (receiver operating characteristic) de la escala de Glasgow-Blatchford para predecir mortalidad, con un intervalo de confianza al 95%. Resultados: un total de 339 registros fueron analizados. El 57,5% fueron varones y la edad media (desviación estándar) fue de 67,0 (15,7) años. La mediana de la escala de Glasgow-Blatchford obtenida en la población fue de 12. El análisis ROC para mortalidad dio un área bajo la curva de 0,59 (IC95% 0,5-0,7). Se estratificó por tipo de hemorragia digestiva alta, obteniendo un área bajo la curva de 0,66 (IC95% 0,53-0,78) para el tipo no variceal. Conclusiones: en la población estudiada, la escala de Glasgow-Blatchford no posee una validez diagnóstica adecuada para predecir mortalidad

BACKGROUND AND AIM: Upper gastrointestinal bleeding is a major cause of hospitalization and the most prevalent emergency worldwide, with a mortality rate of up to 14%. In Peru, there have not been any studies on the use of the Glasgow-Blatchford Scoring System to predict mortality in upper gastrointestinal bleeding. The aim of this study is to perform an external validation of the Glasgow-Blatchford Scoring System and to establish the best cutoff for predicting mortality in upper gastrointestinal bleeding in a hospital of Lima, Peru. METHODS: This was a longitudinal, retrospective, analytical validation study, with data from patients with a clinical and endoscopic diagnosis of upper gastrointestinal bleeding treated at the Gastrointestinal Hemorrhage Unit of the Hospital Nacional Edgardo Rebagliati Martins between June 2012 and December 2013. We calculated the area under the curve for the receiver operating characteristic of the Glasgow-Blatchford Scoring System to predict mortality with a 95% confidence interval. RESULTS: A total of 339 records were analyzed. 57.5% were male and the mean age (standard deviation) was 67.0 (15.7) years. The median of the Glasgow-Blatchford Scoring System obtained in the population was 12. The ROC analysis for death gave an area under the curve of 0.59 (95% CI 0.5-0.7). Stratifying by type of upper gastrointestinal bleeding resulted in an area under the curve of 0.66 (95% CI 0.53-0.78) for non-variceal type. CONCLUSIONS: In this population, the Glasgow-Blatchford Scoring System has no diagnostic validity for predicting mortality

[Validation of the Glasgow-Blatchford Scoring System to predict mortality in patients with upper gastrointestinal bleeding in a hospital of Lima, Peru (June 2012-December 2013)]. / Estudio de validación diagnóstica de la escala de Glasgow-Blatchfordpara la predicción de mortalidad en pacientes con hemorragia digestiva altaen un hospital de Lima, Perú (junio 2012-diciembre 2013).

BACKGROUND AND AIM: Upper gastrointestinal bleeding is a major cause of hospitalization and the most prevalent emergency worldwide, with a mortality rate of up to 14%. In Peru, there have not been any studies on the use of the Glasgow-Blatchford Scoring System to predict mortality in upper gastrointestinal bleeding. The aim of this study is to perform an external validation of the Glasgow-Blatchford Scoring System and to establish the best cutoff for predicting mortality in upper gastrointestinal bleeding in a hospital of Lima, Peru. METHODS: This was a longitudinal, retrospective, analytical validation study, with data from patients with a clinical and endoscopic diagnosis of upper gastrointestinal bleeding treated at the Gastrointestinal Hemorrhage Unit of the Hospital Nacional Edgardo Rebagliati Martins between June 2012 and December 2013. We calculated the area under the curve for the receiver operating characteristic of the Glasgow-Blatchford Scoring System to predict mortality with a 95% confidence interval. RESULTS: A total of 339 records were analyzed. 57.5% were male and the mean age (standard deviation) was 67.0 (15.7) years. The median of the Glasgow-Blatchford Scoring System obtained in the population was 12. The ROC analysis for death gave an area under the curve of 0.59 (95% CI 0.5-0.7). Stratifying by type of upper gastrointestinal bleeding resulted in an area under the curve of 0.66 (95% CI 0.53-0.78) for non-variceal type. CONCLUSIONS: In this population, the Glasgow-Blatchford Scoring System has no diagnostic validity for predicting mortality.

