Reliability and accuracy of a novel classification system using peroral cholangioscopy for the diagnosis of bile duct lesions.

BACKGROUND: The aim of this study was to propose a novel, comprehensive, macroscopic classification for bile duct lesions. METHODS: A two-stage protocol was designed. In Stage I, a retrospective study (September 2013 to September 2015) of patients with bile duct lesions detected by peroral cholangioscopy (POCS) was performed. A total of 315 images with at least 6 months of follow-up were recorded, analyzed, and correlated to histology, and were classified as non-neoplastic (one of three types, 1 - 3) or neoplastic (one of four types, 1 - 4) based on morphological and vascular patterns. In Stage II, a prospective, nonrandomized, double-blind study was performed from December 2015 to December 2016 to validate the proposed classification. Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios (LR + and LR - , respectively) were calculated (gold standard: 6-month follow-up). Inter- and intraobserver agreement (kappa value, κ) among experts and non-experts were calculated. RESULTS: 171 patients were included (65 retrospective; 106 prospective). In Stage I, 28/65 cases were neoplastic and 37 /65 were non-neoplastic, according to the final diagnosis. In Stage II, 56/106 were neoplastic with a sensitivity, specificity, PPV, NPV, LR + , and LR - for neoplastic diagnosis of 96.3 %, 92.3 %, 92.9 %, 96 %, 12.52, and 0.04, respectively. The proposed classification presented high reproducibility among observers, for both neoplastic and subtypes categories. However, it was better for experts (κ > 80 %) than non-experts (κ 64.7 % - 81.9 %). CONCLUSION: The novel classification system could help physicians to distinguish non-neoplastic from neoplastic bile duct lesions.

Is a 7-day Helicobater pylori treatment enough for eradication and inactivation of gastric inflammatory activity?

AIM: To compare the efficacy of a 7-d vs 10-d triple therapy regarding H pylori eradication, endoscopic findings and histological gastric inflammatory inactivation in the Ecuadorian population. METHODS: 136 patients with dyspepsia and H pylori infection were randomized in 2 groups (68 per group): group 1, 7-d therapy; group 2, 10-d therapy. Both groups received the same medication and daily dosage: omeprazole 20 mg bid, clarithromycin 500 mg bid and amoxicillin 1 g bid. Endoscopy was performed for histological assessment and H pylori infection status before and 8 wk after treatment. RESULTS: H pylori was eradicated in 68% of group 1 vs 83.8% of group 2 for the intention-to-treat analysis (ITT) (P = 0.03; OR = 2.48; 95% CI, 1.1-5.8), and 68% in group 1 vs 88% in group 2 for the per-protocol analysis (PP) (P = 0.008; OR = 3.66; 95% CI, 1.4-10). Endoscopic gastric mucosa normalization was observed in 56.9% in group 1 vs 61.2% in group 2 for ITT, with similar results for the PP, the difference being statistically not significant. The rate of inflammatory inactivation was 69% in group 1 vs 88.7% in group 2 for ITT (P = 0.007; OR = 3.00; 95% CI, 1.2-7.5), and 69% in group 1 vs 96% in group 2 for PP (P = 0.0002; OR = 7.25; 95% CI, 2-26). CONCLUSION: In this Ecuadorian population, the 10-d therapy was more effective than the 7-d therapy for H pylori eradication as well as for gastric mucosa inflammatory inactivation.

Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis.

AIM: To evaluate the clinical impact of confocal laser endomicroscopy (CLE) in the diagnosis and management of patients with an uncertain diagnosis. METHODS: A retrospective chart review was performed. Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included. Baseline characteristics, indications, previous diagnostic studies, findings at the time of CLE, clinical management and histological results were analyzed. Interventions based on CLE findings were also analyzed. We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens. RESULTS: A total of 144 patients were included. Of these, 51% (74/144) were female. The mean age was 51 years old. In all, 41/144 (28.4%) lesions were neoplastic (13 bile duct, 10 gastric, 8 esophageal, 6 colonic, 1 duodenal, 1 rectal, 1 ampulloma and 1 pancreatic). The sensitivity, specificity, positive predictive value, negative predictive value, and observed agreement when CLE was used to detect N-lesions were 85.37%, 87.38%, 72.92%, 93.75% and 86.81%, respectively. Cohen's Kappa was 69.20%, thus indicating good agreement. Changes in management were observed in 54% of the cases. CONCLUSION: CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.

