Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis

Abstract Objective To assess the prevalence of GERD exclusively by means of multichannel intraluminal impedanciometry associated with pH monitoring (MIIpH) and compare it with respiratory symptoms in children with CF. To compare MIIpH with pHmetry alone to perform GERD diagnosis. Methods An analytical cross-sectional study was conducted with children diagnosed with CF who underwent MIIpH. Clinical and laboratory markers, including respiratory and digestive symptoms, were used for comparative analyses. High-resolution chest computed tomography was performed on patients with symptoms of chronic lung disease. Severity was classified according to the Bhalla score. Results A total of 29 children < 10 yo (18 girls) were evaluated; 19 of whom with physiological GER and 10 with GERD. Of the children with GERD, seven had predominantly acid GER, two acid+non-acid GER, and one non-acid GER. Three patients had GERD diagnosed only by MIIpH. Bhalla scores ranged from seven to 17.75 with no significant relationship with GERD. The number of pulmonary exacerbations was associated with a decrease in esophageal clearance regardless of the position in pHmetry and MIIpH. Conclusions The prevalence of GERD was 34% in children with CF. There was no association between respiratory disease severity and GER types. MIIpH detected 30% more patients with GERD than pHmetry.

Endoscopic and histopathological assessment of individuals undergoing one anastomosis gastric bypass: a 2-year follow-up.

BACKGROUND: There is much debate over the occurrence of biliary reflux to the gastric pouch after one anastomosis gastric bypass (OAGB) and its potential risks. OBJECTIVE: To assess endoscopic and histopathological findings following a standardized protocol of biopsy collection two years after OAGB. METHODS: A historical cohort study was conducted, based on a prospectively collected database, which involved 39 participants who underwent OAGB. Participants underwent clinical evaluation and esophagogastroduodenoscopy at the time of surgery and 24 months afterward. Post-operatively, biopsy specimens in esophagogastric junction, pouch, and anastomosis were systematically collected. RESULTS: 92.3% of the participants were female and the mean age was 37 ± 8.5 years. The mean body mass index (BMI) significantly decreased from 37.6 ± 5.7 kg/m2 to 27 ± 4.1 kg/m2 after 2 years (p < 0.001). The mean %TWL was 27.2 ± 10.5%. The prevalence of non-erosive gastritis significantly increased from 25.6 to 51.3% (p = 0.02). Erosive gastritis significantly decreased from 28.2 to 10.3% (p = 0.04). Four cases of marginal ulcers were identified (10.3%). The commonest histopathological finding was mild inflammation in 74.3% (esophagogastric junction), 58.9% (pouch), and 71.8% (anastomosis). There was one case of focal intestinal metaplasia in each site of interest and no cases of dysplasia or severe inflammation. CONCLUSIONS: Using a standardized protocol of post-operative biopsy collection, low rates of severe endoscopic and histopathological abnormalities were observed two years after OAGB. Nevertheless, as most patients have histologically proven inflammation, bile in the gastric pouch, and endoscopic gastritis, long-term surveillance is essential because of the uncertain risk of these abnormalities.

Visible intestinal peristalsis and chronic diarrhea due to a rare lymphoproliferative disease.

We present the case of a 45-year-old man with watery diarrhea for 2 years, leading to marked weight loss (52 kg). On admission, the patient presented with pallor, dehydration and cachexia. Abdominal examination revealed increased bowel sounds, painful and visible intestinal peristalsis, suggesting intestinal obstruction. There was no response to a gluten-free diet and nutritional support. Finally, the patient developed pulmonary infection, septic shock and died 3 months after admission. The diagnosis of CD4+/CD8+ indolent T-cell lymphoma of the GI tract was made post-mortem.

Combined multi-channel intraluminal impedance measurement and pHmetry in the detection of gastroesophageal reflux disease in children with cystic fibrosis.

