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2.
Rev. esp. enferm. dig ; 110(8): 505-509, ago. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-177760

RESUMO

Objetivo: el diclofenaco rectal, un antiinflamatorio no esteroideo (AINE), se utiliza para prevenir la pancreatitis en pacientes de alto riesgo en la colangiopancreatografía retrógrada endoscópica (CPRE). La Sociedad Europea de Endoscopia Digestiva (ESGE) recomienda profilaxis con indometacina o diclofenaco a todos los pacientes a los que se les realice una CPRE, incluso en aquellos de riesgo medio-bajo de pancreatitis. Hemos realizado un estudio para investigar la eficacia de esta recomendación. Métodos: estudio de cohortes mixto. Se incluyeron 1.512 CPRE efectuadas en nuestro centro entre enero de 2009 y julio de 2016. Hasta junio de 2012, 718 pacientes no recibieron diclofenaco. Posteriormente, 794 pacientes sin contraindicaciones recibieron 100 mg rectales de diclofenaco al inicio del procedimiento. Se registraron los factores de riesgo para pancreatitis aguda post-CPRE (PAPC) y los casos de PAPC que se definieron por criterios de consenso. Resultados: hubo 47 PAPC (3,1%), un 3,4% de las cuales correspondió al grupo con diclofenaco y un 2,8%, al grupo no tratado (p = 0,554). El 26,1% de todos los pacientes presentaba factores de riesgo para PAPC. En el grupo con diclofenaco hubo un 4,4%, 0,5% y 2,6% de PAPC en papilas intactas, con esfinterotomía previa y con ampliación de la misma, respectivamente, similar al grupo no tratado (4% papila intacta, 0,9% esfinterotomía previa y 2,5% ampliación). La gravedad de la PAPC fue similar en los dos grupos. Conclusiones: en nuestro estudio, el diclofenaco rectal antes de la CPRE en pacientes consecutivos no seleccionados no previene la aparición de pancreatitis aguda post-CPRE


Objective: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed. Methods: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure. Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded. Results: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups. Conclusions: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients


Assuntos
Humanos , Masculino , Feminino , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pancreatite/etiologia , Diclofenaco/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Pancreatite/prevenção & controle , Administração Retal , Fatores de Risco , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Casos e Controles
3.
Rev Esp Enferm Dig ; 110(8): 505-509, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29667415

RESUMO

OBJECTIVE: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed. METHODS: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure. Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded. RESULTS: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups. CONCLUSIONS: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Diclofenaco/administração & dosagem , Diclofenaco/uso terapêutico , Pancreatite/etiologia , Pancreatite/prevenção & controle , Administração Retal , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
5.
Rev. esp. enferm. dig ; 109(10): 731-733, oct. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-166829

RESUMO

El avance de la terapéutica endoscópica está permitiendo abordar patologías que hasta hace poco quedaban reservadas al tratamiento quirúrgico, como las fístulas digestivas. El sistema Padlock(R) consiste en un clip de nitinol introducido recientemente para terapéutica endoscópica. Hasta el momento, son pocas las comunicaciones sobre su utilización en la práctica diaria. Presentamos un caso de fístula colónica tratada mediante este nuevo sistema de clip endoscópico de nitinol (AU)


Recent advances in endoscopic therapeutics allow conditions such as fistulas of the digestive system to be treated endoscopically. These cases were recently managed with surgery. The Padlock(R) system includes a nitinol clip that was recently introduced for endoscopic therapy. There are few reports with regard to its use in the daily clinical practice. We report a case of a colonic fistula that was endoscopically managed with this novel over-the-scope nitinol clip system (AU)


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Fístula/terapia , Fístula , Endoscopia/métodos , Fístula do Sistema Digestório/terapia , Instrumentos Cirúrgicos , Colonoscopia/métodos , Antibacterianos/uso terapêutico , Resultado do Tratamento
6.
Rev Esp Enferm Dig ; 109(10): 731-733, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28942655

RESUMO

Recent advances in endoscopic therapeutics allow conditions such as fistulas of the digestive system to be treated endoscopically. These cases were recently managed with surgery. The Padlock® system includes a nitinol clip that was recently introduced for endoscopic therapy. There are few reports with regard to its use in the daily clinical practice. We report a case of a colonic fistula that was endoscopically managed with this novel over-the-scope nitinol clip system.


