The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. / Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.

[Control of upper digestive tract hemorrhage with Nd-Yag laser]. / Control de la hemorragia del tubo digestivo superior con rayo laser Nd-Yag.

Among the emergency procedures in patients with upper gastrointestinal bleeding the endoscopy is the most accurate; it will establish the diagnosis in about 95% of the cases, before an adequate treatment can be prescribed. Several endoscopic techniques have been employed to control the bleeding and laser photocoagulation, which applies luminous energy, restrain the bleeding. Nd-Yag laser photocoagulation was used in a retrospective study of 217 patients with active upper gastrointestinal bleeding. In all of the cases the bleeding was controlled at the moment of the endoscopic procedure. In 29 patients the hemorrhage recurred, mostly due to diffuse lesions like gastritis duodenitis of esophageal varices and only 18 of these patients required emergency surgery. There were no complications with the procedure. According to these results the Nd-Yag laser photocoagulation is an effective procedure for control of the upper gastrointestinal bleeding. It avoids emergency surgery and, if surgery is required later, the patients will be in better conditions. Gastrointestinal Bleeding, emergency endoscopy, Nd-Yag Laser, photocoagulation.

[Endoscopic resection of the digestive tract mucosa]. / Resección endoscópica de la mucosa del tubo digestivo.

The endoscopic resection of the mucosa of the digestive tract (ERM) is a set of techniques that have as their end the remotion of the mucosa for the diagnosis and treatment of localized diseases. The technique consists of the elevation of the mucosa with a submucosa injection of liquid or with suction in the interior of a transparent overtube. The procedure is indicated in the treatment of incipient malignant tumors of the esophagus, stomach, and colon, with a success rate that vacillates between 60 and 95%. An indispensable condition is the precise selection of patients through endoscopy and high-frequency endoscopic ultrasound. Other indications are the resection of flat and sessile polyps, the biopsies of submucosa tumors, and the taking of biopsies of great volume for the study of infiltrating and inflammatory neoplastic diseases. Based on the literature, principally descriptive and not comparative, the treatment of incipient digestive tract carcinomas with ERM has encountered serious difficulties in the Western world because of the rarity of the diagnosis, the scarce availability of endoscopic ultrasound, and lack of information of long-term results. On the other hand, in the diagnostic field of mucosa diseases, and in the treatment of polyps, its utility is evident. In conclusion, ERM is added to the new endoscopic techniques for the obtaining of specimens of great volume and for the resection of sessile polyps. In the treatment of malignant tumors, ERM should be used with caution.

[Diagnostic accuracy of biopsy and endoscopic cytology in cancer of the esophagus and stomach. Experience and analysis of error factors]. / Exactitud diagnóstica de la biopsia y la citología endoscoica en el cáncer del esófago y estómago Experiencia y análisis de los factores de error.

The definitive diagnosis of esophageal and gastric carcinoma rests upon histological confirmation of the lesion and it is one of the basis for planning the proper treatment. With the advent of exfoliative citology in 1947 the possibility of studying isolated cells detached from the esophagogastric mucosa became a reality. Later on, the development of the fiberoptic endoscopy permitted the direct observation of the lesion, and histological and citological diagnosis. In this report we publish the results obtained in 270 consecutive cases of esophageal and gastric carcinoma. The biopsies were positive in 86.2% of the cases and the citology was positive in 61.8% of the cases. Both procedures combined yielded 90.3% of positive results. Most false negative studies were related to lesions located in the cervical esophagus, and in the esophago-gastric junction, It is suggested that retrograde esophagoscopy through a gastrostomy could improve the results. The false negative cases of gastric carcinoma are related to inadequate gastric evacuation or to submucosal extension of the tumor. The adequate handling of the specimens is vital if good standards are to be kept.

[Percutaneous cholangioscopy. An alternative in the treatment of retained stones]. / La colangioscopia percutánea. Una alternativa en el tratamiento de los cálculos retenidos.

We report our experience in the use of percutaneous cholangioscopy for extraction of retained stones in the biliary tract, at the Oncology Hospital, Centro Médico Nacional, IMSS, between July 1984 and January 1990. Ninety seven patients were evaluated; the endoscopic manipulation was successful in 82 patients (84.5%). The main causes of failure were: narrow fistula, impacted stone, very small stones and false way. There were minor complications on 13 patients, but in two cases intestinal perforation indicated laparotomy. No death was reported. The main disadvantage of cholangioscopy was the waiting period, necessary to obtain a strong fistula. Nevertheless, the endoscopist can also relay on other techniques, such as sphincterectomy; the choice depends of each particular case.

[Treatment of gastric ulcer with famotidine. (Multicenter study)]. / Tratamiento de la ulcera gástrica con famotidina. (Estudio multicéntrico).

A multicentric open study designed to evaluate the effect of famotidine in the treatment of gastric ulcer was performed in several institutions located in 15 different cities of Mexico. 54 patients with gastric ulcer demonstrated by endoscopy were given 40 mg of famotidine daily, administered as a single dose at night. After 6 and 8 weeks of treatment, healing of the ulcer was observed in 63% and 88.9%, respectively. Side-effects were very unusual.

[Treatment of duodenal ulcer with famotidine. (Multicenter study)]. / Tratamiento de la ulcera duodenal con famotidina. (Estudio multicéntrico).

A multicenter open study aimed at evaluating the effect of famotidine in the treatment of duodenal ulcer was performed in several institutions located in 15 different cities of Mexico. One-hundred-and-fourteen patients with duodenal ulcer demonstrated by endoscopy were given 40 mg. of famotidine daily, administered as a single dose at night. After 4 and 6 weeks of treatment, healing of the ulcer was observed in 81.6% and 95.6% of patients, respectively. Side-effects were very unusual. In only one patient, who experienced vertigo during the treatment, administration of the drug had to be stopped.

[Endoscopic diagnosis of tumors of Vater's ampulla]. / Diagnóstico endoscópico de los tumores del ámpula de Vater.

The diagnosis of ampulla of Vater tumors is complex due to the proximity of other anatomical structures that are the originating sites of tumors with different natural histories, treatment and prognosis. A retrospective study of 65 consecutive patients with conclusive ampulla of Vater tumor diagnosis from January 1994 to April 1998 was conducted. Icterus was the principal symptom in 92%. In 34/65 patients on whom ultrasound or CT scan were performed, nearly half showed only dilation in the bile ducts, an ampullar tumor was suspected in six, in another six, pancreatic tumor was suspected and then discarded, and seven had no specific findings. Endoscopic imaging discovered the tumor in all of the cases, but the biopsy was diagnostic in only 84.6%: forty-eight carcinomas were discovered in addition to six adenomas (two with carcinoma and one with dysplasia) and one lymphoma. A diagnosis was arrived at in ten patients with negative biopsies through other means. Surgeries uncovered two carcinoids with endoscopic diagnosis of carcinoma. It was concluded that endoscopy is a good diagnostic method that allows palliation; however, it requires a perfecting process such as endoluminal ultrasound, specially if, taking into consideration the elevated morbimortality involved in pancreatoduodenectomies, conservative treatment is sought.

Barrett's esophagus: endoscopic treatments I.

The following on endoscopic treatments of Barrett's esophagus includes commentaries on indications for endoscopic treatments; endo-luminal plication procedures; the cellular modifications induced by the endoscopic ablation therapies; eradication by banding without resection; the evaluation of complete ablation; recurrence after ablation; association of antireflux surgery; radiofrequency ablation; and nondysplastic Barrett's esophagus.