El esófago de Barrett es una condición donde el epitelio esofágico es reemplazado por un epitelio columnar con células caliciformes. El riesgo de evolución hacia adenocarcinoma de esófago tiene una ...prevalencia del 0.5% anual. La cromoendoscopia virtual nos permite lograr un efecto similar a las tinciones, pero con solo apretar un botón, facilitando y dirigiendo específicamente la toma de biopsias.
Determinar la utilidad de la imagen de banda estrecha (NBI) en las endoscopias de pacientes con sospecha o diagnóstico de esófago de Barrett.
Es un estudio de evaluación diagnóstica de las biopsias tomadas con luz blanca comparado con las tomadas con NBI en donde se tenga sospecha o seguimiento del esófago de Barrett en el Servicio de Endoscopia del Hospital Central Sur de Alta Especialidad de PEMEX en el período de estudio.
En el período de estudio se realizaron 1,225 panendoscopias; se tomaron 127 biopsias por sospecha de esófago de Barrett (63 fueron hechas con luz blanca y 64 con NBI) y 124 por seguimiento del mismo (71 con luz blanca y 53 con NBI). Se observó que la sensibilidad y la especificidad para las endoscopias por primera vez con luz blanca fueron del 100% y del 84% respectivamente; y con NBI la sensibilidad fue del 100% y la especificidad del 93%. Para los estudios subsecuentes con luz blanca la sensibilidad fue del 92% y la especificidad del 92%; y con el uso de NBI la sensibilidad fue del 92% y la especificidad del 93%.
El uso de NBI en los estudios de endoscopia con sospecha de esófago de Barrett aumenta la especificidad.
Barrett esophagus is a condition that develops when the normal epithelium is replaced by a columnar epithelium with caliciform cells, with a prevalence of 5%. The risk of adenocarcinoma of the esophagus is 0.5% per year. Virtual chromoendoscopy gives similar results to using stains, but with only at the push of a button, specifically helps to direct the taking of biopsies.
Determine the usefulness of the narrow band imaging (NBI) in the endoscopies of patients with suspected or known Barrett esophagus.
An diagnosis evaluation study was performed on the biopsies taken with light compared with NBI of all the consecutive patients that had an endoscopy with the suspicion of or a known Barrett esophagus in the Endoscopy Service of the Hospital Central Sur de Alta Especialidad de PEMEX in the period of the study.
A total of 1,225 upper endoscopies were performed during the study period, with 127 biopsies taken due to the suspicion of Barrett esophagus (63 with white light and 64 with NBI). There were also 124 biopsies taken for follow-up of Barrett esophagus (71 with white light and 53 with NBI). The sensitivity and specificity of the white light endoscopies was 100% and 84%, respectively, and with NBI the sensitivity was 100% and specificity 93%. For the follow-up studies of Barrett esophagus with white light, the sensitivity and specificity were both 92%, and in the NBI follow-up studies the sensitivity was 92% and specificity 93%.
The use of NBI for studies of suspected Barrett esophagus increases the specificity and PPV compared with white light.
La obesidad es un problema de salud en México; la cirugía bariátrica es eficaz en el manejo de esta enfermedad; se requiere una endoscopia alta preoperatoria para detectar patología no diagnosticada; ...muchos obesos no presentan síntomas gastrointestinales y cuando los presentan suelen ser más intensos. Se ha evaluado poco la relación entre síntomas y hallazgos endoscópicos preoperatorios.
Conocer la relación entre los hallazgos endoscópicos y los síntomas gastrointestinales en los pacientes obesos previo a la cirugía bariátrica.
Se realizó un análisis retrospectivo de 5 años, de corte transversal. Se incluyó a obesos grado ii con comorbilidades y obesos grado iii o mayores que se les haya realizado endoscopia digestiva alta preoperatoria y se interrogaron sobre la presencia o ausencia de síntomas gastrointestinales. Se excluyeron a<18 o>65 años, embarazo, lactancia o patología subyacente grave o terminal. Se correlacionaron hallazgos endoscópicos y síntomas con el uso de coeficiente de phi.