OBJECTIVE: To assess the prevalence of GERD exclusively by means of multichannel intraluminal impedanciometry associated with pH monitoring (MIIpH) and compare it with respiratory symptoms in children with CF. To compare MIIpH with pHmetry alone to perform GERD diagnosis. METHODS: An analytical cross-sectional study was conducted with children diagnosed with CF who underwent MIIpH. Clinical and laboratory markers, including respiratory and digestive symptoms, were used for comparative analyses. High-resolution chest computed tomography was performed on patients with symptoms of chronic lung disease. Severity was classified according to the Bhalla score. RESULTS: A total of 29 children < 10 yo (18 girls) were evaluated; 19 of whom with physiological GER and 10 with GERD. Of the children with GERD, seven had predominantly acid GER, two acid+non-acid GER, and one non-acid GER. Three patients had GERD diagnosed only by MIIpH. Bhalla scores ranged from seven to 17.75 with no significant relationship with GERD. The number of pulmonary exacerbations was associated with a decrease in esophageal clearance regardless of the position in pHmetry and MIIpH. CONCLUSIONS: The prevalence of GERD was 34% in children with CF. There was no association between respiratory disease severity and GER types. MIIpH detected 30% more patients with GERD than pHmetry.

EFFICACY ANALYSIS OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE EARLY GASTRIC CANCER AND PRECANCEROUS LESIONS.

BACKGROUND: Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. OBJECTIVE: This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. METHODS: This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar's test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). RESULTS: The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. CONCLUSION: Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.

Análise de eficácia da dissecção endoscópica da submucosa para o câncer gástrico precoce e lesões pré-cancerosas / Efficacy analysis of endoscopic submucosal dissection for the early gastric cancer and precancerous lesions

ABSTRACT Background: Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. Objective: This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. Methods: This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar's test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). Results: The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. Conclusion: Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.

RESUMO Contexto: O tratamento endoscópico das lesões pré-cancerosas e do câncer gástrico precoce tem sido amplamente aceito nos últimos anos. A dissecção endoscópica da submucosa (submucosectomia), obedecendo a critérios estabelecidos de indicação, pode levar a cura da doença em mais de 90% dos casos. Objetivo: Este estudo teve como objetivo analisar o uso da dissecção submucosa endoscópica em pacientes com câncer gástrico precoce e lesões pré-cancerosas, bem como os resultados do procedimento, suas complicações e eficácia no controle da doença. Métodos: Foram analisados 41 pacientes, com idade variando de 53 a 87 anos (média de 65 anos), sendo 58,53% do sexo masculino, no período de 2008 a 2019, sendo este estudo do tipo coorte retrospectivo. As variáveis coletadas dos prontuários foram: comorbidades, classificação da lesão quanto aos critérios de ressecção, tipo de ressecção, histologia, grau de invasão, margem de resseção, complicações, recidiva de doença. A análise estatística foi feita com o uso do teste de Kruskal-Wallis, teste de McNemar e teste de Mann-Whitney, com significância estatística de 5% (P<0,05). Resultados: O local mais frequente da lesão foi o antro gástrico e a apresentação predominante pela classificação japonesa ou de Paris foram os com componentes deprimidos em 56,09%. O adenocarcinoma ocorreu em 75,6% das biópsias e o restante foram adenomas sem neoplasia. A ressecção em bloco ocorreu em 97,57% dos casos, e o comprometimento da margem de segurança ocorreu em um paciente. A principal comorbidade pré-existente foi a cirrose hepática em 29,26% dos casos. Houve um aumento significativo de adenocarcinoma após dissecção endoscópica da submucosa em comparação ao diagnóstico pré ressecção. O tempo médio de seguimento foi de 38,4 meses, sendo registrado uma recidiva (2,43%) e duas lesões metacrônicas (4,87%). As complicações durante e após o procedimento ocorreram em 3 (7,31%) pacientes, sendo por sangramento (dois casos) e perfuração (um caso). Houve um óbito por evento cardiológico, não relacionado diretamente com o procedimento. Conclusão: A ressecção endoscópica da submucosa mostrou ser procedimento seguro, com baixa taxa de complicação e de recidiva. A sua indicação deve ser dentro dos critérios estabelecidos, entretanto, pode ser indicada em pacientes fora de critérios, se há alto risco para o tratamento cirúrgico.

Risk stratification in acute variceal bleeding: Far from an ideal score.

OBJECTIVES: Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a life-threatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/or mortality associated with AVB. METHODS: This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively). RESULTS: In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively). CONCLUSION: Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.