Multiple Intestinal Erosions as a Result of Hemorrhage due to Parasites: Case Reports and Review of the Literature.

Obscure gastrointestinal bleeding appears to be uncommon in patients with parasites. In spite of that some reports had described this relationship in patients evaluated during capsule endoscopy procedures; the characteristic of the bleeding lesions remains unclear. This paper describes two patients with a massive obscure gastrointestinal bleeding due to ascariasis, using the new capsule endoscopy technology "MiroCam", describing the characteristic of the lesions found in our patients (observed in a better image quality), and reviewing the literature.

Endoscopic chemotherapy with 5-fluorouracil in advanced gastric cancer.

INTRODUCTION: It has been reported that a local injection of 5-fluorouracil (5-FU) administered endoscopically can have a favorable result in patients with early gastric cancer. METHODS: We report the application of a local injection of 5-FU administered endoscopically in three patients with advanced gastric cancer (AGC) who refused or were not suitable for surgery or systemic chemotherapy. The benefits of locally applied endoscopic chemotherapy (EC) with 5-FU as an alternative therapy were evaluated. RESULTS: Good tolerance with an important reduction of the tumor size and no adverse reactions was observed in all three patients. CONCLUSION: EC with 5-FU is a feasible technique that can be applied in a certain group of patients with AGC. Further studies will be required to corroborate these results.

Cáncer gástrico diminuto: reporte de caso clínico / Tiny gastric cancer: report of clinical case

Existe un incremento de las afecciones gástricas en nuestro país, especialmente de la úlcera y el cáncer gástrico, constituyéndose este último como la primera causa de mortalidad dentro de todos los tumores, por motivo de su diagnóstico tardío. Nosotros reportamos un caso de cáncer gástrico incipiente-diminuto, con seguimiento clínico y endoscópico de 3 años y medio con intervalos asintomáticos y constatación macroscópica de cicatrizzación y reactivación después del tratamiento médico, compatible con la historia natural que puede presentar en su evolución el cáncer gástrico, de acuerdo a trabajos publicados por autores japoneses. La presencia de helicobacter pylori fue evidenciada al inicio del estudio por test de ureasa y anatomía patológica. El diagnóstico endoscópico fue el de un cáncer gástrico diminuto (8mm. de diámetro), de tipo IIa+IIc con estudio histológico de adenocarcinoma diferenciado de tipo tubular intramucuso asociado a gastritis crónica atrófica y metaplasia intestinal...

Factores epidemiológicos e incidencia del cáncer gástrico en población hospitalaria rural de Manabí / Factors epidemiologists and incidence of the gastric cancer in rural hospitable population in Manabí

Motivados por la alta incidencia y mortalidad del cáncer gástrico en el Ecuador, patología que se constituye en la principal causa de muerte de los ecuatorianos dentro de todos los tumores, especialmente en la Provincia de Manabí, que en esta última década se ha constituido en un grave problema de centros de diagnósticos. Después de haber constatado en 1987 que el 19,3xciento de los cánceres procedían de un área rural ubicada en la zona central de la provincia, iniciamos nuestro primer trabajo de despistaje poblacional en la parroquia Alajuela y posteriormente en San Plácido y Calderón. La encuesta epidemiológica detreminó el consumo de manera importante de alimentos orgánicos de origen animal (carne y/o pescado), conservados en sal en un 75,5xciento de la población y, el análisis de la concentración de nitritos en 30 pozos que reportó 2 con elevada concentración y 8 con un ligero aumento...