Assuntos
Doenças do Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Fístula Intestinal/cirurgia , Hepatopatias/cirurgia , Idoso , Ligas , Feminino , Humanos , Instrumentos Cirúrgicos
7.
Gastroenterol. hepatol. (Ed. impr.) ; 40(1): 10-15, ene. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-159677

RESUMO

Introducción: La influencia de la experiencia acumulada del médico que interpreta cápsulas endoscópicas sobre su capacidad diagnóstica es discutida. Objetivo: Determinar si existen diferencias en el valor predictivo negativo de las cápsulas endoscópicas informadas por los mismos endoscopistas a lo largo del tiempo. Métodos: Revisamos las 900 primeras cápsulas endoscópicas realizadas por tres gastroenterólogos expertos en endoscopia durante 8 años. Se dividieron en 3 grupos de 300 cápsulas cada uno. El grupo 1 fue la suma de las tres primeras centenas informadas por cada uno, el grupo 2 la suma de las tres segundas centenas y el grupo 3 la suma de las tres terceras centenas. Se hizo un seguimiento mínimo de 28 meses a los casos con exploración normal. Resultados: Aunque se consideraron normales el 18% de las cápsulas del grupo 1, el 19,3% de las del grupo 2 y el 15,6% de las del grupo 3, solo fue posible seguir y finalmente analizar a 34 enfermos en el grupo 1, a 38 en el 2 y a 36 en el 3. Sobre estos casos, el valor predictivo negativo fue del 88,2% en el grupo 1, del 89,5% en el grupo 2 y del 97% en el grupo 3 (p>0,05). Conclusión: El valor predictivo negativo de la cápsula endoscópica, aunque con tendencia a aumentar, se mantiene alto y sin diferencias significativas desde las 100 primeras exploraciones si los médicos que la interpretan son expertos en endoscopia convencional y tienen formación específica previa (AU)


Introduction: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. Aim: To determine whether the negative predictive value of CE findings changes along the learning curve. Methods: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. Results: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P>.05). Conclusion: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training (AU)


Assuntos
Humanos , Endoscopia por Cápsula/estatística & dados numéricos , Cápsulas Endoscópicas/estatística & dados numéricos , Enteropatias/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Valor Preditivo dos Testes , Interpretação de Imagem Assistida por Computador/métodos , Curva de Aprendizado , Endoscopia por Cápsula/educação , Intestino Delgado
8.
Gastroenterol Hepatol ; 40(1): 10-15, 2017 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27085915

RESUMO

INTRODUCTION: The impact of the accumulated experience of the capsule endoscopy (CE) reader on the accuracy of this test is discussed. AIM: To determine whether the negative predictive value of CE findings changes along the learning curve. METHODS: We reviewed the first 900 CE read by 3 gastroenterologists experienced in endoscopy over 8 years. These 900 CE were divided into 3 groups (300 CE each): group 1 consisted of the sum of the first 100 CE read by each of the 3 endoscopists; group 2, the sum of the second 100 and groups 3, the sum of the third 100. Patients with normal CE were monitored for at least 28 months to estimate the negative predictive value. RESULTS: A total of 54 (18%) CE in group 1, 58 (19.3%) in group 2 and 47 (15.6%) in group 3 were normal, although only 34 patients in group 1, 38 in group 2 and 36 in group 3 with normal CE completed follow up and were eventually studied. The negative predictive value was 88.2% in group 1, 89.5% in group 2 and 97% in group 3 (P>.05). CONCLUSION: The negative predictive value tended to increase, but remained high and did not change significantly after the first 100 when readers are experienced in conventional endoscopy and have preliminary specific training.


Assuntos
Endoscopia por Cápsula , Gastroenterologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
10.
Gastroenterol. hepatol. (Ed. impr.) ; 39(10): 647-655, dic. 2016. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-158328