Risk stratification in acute variceal bleeding: Far from an ideal score

OBJECTIVES: Acute variceal bleeding (AVB) results from rupture of esophageal or gastric varices. It is a life-threatening complication of portal hypertension. Nevertheless, it remains unclear how to predict adverse outcomes and identify high-risk patients. In variceal hemorrhage, high Child-Turcotte-Pugh (Child) and Model for End-stage Liver Disease (MELD) scores are associated with a worse prognosis. The Rockall system (Rockall), Glasgow-Blatchford (Blatchford), and AIMS65 scores have been validated for risk stratification for nonvariceal upper gastrointestinal bleeding; however, their use is controversial in AVB. The aim of this study was to compare the performance of Child, MELD, Rockall, Blatchford, and AIMS65 scores in risk stratification for rebleeding and/or mortality associated with AVB. METHODS: This retrospective study was conducted at a tertiary care hospital over 42 months. The outcomes were 6-week rebleeding and mortality. The AUROC was calculated for each score (1-0.9, 0.9-0.8, and 0.8-0.7, indicating excellent, good, and acceptable predictive power, respectively). RESULTS: In total, 222 patients were included. Six-week rebleeding and mortality rates were 14% and 18.5%, respectively. No score was useful for discriminating patients at a higher risk of rebleeding. The AUROCs were 0.59, 0.57, 0.61, 0.63, and 0.56 for Rockall, Blatchford, AIMS65, Child, and MELD scores, respectively. Prediction of 6-week mortality based on Rockall (AUROC 0.65), Blatchford (AUROC=0.60), and AIMS65 (AUROC=0.67) scores were also not considered acceptable. The AUROCs for predicting mortality were acceptable for Child and MELD scores (0.72 and 0.74, respectively). CONCLUSION: Rockall, Blatchford, and AIMS65 scores are not useful for predicting 6-week rebleeding or mortality in patients with AVB. Child and MELD scores can identify patients at higher risk for 6-week mortality but not for 6-week rebleeding.

Hypoalbuminemia as a risk factor for thromboembolic events in inflammatory bowel disease inpatients.

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) are chronic entities characterized by local and systemic inflammation and may be associated with thrombosis. The aim of this study was to identify the prevalence of thromboembolic events (TEE) in hospitalized IBD patients and identify risk factors for their occurrence. METHODS: This retrospective, single-center study included patients treated at a Brazilian IBD referral unit between 2004 and 2014. Patients hospitalized for more than 48 hours due to active IBD and who did not receive prophylaxis for TEE during hospitalization were included. Patients were allocated to 2 groups: those with TEE up to 30 days or at the time of hospitalization (TEE-group) and patients without TEE (control-group). Clinical and laboratory characteristics were evaluated. RESULTS: Of 53 patients evaluated, 69,8% with Crohn's disease (CD) and 30.2% with ulcerative colitis (UC). The prevalence of TEE 30 days before or during hospitalization was 15.1%, with 10.8% in CD and 25% in UC. In the TEE group, mean serum albumin was 2.06 g/dL versus 3.30 g/dL in the control group. Patients with albumin levels below 2.95 g/dL (43.18%) had a higher risk of developing TEE (relative risk, 1.72; 95% confidence interval, 1.17-2.53) (P<0.001). CONCLUSIONS: Albumin levels were significantly lower in patients with TEE, and hypoalbuminemia was considered a risk factor for the development of TEE in this population.

Irritable bowel syndrome: associations between FODMAPS intake, problematic foods, adiposity, and gastrointestinal symptoms.

This study investigated the association between fermentable oligo-di-mono-saccharides and polyols (FODMAPs) intake, problematic foods, body adiposity, and gastrointestinal symptoms in 44 women with irritable bowel syndrome (IBS). Around 84% reported to have excluded some food from their diet. Adiposity was not associated with the frequency of gastrointestinal symptoms and IBS severity. Controlling for BMI, there were significant correlations between number of problematic foods versus waist circumference (r = 0.306; p = 0.049) and protein intake (r = -0.378; p = 0.014). The IBS severity correlated to the carbohydrate intake (r = -0.320; p = 0.039). Patients with diarrhea demonstrated statistical tendency to restrict the intake of fat (p = 0.058), free fructose (p = 0.07), and oligosaccharides (p = 0.051). Patients with mucus in the stool had higher lactose intake (p = 0.025). The number of food considered problematic was higher for patients who reported stomach burning (p = 0.0001). Associations among adiposity, gastrointestinal symptoms, problematic food, and FODMAPs were identified and reaffirm the role of individualized nutritional treatment in the management of IBS.