Experiencia inicial en ecoendoscopía en el Hospital Edgardo Rebagliati, EsSalud, Lima, Perú / Initial Experience in endoscopic ultrasonography in Edgardo Rebagliati Hospital, Essalud, Lima, Peru

La experiencia local que se tiene con la ultrasonografía endoscópica (USE) es aún pequeña debido a la poca cantidad de centros que cuentan con el equipamiento y a la escasez de centros de entrenamiento así como una larga curva de aprendizaje. Objetivo: Reportar la experiencia en ecoendoscopías en el hospital que laboramos. Materiales y Métodos: Se realiza un estudio retrospectivo de las ecoendoscopÍas (USE) realizadas en el Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú, desde enero a diciembre del 2012, recogiendo datos de filiación, diagnóstico endosonográfico, biopsia aspiración con aguja fina y citología. Los resultados se reportaron con estadística descriptiva. Resultados: Se realizaron 205 ecoendoscopías, de las cuales 116 (56,6%) fueron mujeres y 89 (43,4%) hombres. La edad media fue 60,8 +/- 15,6 años (rango: 17-84) 51,3% correspondieron a pacientes mayores de 60 años. De los exámenes realizados, 157 (76,6%) fueron en el tracto digestivo superior y 48 (23,4%) en la región ano-rectal. Los diagnósticos más frecuentes en las USE en el tracto digestivo superior fueron: lesiones sub-epiteliales (23,6%), normal (23,6%), neoplasias malignas (14,0%) siendo la del páncreas la más frecuente (7,6% del total), litiasis de la vía biliar-pancreática (12,7%) y lesiones quísticas del páncreas (12,1%). En cuanto a las USE de la región ano rectal, el diagnóstico más frecuente fue la neoplasia maligna (NM) de recto (47,9%). Se realizaron un total de 20 (9,8%) biopsias aspiración con aguja fina (BAAF). No se reportó complicación alguna...

Report our experience with endoscopic ultrasonography. Material and Methods: In this report we analyze retrospectivement the data of 205 EUS studies done from January to December 2012 at the Hospital. Lima, Peru. Age, sex, endoscopic diagnosis and the results of fine needle aspiration (FNA) are analyzed. Results: In this study 205 patients underwent to EUS. There were 116 patients (56.6%) females and 89 (43.4%) males. Mean age was 60.8 +/- 15.6 years (range: 17 û 84), 51.3% were over 60. 157patients (76.6%) had upper GI EUS tract and 48 (23.4%) of the lower. In upper GI EUS the most frequent diagnosis was: Sub epithelial lesions (22.7%), malignant neoplasm (13.5%) and pancreatic cancer the most frequent one (6.7%). Stones in the biliary and pancreatic duct (12.2%) and pancreatic cystic disease (9.8%) were found. Rectal cancer was the most frequent diagnosis in the ano-rectal EUS (47.9%). 20 fine needle aspiration biopsies were performed. No complications were reported...

[Initial experience in endoscopic ultrasonography in Edgardo Rebagliati Hospital, Essalud, Lima, Peru]. / Experiencia inicial en ecoendoscopía en el Hospital Edgardo Rebagliati, EsSalud, Lima, Perú