Se incluyó a 53 pacientes. La media de edad fue de 45±9 años de edad (rango: 23-61); 22 hombres y 31 mujeres. El índice de masa corporal medio fue de 49.1kg/m2 (rango: 37.5-92.5). En la endoscopia digestiva alta el 83.01% (n=44) presentó algún tipo de hallazgo endoscópico y el 16.98% (n=9) endoscopia normal. El análisis de correlación con el uso de coeficiente de phi reportó una correlación positiva (rϕ=0.271, p=0.049) estadísticamente significativa con una p<0.05.
Existe correlación positiva, estadísticamente significativa, entre los síntomas presentados en los pacientes obesos candidatos a cirugía bariátrica y los hallazgos endoscópicos observados.
Obesity is a public health problem in Mexico. Bariatric surgery has been effective for its management. Preoperative endoscopy is required to detect any disease that not has been diagnosed. Many obese patients do not present with gastrointestinal symptoms, but when they do, they are more intense. There have been few evaluations on the relationship between these symptoms and preoperative endoscopic findings.
To determine the relationship between the preoperative endoscopic findings and the gastrointestinal symptoms in obese patients prior to bariatric surgery.
A 5-year retrospective and cross-sectional study was performed, that included patients with obesity grade ii with comorbidities, and obesity grade iii or greater, who have undergone preoperative upper endoscopy, and were questioned about the presence or absence of gastrointestinal symptoms. Exclusion criteria:<18 years,>65 years, pregnancy, breastfeeding and serious or terminal underlying disease. The correlation between the symptoms and endoscopic findings was calculated using phi coefficient, with P<.05 being statistically significant.
The study included 53 patients. The mean age was 45±9 years (range: 23-61); with 22 males and 31 females. The mean Body Mass Index was 49.1kg/m2 (range: 37.5-92.5). Upper gastrointestinal endoscopy showed some kind of finding in 83.01% (n=44), and 16.98% (n=9) normal endoscopy. The phi coefficient reported a positive correlation (rϕ=0.271, P=.049).
There is statistically significant positive correlation between the symptoms presented in obese patients for bariatric surgery and endoscopic findings.
Manejo endoscópico de la acalasia: revisión clínica Farell-Rivas, Jorge; Soto-Pérez, Julio César; Mata-Quintero, Carlos J. ...
Endoscopia,
July-September 2014, 2014-07-00, Letnik:
26, Številka:
3
Journal Article
Odprti dostop
La acalasia es un trastorno motor primario del esófago, de etiología desconocida e incurable. La intención de todo tratamiento es debilitar el esfínter esofágico inferior. Los 3 tratamientos ...endoscópicos establecidos son: la aplicación de toxina botulínica y las dilataciones neumáticas, además de otro en desarrollo llamado POEM (per-oral endoscopic myotomy). Los 2 primeros logran de manera efectiva debilitar la presión del esfínter esofágico inferior, sin embargo su efectividad y duración son muy variables. En el caso de la toxina botulínica tiene una recurrencia de síntomas en un 50% de los pacientes a 6 meses y en un 100% al año, mientras que en las dilataciones neumáticas a 5 años solo el 60% de los pacientes permanecen asintomáticos y la necesidad de múltiples dilataciones es la regla en más del 90% de los pacientes. El factor predictivo para remisión duradera es una presión del esfínter esofágico inferior<15mmHg posterior a la realización de cualquier tipo de procedimiento. Una nueva técnica promisoria y en evolución es el POEM, con resultados iniciales similares a la miotomía de Heller, sin embargo aún nos encontramos a la espera de que la técnica madure y tenga mayor experiencia.