RESUMO

Introducción: La colonoscopia es el gold standard en la detección y prevención del cáncer colorrectal (CCR). No obstante, en la práctica clínica habitual nos encontramos con pacientes que desarrollan un CCR a pesar de que se habían sometido a una colonoscopia previamente. Objetivos: Estudiar la prevalencia de CCR de novo o no detectados tras la realización de una colonoscopia y valorar los posibles factores de riesgo. Pacientes: Se incluyen los pacientes diagnosticados de CCR registrados en la base de datos endoscópicos de nuestro hospital entre marzo de 2004 y septiembre de 2011. Identificamos los pacientes que tenían realizada una colonoscopia en los 5 años previos. Se recogieron: edad, sexo, comorbilidades e indicación de la colonoscopia, tamaño y localización del tumor, así como su grado de diferenciación, su clasificación TNM y las posibles causas. Posteriormente comparamos este subgrupo de pacientes con los que habían sido diagnosticados de CCR en su primera colonoscopia (CCR esporádico, grupo control). Resultados: Se incluyeron 712 pacientes diagnosticados de CCR. Veinticuatro de ellos (3,6%) tenían una colonoscopia realizada en los 5 años previos (50% varones, 50% mujeres, edad media 72años). Estos CCR poscolonoscopia se atribuyeron: uno (4,2%) a colonoscopia incompleta, 4 (16,6%) a resección incompleta de adenoma, uno (4,2%) a biopsia fallida, 8 (33,3%) a «lesiones no detectadas» y 10 (41,7%) fueron CCR de nueva aparición. Los CCR poscolonoscopia eran de menor tamaño que los CCR esporádicos (3,2 vs 4,5cm, p<0,001), principalmente localizados en colon proximal (62% vs 35%, p=0,006); no hubo diferencias en cuanto al grado histológico (p=0,125), pero sí una tendencia a presentar un mejor estadio TNM (p=0,053). Conclusiones: La tasa de CCR tras una colonoscopia previa en nuestra serie es del 3,6%. Las posibles causas de estos CCR se atribuyeron en su mayoría (58,4%) a factores relacionados al procedimiento endoscópico y, por tanto, evitables. Estos hallazgos reafirman la importancia de ajustarse a los indicadores de calidad de la colonoscopia. Los CCR poscolonoscopia fueron de menor tamaño, localizados fundamentalmente en colon derecho y con tendencia a presentar un estadio TNM más precoz (AU)


Background: Colonoscopy is the gold standard for the detection and prevention of colorectal cancer (CRC). However, some individuals are diagnosed with CRC soon after a previous colonoscopy. Aims: To evaluate the rate of new onset or missed CRC after a previous colonoscopy and to study potential risk factors. Methods: Patients in our endoscopy database diagnosed with CRC from March 2004 to September 2011 were identified, selecting those with a colonoscopy performed within the previous 5years. Medical records included age, gender, comorbidities and colonoscopy indication. Tumour characteristics studied were localization, size, histological grade and TNM stage and possible cause. These patients were compared with those diagnosed with CRC at their first endoscopy (sporadic CRC-control group). Results: A total of 712 patients with CRC were included; 24 patients (3.6%) had undergone colonoscopy within the previous 5 years (50% male, 50% female, mean age 72). Post-colonoscopy CRCs were attributed to: 1 (4.2%) incomplete colonoscopy, 4 (16.6%) incomplete polyp removal, 1 (4.2%) failed biopsy, 8 (33.3%) ‘missed lesions’ and 10 (41.7%) new onset CRC. Post-colonoscopy CRCs were smaller in size than sporadic CRCs (3.2cm vs. 4.5cm, P<.001) and were mainly located in the proximal colon (63% vs. 35%, P=.006); no difference in histological grade was found (P=.125), although there was a tendency towards a lower TNM stage (P=.053). Conclusions: There is a minor risk of CRC development after a previous colonoscopy (3.6%). Most of these (58.4%) are due to preventable factors. Post-colonoscopy CRCs were smaller and mainly right-sided, with a tendency towards an earlier TNM stage (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Colonoscopia/estatística & dados numéricos , Neoplasias do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Reações Falso-Negativas , Fatores de Risco , Neoplasias do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia
11.
Gastroenterol Hepatol ; 39(10): 647-655, 2016 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26996465

RESUMO

BACKGROUND: Colonoscopy is the gold standard for the detection and prevention of colorectal cancer (CRC). However, some individuals are diagnosed with CRC soon after a previous colonoscopy. AIMS: To evaluate the rate of new onset or missed CRC after a previous colonoscopy and to study potential risk factors. METHODS: Patients in our endoscopy database diagnosed with CRC from March 2004 to September 2011 were identified, selecting those with a colonoscopy performed within the previous 5years. Medical records included age, gender, comorbidities and colonoscopy indication. Tumour characteristics studied were localization, size, histological grade and TNM stage and possible cause. These patients were compared with those diagnosed with CRC at their first endoscopy (sporadic CRC-control group). RESULTS: A total of 712 patients with CRC were included; 24 patients (3.6%) had undergone colonoscopy within the previous 5 years (50% male, 50% female, mean age 72). Post-colonoscopy CRCs were attributed to: 1 (4.2%) incomplete colonoscopy, 4 (16.6%) incomplete polyp removal, 1 (4.2%) failed biopsy, 8 (33.3%) 'missed lesions' and 10 (41.7%) new onset CRC. Post-colonoscopy CRCs were smaller in size than sporadic CRCs (3.2cm vs. 4.5cm, P<.001) and were mainly located in the proximal colon (63% vs. 35%, P=.006); no difference in histological grade was found (P=.125), although there was a tendency towards a lower TNM stage (P=.053). CONCLUSIONS: There is a minor risk of CRC development after a previous colonoscopy (3.6%). Most of these (58.4%) are due to preventable factors. Post-colonoscopy CRCs were smaller and mainly right-sided, with a tendency towards an earlier TNM stage.