OBJECTIVE: Report our experience with endoscopic ultrasonography. MATERIAL AND METHODS: In this report we analyze retrospectivement the data of 205 EUS studies done from January to December 2012 at the Hospital. Lima, Peru. Age, sex, endoscopic diagnosis and the results of fine needle aspiration (FNA) are analyzed. RESULTS: In this study 205 patients underwent to EUS. There were 116 patients (56.6%) females and 89 (43.4%) males. Mean age was 60.8 ± 15.6 years (range: 17 - 84), 51.3% were over 60. 157 patients (76.6%) had upper GI EUS tract and 48 (23.4%) of the lower. In upper GI EUS the most frequent diagnosis was: Sub epithelial lesions (22.7%), malignant neoplasm (13.5%) and pancreatic cancer the most frequent one (6.7%). Stones in the biliary and pancreatic duct (12.2%) and pancreatic cystic disease (9.8%) were found. Rectal cancer was the most frequent diagnosis in the ano-rectal EUS (47.9%). 20 fine needle aspiration biopsies were performed. No complications were reported. CONCLUSION: This one year experience is the first step for the development of endoscopic ultrasonography in our country. Despite of problems with the design and number of patients, we believe we can say that GI EUS is a useful and safe for the diagnosis of different diseases of the GI tract and appropriate training is needed.

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.

The management of HCV-infected pregnant women.

Hepatitis C is, at present, a worldwide health problem and is the most common cause of liver transplantation. Its prevalence in pregnant women is similar to that of the general population. In the absence of cirrhosis and portal hypertension, most HCV-infected pregnant women do not have obstetric complications. Screening of pregnant women that are asymptomatic and do not have risk factors is not cost effective. A high hepatitis C viral load reportedly increases vertical transmission and is higher in women who are coinfected with HIV or who are intravenous drug users. Prolonged rupture of the membrane for more than 6 h, amniocentesis, and perineal lacerations increase the potential risk of perinatal transmission. Although the hepatitis C virus can be transmitted intrapartum, prevention by caesarean delivery is not generally indicated. The HCV virus can be found in maternal milk; however, breast feeding is not contraindicated. In conclusion, there are no antiviral treatment recommendations for HCV-infected women during pregnancy, or guidelines for the prevention of vertical transmission.

[Preneoplastic gastric lesions and helicobacter pylori in endoscopic detection and early diagnosis of gastric cancer in a population of a medium and high socio-economic level]. / Lesiones gastricas preneoplasicas y helicobacter pylori en despistaje endoscopico para cancer gastrico en poblacion de nivel socioeconomico medio y alto.

OBJECTIVES: To determine the prevalence and characteristics of premalignant gastric lesions and its relationship with helicobacter pylori infection. METHODS: We performed a cross-sectional retrospective study. Between january and june 2008, consecutive subjects of middle and high socioeconomic status were evaluated by upper gastrointestinal endoscopy during a gastric cancer screening in Central FAP Hospital. The demografic, clinic and endoscopic information were analysed. RESULTS: 2616 patients were evaluated. Diagnosis histological of premalignant gastric lesions was made in 187 patients (7.1%) 34 (1.3%) atrophic gastritis (AG), 55 (2.1%), complete intestinal metaplasia (CIM), 92 (3.5%) incomplete intestinal metaplasia (IIM), and 6 (0.2%) dysplasia. The frequency of helicobacter pylori infection was 76.5% (p=0.04), 65.5% (p=NS), 55.4% (p=NS) and 16.7% (p=0.03), in AG, CIM, IIM and dysplasia, respectively. The median age of presentation was similar between the lesions: 53.5 (+/-9.3), 52.6 (+/-11.2), 54.3 (+/-7.8) y 54.2 (+/-12.1) years in AG, CIM, IIM and dysplasia, respectively. The premalignant gastric lesions were more frequent in male subjects and under 60 years (p=NS). There were no significant differences among the differents gastric premalignant lesions and family history of gastric cancer, smoking and alcohol consumption (p=NS). CONCLUSIONS. The prevalence of premalignant gastric lesions in our study was low. The frequency of H. pylori infection was decreased in premalignant lesions more advanced. Association significant was only found among H. pylori infection and AG and dysplasia.