Gastrointestinal involvement in lipoid proteinosis: a ten-year follow-up of a brazilian female patient.

Lipoid proteinosis is a rare autosomal recessive disease characterized by the deposition of hyaline material in the skin and internal organs. The main clinical features are hoarseness and typical skin lesions. In this report we describe the endoscopic and radiologic findings in a Brazilian female patient presenting extensive gastrointestinal involvement and the evolution of the detected lesions in ten years of follow-up. Initial upper endoscopy and colonoscopy showed a similar pattern of multiple yellowish nodules throughout the esophagus, stomach, duodenum, and colons. Histological analysis confirmed the diagnosis of lipoid proteinosis. In addition, small bowel follow through demonstrated numerous well defined, round, small filling defects throughout the jejunum. Ten years later, the esophageal lesions remained the same, but none of the previous alterations were detected in the stomach, duodenum, and colons. In conclusion, lipoid proteinosis may affect all gastrointestinal organs with the same pattern of macroscopic and microscopic lesions. Some lesions may regress with increasing age.

Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh's A and B patients.

BACKGROUND: The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS. METHODS: Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors. RESULTS: During follow-up evaluations averaging 34.9 +/- 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14-13.1, P = 0.029). CONCLUSIONS: Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence.

Esofagite eosinofílica em adultos: [revisão] / Eosinophilic esophagitis in adults: [review]

Esofagite eosinofílica é uma doença inflamatória primária crônica na qual ocorre infiltração de eosinófilos na mucosa esofágica. Tem patogênese indefinida, porém há importante associação com doenças alérgicas e história familiar. Os sintomas principais são disfagia e impactação de bolo alimentar, mas pode haver também pirose. O diagnóstico é estabelecido através de endoscopia e análise histológica da mucosa esofágica. O tratamento mais eficaz tem sido a corticoterapia tópica, havendo boa resposta clínica e histológica.

One-week dual therapy with ranitidine bismuth citrate and clarithromycin for the treatment of Helicobacter pylori infection in Brazilian patients with peptic ulcer.

AIM: To assess the efficacy and safety of ranitidine bismuth citrate plus clarithromycin given for 1 wk in Brazilian patients with peptic ulcer. METHODS: One hundred and twenty patients with peptic ulcer were randomized in two treatment groups: (1) 1-wk regimen consisting of ranitidine bismuth citrate 400 mg b.i.d. with clarithromycin 500 mg b.i.d. or (2) 2-wk regimen of the same treatment. Eradication of the infection was considered when both the histologic examination and the urease test were negative for the infection 3 mo after treatment. RESULTS: By intention to treat analysis, Helicobacter pylori (H pylori) was eradicated in 73% and 76% of patients, respectively treated for 1 or 2 wk (P>0.05). By per protocol analysis, the eradication rates were 80% and 83%, respectively, in patients treated for 1 or 2 wk (P>0.05). Nine patients (8.2%) reported minor side effects. CONCLUSION: One-week therapy with ranitidine bismuth citrate and clarithromycin is safe, well tolerated and effective for treatment of H pylori infection, and appears to be comparable to the 2-wk regimen in terms of efficacy.

Tratamento endoscópico das varizes esofágicas: ainda há lugar pra a escleroterapia? / Endoscopic treatment of esophageal varices: is sclerotherapy stil an efficient therapeutic option?

A escleroterapia endoscópica é um método terapêutico muito difundido e utilizado no tratamento das varizes esofágicas. É um procedimento de baixo custo, factível de ser realizado na maioria dos serviços de endoscopia, contribuindo para diminuir o risco de hemorragia nos hepatopatas crônicos. Foram analisados tardiamente 95 doentes hepatopatas (47 cirróticos, 42 esquistossomóticos e seis outras hepatopatias) no Gastrocentro-Unicamp, sendo 65 classificados com o child A (68,4por cento), 25 com child B(26,3por cento) e cinco com child C (5,2por cento), submetidos a escleroterapia de varizes, seguidos por tempo variável entre dois e 11 anos (média de três anos e quatro meses). O agente esclerosante mais utilizado foi o oleato de etanolamina a 5por cento em 66 casos(69,5por cento) e o alcool absoluto em 29 casos (30,5por cento). A escleroterapia foi paravasal, com o número médio de nove sessões por doente. O ressangramento na vigência da escleroterapia ocorreu em 47 doentes (49,5por cento), não havendo diferença significativa (p>0,05) entre os agentes esclerosantes utilizados. A mortalidade durante o tratamento foi de 12,6por cento. Os doentes incluídos no grupo A de Child tiveram sobrevida maior e estatisticamente significante ( p < 0,05) quando comparados com os dos grupos B e C. Considerando as etiologias das hepatopatias não houve diferença estatistica (p >0,05) na sobrevida de portadores de esquistossomose, quando comparada com as demais hepatopatias. Quarenta e seis doentes (48,5por cento) tiveram sobrevida maior que 60 meses. Concluindo, a escleroterapia endoscópica continua sendo um recurso terapêutico muito útil nos dias atuais. A longo prazo, a indicação de endoscopias digestivas periodicas e sessões de escleroterapia em hepatopatas contribuem para elevar a sobbrevida