Assuntos
Colonoscopia , Neoplasias Colorretais/etiologia , Adolescente , Adulto , Idoso de 80 Anos ou mais , Biópsia , Estudos de Casos e Controles , Transformação Celular Neoplásica , Pólipos do Colo/diagnóstico , Pólipos do Colo/cirurgia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Erros de Diagnóstico , Progressão da Doença , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia , Adulto Jovem
12.
Lab Med ; 46(2): 123-35, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25918191

RESUMO

OBJECTIVES: To detect whether signs of oxidative stress appear at early stages of colorectal adenocarcinoma (CRC), particularly in the polyp stage. We also aimed to evaluate the specific entities myeloperoxidase (MPO) and oxidized low-density lipoprotein (oxLDL) as novel markers of oxidation in the plasma of patients with CRC and to study the relationship between oxidative status in plasma and patient survival. METHODS: We assayed serum or plasma specimens from healthy control subjects (n = 14), from patients with intestinal polyps (n = 39), and from patients with CRC (n = 128) to calculate the modified oxidative balance score (MOBS) using several serum markers (ß-carotene, lycopene, vitamin A, vitamin E, MPO, and oxLDL). We also assayed the levels of C-reactive protein (CRP) and obtained lipid profiles. Finally, we studied the survival of patients in relationship to oxidative status (antioxidants and pro-oxidants) and inflammation markers, and added theses data to the lipid profile for each patient. RESULTS: Oxidative stress levels increased as disease stage advanced. This increase was detected early in the polyp stage, before polyps progressed to cancer, and could be measured by the increase of such new markers as MPO and oxLDL, the decrease in antioxidants, and the MOBS value. Higher levels of oxidation correlated with lower survival. CONCLUSION: The oxidation process, which can cause mutations leading to CRC, begins development in the polyp stage. This process may be detected early by monitoring serum markers such as MPO and oxLDL.


Assuntos
Polipose Adenomatosa do Colo/sangue , Polipose Adenomatosa do Colo/diagnóstico , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Lipoproteínas LDL/sangue , Peroxidase/sangue , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Proteína C-Reativa/metabolismo , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Gastroenterol. hepatol. (Ed. impr.) ; 36(1): 26-29, ene. 2013. ilus
Artigo em Espanhol | IBECS | ID: ibc-109246

RESUMO

Describimos el caso de un paciente varón de 43 años recientemente diagnosticado de enfermedad de Crohn de íleon que presenta una perforación intestinal por un divertículo de Meckel, detectándose enterolitos en la luz intestinal. Rara vez se ha comunicado la coexistencia de enfermedad de Crohn, divertículo de Meckel y enterolitos. El divertículo de Meckel puede hacer más difícil el tratamiento del paciente con enfermedad de Crohn (AU)


We describe the case of a 43-year-old man recently diagnosed with ileal Crohn's disease complicated by a free peritoneal perforation of a Meckel's diverticulum and the presence of enteroliths in the intestinal lumen. The coexistence of Crohns disease, Meckel's diverticulum and enteroliths has rarely been reported. Meckel's diverticulum can hamper the management of Crohn's disease (AU)


Assuntos
Humanos , Masculino , Adulto , Divertículo Ileal/complicações , Doença de Crohn/complicações , Perfuração Intestinal/complicações , Obstrução Intestinal/etiologia , Fatores de Risco
14.
Gastroenterol Hepatol ; 36(1): 26-9, 2013 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-22749502

RESUMO

We describe the case of a 43-year-old man recently diagnosed with ileal Crohn's disease complicated by a free peritoneal perforation of a Meckel's diverticulum and the presence of enteroliths in the intestinal lumen. The coexistence of Crohns disease, Meckel's diverticulum and enteroliths has rarely been reported. Meckel's diverticulum can hamper the management of Crohn's disease.


Assuntos
Doença de Crohn/complicações , Obstrução Intestinal/etiologia , Litíase/etiologia , Divertículo Ileal/etiologia , Adulto , Humanos , Masculino
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