Lesiones gástricas preneoplásicas y helicobacter pylori en despistaje endoscópico para cáncer gástrico en población de nivel socioeconómico medio y alto / Preneoplastic gastric lesions and helicobacter pylori in endoscopic detection and early diagnosis of gastric cancer in a population of a medium and high socio-economic level

OBJETIVO: Estudiar la frecuencia y características de las lesiones gástricas preneoplásicas y su relación con el helicobacter pylori (HP). MÉTODO: Se realizó un estudio transversal retrospectivo en una población de nivel socioeconómico medio y alto participante en una campaña de despistaje de cáncer gástrico, desde enero a junio del 2008 en el Hospital Central de la FAP. Se evaluaron variables demográficas, clínicas y endoscópicas. RESULTADOS: De 2616 pacientes estudiados, 187 (7.1%) presentaron diagnostico histológico de lesiones gástricas preneoplásicas: 34 (1.3%) gastritis atrófica (GA), 55(%) metaplasia intestinal completa (MIC), 92 (3.5%) metaplasia intestinal incompleta (MII), y 6 (0.2%) displasia. La frecuencia de infección por HP fue de 76.5% (p=0.04), 65.5% (p=NS), 55.4% (p=NS) y 16.7% (p=0.03), en la GA, MIC, MII y displasia, respectivamente. La edad media de presentación fue similar entre las 4 lesiones: 53.5 (±9.3), 52.6 (±11.2), 54.3 (±7.8) y 54.2 (±12.1) años en la GA, MIC, MII y displasia, respectivamente. Las lesiones preneoplásicas fueron mas frecuentes en varones y menores de 60 años de edad (p=NS). No se encontró asociación entre las lesiones preneoplásicas y el antecedente familiar de cáncer gástrico, consumo de alcohol y tabaco (p=NS). CONCLUSIONES: La prevalencia de las lesiones gástricas preneoplásicas en nuestro estudio fue baja. La frecuencia de la infección por HP fue decreciente en las lesiones preneoplásicas mas avanzadas. Solo se encontró asociación entre la infección por HP y la gastritis atrófica y la displasia gástrica.

OBJECTIVES: To determine the prevalence and characteristics of premalignant gastric lesions and its relationship with helicobacter pylori infection. METHODS: We performed a cross-sectional retrospective study. Between january and june 2008, consecutive subjects of middle and high socioeconomic status were evaluated by upper gastrointestinal endoscopy during a gastric cancer screening in Central FAP Hospital. The demografic, clinic and endoscopic information were analysed. RESULTS: 2616 patients were evaluated. Diagnosis histological of premalignant gastric lesions was made in 187 patients (7.1%), 34 (1.3%) atrophic gastritis (AG), 55 (2.1%), complete intestinal metaplasia (CIM), 92 (3.5%) incomplete intestinal metaplasia (IIM), and 6 (0.2%) dysplasia. The frequency of helicobacter pylori infection was 76.5% (p=0.04), 65.5% (p=NS), 55.4% (p=NS) and 16.7% (p=0.03), in AG, CIM, IIM and dysplasia, respectively. The medianage of presentation was similar between the lesions: 53.5 (±9.3), 52.6 (±11.2), 54.3 (±7.8) y 54.2 (±12.1) years in AG, CIM, IIM and dysplasia, respectively. The premalignant gastric lesions were more frequent in male subjects and under 60 years (p=NS). There were no significant differences among the differents gastric premalignant lesions and family history of gastric cancer, smoking and alcohol consumption (p=NS). CONCLUSIONS. The prevalence of premalignant gastric lesions in our study was low. The frequency of H. pylori infection was decreased in premalignant lesions more advanced. Asociation significant was only found among H. pylori infection and AG and dysplasia.

[Prevalence, clinical-endoscopic characteristics and predictive factors of Barrett's Esophagus in endoscopic screening for gastric cancer]. / Prevalencia, características clínico-endoscópicas y factores predictivos de Esófago de Barrett.