Achalasia is an incurable primary esophageal motor disorder of unknown aetiology. The intent of any treatment is to weaken the lower esophageal sphincter. Established treatments for endoscopic management are endoscopic application of botulism toxin and pneumatic dilation, along with other treatments under development such as POEM (per-oral endoscopic myotomy). The first 2 are very effective in weakening lower esophageal sphincter pressure, but their efficacy and duration vary greatly. There is a recurrence of symptoms of 50% at 6 months and almost 100% in one year for botulism toxin, while with pneumatic dilation only 60% of patients are asymptomatic at 5 years, so the need for multiple pneumatic dilation is the rule in>90% of patients. The best positive predictor of lasting symptomatic response is lower esophageal sphincter pressure<15mmHg after performing any procedure. The POEM technique is promising and still evolving, initially offering results similar to the Heller myotomy; however, we are waiting for greater experience with more patients and for long-term results.
Las estenosis esofágicas benignas en niños se presentan más comúnmente secundarias a causas congénitas (atresia esofágica) y como resultado de tratamientos quirúrgicos de esta causa. El estándar de ...oro actualmente es dilatación esofágica neumática (con balón), sin embargo en casos de estenosis residuales actualmente se ha favorecido la colocación de stents esofágicos parcialmente cubiertos o totalmente cubiertos, con buena respuesta clínica a 2 años de seguimiento de hasta 70 a 100% de los pacientes pediátricos estudiados. Las complicaciones más comunes son migración del stent, recidiva, fístulas traqueoesofágicas, y perforación en menor grado.
Benign oesophageal strictures in children are commonly developped secondary to genetic causes, such as oesophageal atresia and the its surgical treament. The reference standard is curently balloon dilatation. However, in cases of refractory strictures the use of a partially or fully covered self-expandable metal stent is recommended, as it has around 70 to 100% positive results after a follow up of 2 years. The major complications were stent migration, tracheoesophageal fistulas, and perforation.
Corneal edema during penetrating keratoplasty (PK) precludes the visualization of the fundus required to perform vitreoretinal surgery. In this study, the clearing of the cornea and fundus ...visualization with dextran 40 following PK was evaluated.
Topical dextran 40 was used in 12 eyes that underwent uncomplicated PK (phase 1) and in 5 eyes that underwent combined PK with vitreoretinal surgery (phase 2).
Clearing of the cornea and visualization of the fundus were observed in all eyes after dextran had been instilled for a mean of 4 and 5 minutes in eyes for phase 1 and 2, respectively. Vitreoretinal surgery could successfully be performed after PK in all eyes of phase 2.
Topical use of dextran 40 following PK produces enough clearing of the cornea to enable visualization of the fundus for further vitreoretinal procedures after the graft has been sutured.
We report on the clinical status of 5 patients with Parkinson's disease (PD) 3 years after autologous adrenal medullary (AM)-to-caudate nucleus (CN) implantation, and of 2 PD patients, 2 years after ...fetal ventral mesencephalon (VM)- and fetal adrenal (A)-to-CN homotransplantation. Current clinical evaluation of 4 of the AM grafted patients revealed sustained bilateral amelioration of their PD signs, most notably of rigidity, postural imbalance and gait disturbances, resulting in a substantial improvement in their quality of life. The disease-related dystonia of one of them disappeared only 2 years after surgery. The levodopa requirements of 2 of these patients and the anticholinergic therapy of another have been reduced. In agreement with the satisfactory clinical evaluation of these 4 patients, their neuropsychological and electrophysiological improvements, initially registered 3 months after surgery, have been maintained for 3 years. After 1 year of significant recovery, the 5th patient of this group has almost returned to her preoperative state. The 2 homotransplanted patients also showed sustained bilateral improvement of their PD signs. Two years after surgery, the most improved signs of the fetal VM case were rigidity, bradykinesia, postural imbalance, gait disturbances and facial expression. The fetal A case has only shown amelioration of rigidity and bradykinesia. Neither of them has shown significant neuropsychological changes. Their current levodopa requirements are less than before surgery. The improvements shown here by PD patients after brain tissue grafts go beyond those obtained using any other therapeutic approach, when levodopa fails. Although more studies and the development of these procedures are obviously required, these initial human trials appear to be resisting the test of time.
PDF