A importância da endoscopia digestiva alta com soluçäo de lugol no diagnóstico de câncer superficial e displasia em esôfago de doentes com neoplasias de cabeça e pescoço / The importance of the upper digestive endoscopy using lugol dye solution for diagnosis of the superficial esophageal cancer and dysplasia in patients with head and neck cancer

Head and neck cancer has a high incidence in Brazil, with cancer of the oral cavity being one of the five most common cancers among Brazilians. Alcohol and tobacco consumption may contribute to synchronous or metachronous head and neck cancer and esophageal cancer. A prospective study involving 60 patients with head and neck cancer was carried out at the State University of Campinas--UNICAMP, Campinas, SP, Brazil to screen for superficial esophageal cancer and dysplasia using endoscopy and a 2 per cent lugol dye solution followed by biopsy of the suspicious areas. Five patients (8.3 per cent) had superficial esophageal cancer, which was diagnosed as intraepithelial carcinoma in three of them (5.0 per cent). In four patients, the superficial esophageal cancer was synchronous and in one it was metachronous to head and neck cancer. Five patients (8.3 per cent) had dysplasias in the esophageal epithelium (three were classified as mild and two as moderate). These results demonstrate the value of endoscopic screening of the esophagus using lugol dye in patients with head and neck cancer, particularly since superficial esophageal cancer is extremely difficult to detect by conventional methods in asymptomatic patients

Eletrocauterização bipolar da mucosa de Barrett após cirurgia anti-refluxo / Antireflux surgery followed by bipolar electrogoagulation in the treatment of Barrett's esophagus

Introdução: O tratamento da mucosa de Barrett permanece controverso. A importância de tentar reverter o epitélio de Barrett é que teoricamente poderia prevenir o aparecimento da displasia e do câncer. Tanto o tratamento clínico como a cirurgia anti-refluxo não mostram evidências de regressão do epitélio de Barrett ou parada de progressão da displasia até o adenocarcinoma. O objetivo deste estudo foi avaliar a eletrocauterização bipolar da mucosa de Barrett, após a correção cirúrgica do refluxo gastroesofágico. Métodos: O grupo se constituiu de 14 pacientes com mucosa de Barrett, sem displasia (11 do sexo masculino e 3 do sexo feminino). A média de idade foi de 45,6 anos (13 - 65 anos). Todos os pacientes foram submetidos previamente à cirurgia anti-refluxo pelo método laparoscópico e, na ausência de sintomas e com a válvula anti-refluxo bem configurada na manobra de retrovisão, iniciou-se a ablação da mucosa de Barrett com o BICAP (BICAPII, Circon-ACMI, Stanford, CT, USA). A eletrocauterização da mucosa foi realizada até o aparecimento de coágulo esbranquiçado. As endoscopias foram realizadas em intervalos de quatro semanas até toda a mucosa de Barrett ser eletrocauterizada. Após a reepitelização da área eletrocoagulada, realizaram-se biópsias seriadas para avaliar o tipo de epitélio e a presença de células caliciformes. Resultados: Dois pacientes apresentaram odinofagia e um, disfagia, sendo ambas de modo transitório. Conclusão: A eletrocauterização bipolar da mucosa de Barrett após a cirurgia anti-refluxo promove a regressão do epitélio de Barrett, com poucas complicações. Estudos com seguimento de longo prazo são necessários para determinar se a regressão será mantida, e se afetará o aparecimento de câncer.