PURPOSE: Determine the prevalence, clinical-epidemiological characteristics and predictive factors for Barrets Esophagus (BE). METHOD: An analytical and transversal study was conducted, followed by a case-control study nested in a population participating in a gastric cancer screening campaign, from January to June 2008 at the Central Hospital of the Peruvian Air Force (FAP). A BE case was defined due to the endoscopic presence of columnar-appearing mucosa confirmed by intestinal metaplasia at biopsy. Demographic, clinical and endoscopic variables were evaluated, and bivariate and multivariate studies were conducted to identify predictive risk factors, using patients with gastroesophagic reflux and control patients of the study population as control groups. RESULTS: Out of 2273 patients studied, 11 (0.48%) patients with an average age of 52.2 +/- 7.7 years (43-69 year range) suffered from BE, out of which 81.8% were male. The 81.8% were symptomatic, with dyspepsia in 54.5% and with reflux in 27.3%, while 18.2% were asymptomatic. The short-segment BE was more common than the long-segment BE (72.7% versus 27.3%). The predictive factors found after the bivariate and multivariate analysis (comparing cases versus population control group) were: hiatal hernia [OR = 12.1, CI 95% 2.25 64.75], consumption of AINES [OR = 6.72, CI 95% 1.6-29.1] and consumption of alcohol [OR = 4.22, CI 95% 1.1-16.91]. CONCLUSIONS: BE prevalence in the study was low. The presence of hiatal hernia, consumption of AINES, and consumption of alcohol were predictive risk factors to develop BE in the study.

Prevalencia, características clínico-endoscópicas y factores predictivos de esófago de barrett / Prevalence, clinical-endoscopic characteristics and predictive factors of BarrettÆs Esophagus in endoscopic screening for gastric cancer

OBJETIVO: Determinar la prevalencia, características clínico-epidemiológicas y factores predictivos para Esófago de Barrett (EB). MÉTODO: Se realizó un estudio analítico y transversal, seguido de un estudio casos y controles anidado en una población participante en una campaña de despistaje de cáncer gástrico, desde enero a junio del 2008 en el Hospital Central de la FAP. Se definió caso de EB a la presencia endoscópica de mucosa de apariencia columnar en esófago distal confirmada con metaplasia intestinal en la biopsia. Se evaluaron variables demográficas, clínicas y endoscópicas, y se realizó estudio bivariado y multivariado para identificar factores de riesgo predictivos, teniendo como grupos controles a pacientes con reflujo gastroesofágico y a pacientes controles de la población estudiada. RESULTADOS: De 2273 pacientes estudiados, 11 (0.48 por ciento) presentaron EB, con una edad promedio de 52.2 ± 7.7 años (rango 43-69 años), de los cuales 81.8 por ciento fueron varones. El 81.8 por ciento fueron sintomáticos con dispepsia en 54.5 por ciento y reflujo en 27.3 por ciento, mientras que el 18.2 por ciento fueron asintomáticos. La variedad de EB segmento corto fue más frecuente que elsegmento largo (72.7 por ciento vs 27.3 por ciento). Los factores predictivos encontrados luego del análisis bivariado y multivariado (comparando casos vs grupo control Población) fueron: herniahiatal [OR= 12.1, IC 95 por ciento 2.25-64.75], consumo de AINES [OR= 6.72, IC 95 por ciento 1.6-29.1] y el consumo de alcohol [OR= 4.22, IC 95 por ciento 1.1-16.91]. CONCLUSIONES: La prevalencia del EB en nuestro estudio fue baja. La presencia de hernia hiatal, consumo de AINES y de alcohol fueron factores de riesgo predictivos parapresentar EB en nuestro estudio.

PURPOSE: Determine the prevalence, clinical-epidemiological characteristics and predictive factors for BarretÆs Esophagus (BE). METHOD: An analytical and transversal study was conducted, followed by a case-control study nested in a population participating in a gastric cancer screening campaign, from January to June 2008 at the Central Hospital of the Peruvian Air Force (FAP). A BE case was defined due to the endoscopic presence of columnar-appearing mucosa confirmed by intestinal metaplasia at biopsy. Demographic, clinical and endoscopic variables were evaluated, and bivariate and multivariate studies were conducted to identify predictive risk factors, using patients with gastroesophagic reflux and control patients of the study population as control groups. RESULTS: Out of 2273 patients studied, 11 (0.48 per cent) patients with an average age of 52.2 ± 7.7 years (43-69 year range) suffered from BE, out of which 81.8 per cent were male. The 81.8 per cent were symptomatic, with dyspepsia in 54.5 per cent and with reflux in 27.3 per cent, while 18.2 per cent were asymptomatic. The short-segment BE was more common than the long-segment BE(72.7 per cent versus 27.3 per cent). The predictive factors found after the bivariate and multivariate analysis (comparing cases versus population control group) were: hiatal hernia [OR= 12.1, CI 95 per cent 2.25 û 64.75], consumption of AINES [OR = 6.72, CI 95 per cent 1.6-29.1] and consumptionof alcohol [OR = 4.22, CI 95 per cent 1.1-16.91]. CONCLUSIONS: BE prevalence in the study was low. The presence of hiatal hernia, consumption of AINES, and consumption of alcohol were predictive risk factors to develop BE in the study.

[Seroprevalence of the infection and risk factors of hepatitis B and C in healthy military personnel]. / Seroprevalencia de la infección factores de riesgo para hepatitis B y C en personal militar sano.

OBJECTIVE: Determine the prevalence of infections by the hepatitis B (HBV) and C (HCV) viruses and the risk factors associated with their acquisition in clinically healthy military personnel. METHOD: Correlational and analytic transversal study. The population was made up of active, clinically healthy military personnel from the Peruvian Air Force that volunteered for a screening program between October and December 2007. The HBsAg and anti-HBc markers of HBV and the anti-HCV marker of HVC were evaluated. RESULTS: Of the 3,343 military personnel studied, 93.2% (3,116) were male and 6.8% (227) were female, with an average age of 38.9+/-8.6 years (range: 18 to 60 years old), mostly non-commissioned officers (79.5%). An HBsAg prevalence of 0.33% was found, with an anti-HBc prevalence of 0.58%, while the prevalence of anti-HCV was 0.21%. The risk factor associated with active infection by HBV (HBsAG) was risky sexual behavior (OR: 8.3; IC 95%:1.6-42.4 and p=0.01). On the hand, for the past infection by HBV (anti-HBc), the associated risk factors were risky sexual behavior (OR: 6.3; IC 95%:1.7-23.4 and p=0.006) and tattoos (OR: 5.5; IC 95%:1.2-25.8 and p=0.031). No association was found between the risk factors studied and seropositivity by HCV. CONCLUSIONS: We found a low prevalence of the serological markers of infection by hepatitis B and C viruses in active military personnel. The risk factors associated with infection by HBV were risky sexual conduct and the use of tattoos. There was no risk factor found to be associated with infection by HCV in this population.

Seroprevalencia de la infección y factores de riesgo para hepatitis B y C en personal militar sano / Seroprevalence of the infection and risk factors of hepatitis B and C in healthy military personnel

OBJETIVO: Determinar la prevalencia de las infecciones por los virus de la hepatitis B (VHB) y C (VHC), así como los factores de riesgo asociados a su adquisición en personal militar clínicamente sano. MÉTODO: Estudio transversal, analítico y correlacional. La población estuvo conformada por militares de la Fuerza Aérea del Perú en actividad, clínicamente sanos que acudieron voluntariamente a un programa de despistaje de Octubre a Diciembre del 2007. Se evaluaron los marcadores Ag-HBs y anti-HBc del VHB y anti-VHC del VHC. RESULTADOS: De los 3343 militares estudiados, el 93.2% (3116) fueron del sexo masculinoy el 6.8% (227) del sexo femenino, con una edad promedio de 38.9 ± 8.6 años (rango, 18 a 60 años), siendo en su mayoría suboficiales (79.5%). Se encontró una prevalencia de Ag-HBs de 0.33% y de anti-HBc de 0.58%, mientras que la prevalencia de anti-VHCfue de 0.21%. El factor de riesgo asociado a la infección crónica por VHB (Ag-HBs) fue la conducta sexual de riesgo (OR: 8.3; IC 95%:1.6-42.4 y p=0.01). En cambio, para la infección pasada por VHB (anti-HBc) los factores de riesgo asociados fueron la conductasexual de riesgo (OR: 6.3; IC 95%:1.7-23.4 y p=0.006), y el uso de tatuajes (OR: 5.5; IC 95%:1.2-25.8 y p=0.031). No se encontró ninguna asociación entre los factores de riesgo estudiados y la seropositividad por VHC. CONCLUSIONES: Encontramos una baja prevalencia de los marcadores serológicos de infección por hepatitis virales B y C en el personal militar en actividad. Los factores de riesgo asociados a la infección por VHB fueron la conducta sexual de riesgo y el usode tatuajes. No se encontró ningún factor de riesgo asociado a la infección por VHC en esta población.

OBJECTIVE: Determine the prevalence of infections by the hepatitis B (HBV) and C (HCV) viruses and the risk factors associated with their acquisition in clinically healthy military personnel.METHOD: Correlational and analytic transversal study. The population was made up of active, clinically healthy military personnel from the Peruvian Air Force that volunteered for a screening program between October and December 2007. The HBsAg and anti-HBc markers of HBV and the anti-HCV marker of HVC were evaluated. RESULTS: Of the 3,343 military personnel studied, 93.2% (3,116) were male and 6.8% (227) were female, with an average age of 38.9 ± 8.6 years (range: 18 to 60 years old), mostlynon-commissioned officers (79.5%). An HBsAg prevalence of 0.33% was found, with an anti-HBc prevalence of 0.58%, while the prevalence of anti-HCV was 0.21%. The risk factor associated with active infection by HBV (HBsAG) was risky sexual behavior (OR: 8.3; IC 95%:1.6-42.4 and p=0.01). On the hand, for the past infection by HBV (anti-HBc), the associated risk factors were risky sexual behavior (OR: 6.3; IC 95%:1.7-23.4 and p=0.006) and tattoos (OR: 5.5; IC 95%:1.2-25.8 and p=0.031). No association was found between the risk factors studied and seropositivity by HCV. CONCLUSIONS: We found a low prevalence of the serological markers of infection byhepatitis B and C viruses in active military personnel. The risk factors associated with infection by HBV were risky sexual conduct and the use of tattoos. There was no risk factor found to be associated with infection by HCV in this population.

[Endoscopic lesions in the upper digestive tract in patients with terminal chronic renal insufficiency]. / Lesiones endoscópicas del tracto digestivo alto en pacientes con insuficiencia renal crónica terminal.

INTRODUCTION: End Stage Renal Disease (ESRD) causes changes that affect every organ system including the digestive tract. These changes are manifested by a variety of symptoms and are responsible for a high degree of morbidity and mortality. The main objective of this study is to determine the most common endoscopic lesions of the upper gastrointestinal tract seen in patients with a diagnosis of ESRD. MATERIAL AND METHODS: This is a descriptive and retrospective study that included patients (age > 18 yrs.) with a known diagnosis of ESRD. The study was done at Hospital Central FAP - Hemodialysis Program from January, 2000 to February, 2007. Patients had an esophagogastroduodenoscopy (EGD) during that period of time. We conducted a chart review to evaluate medical history, demographics and EGD results. RESULTS: The study included 54 patients with a diagnosis of ESRD; mean age was 73.2 years and the male to female ratio was 1.45:1. The average time from diagnosis was 32 months and the mean blood urea nitrogen and creatinine were 94.4 and 3.9 mg/dL respectively. Symptoms were present in 37.1% of the patients and the most common cause of endoscopic evaluation was upper gastrointestinal bleed (29.6%). The most prevalent endoscopic findings included gastric erosions (35.2%), patchy antral erythema (27.8%), gastric ulcer (24.1%), and duodenal erosions (18.5%). The most common histopathologic diagnosis was superficial chronic gastritis (65.8%). Helicobacter pylori was found in 38.6% of the studied individuals. CONCLUSIONS: The most common endoscopic changes seen in patients with ESRD were gastric erosions, patchy antral erythema, gastric ulcers, and duodenal erosions.