Search

Los resultados de la disección submucosa endoscópica (DSE) en el esófago no han sido evaluados en nuestro país. Nuestro objetivo principal fue analizar la efectividad y la seguridad de la técnica.

Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en‐bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed. Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty‐eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60–150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45–121] vs. 110 min [62–160]; p= 0.038). En‐bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p= 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1–11.74 and OR 5.07, 95%CI 1.6–16.08; respectively). Although the number of cases is limited, the results of this analysis show acceptable en‐bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD. Summarize the established knowledge on this subjectEndoscopic submucosal dissection (ESD) is the standard of care for treatment of early gastric cancers (GC). Due to a lower incidence of GC in European countries, the introduction of gastric ESD has been more gradual than in the East.ESD complications, technical and clinical success depend on the endoscopist's experience, the presence of submucosal fibrosis or invasive cancer, and poor access location. Endoscopic submucosal dissection (ESD) is the standard of care for treatment of early gastric cancers (GC). Due to a lower incidence of GC in European countries, the introduction of gastric ESD has been more gradual than in the East. ESD complications, technical and clinical success depend on the endoscopist's experience, the presence of submucosal fibrosis or invasive cancer, and poor access location. What are the significant and/or new findings of this study?This study shows the results from a prospective nationwide registry of gastric ESD in a low GC incidence country. Despite a relative low number of cases, quite acceptable outcomes (en‐bloc, R0 and curative resection of 91.3%, 75.2% and 70.9%, respectively) were observed considering the wide variability in experience among the operators.Difficult ESD were mainly associated with the presence of submucosal fibrosis and poor maneuverability; however, independent pre‐procedural factors were not identified. There was a trend of association between ESD difficulty and the location of the lesion in the upper/middle stomach This study shows the results from a prospective nationwide registry of gastric ESD in a low GC incidence country. Despite a relative low number of cases, quite acceptable outcomes (en‐bloc, R0 and curative resection of 91.3%, 75.2% and 70.9%, respectively) were observed considering the wide variability in experience among the operators. Difficult ESD were mainly associated with the presence of submucosal fibrosis and poor maneuverability; however, independent pre‐procedural factors were not identified. There was a trend of association between ESD difficulty and the location of the lesion in the upper/middle stomach

Este documento de posicionamiento, auspiciado por la Asociación Española de Gastroenterología, la Sociedad Española de Endoscopia Digestiva y la Sociedad Española de Anatomía Patológica, tiene como objetivo establecer recomendaciones para el cribado del cáncer gástrico (CG) en poblaciones con incidencia baja, como la española. Para establecer la calidad de la evidencia y los niveles de recomendación se ha utilizado la metodología basada en el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Se obtuvo el consenso entre expertos mediante un método Delphi. El documento evalúa el cribado en población general, individuos con familiares con CG y lesiones precursoras de CG (LPCG). El objetivo de las intervenciones debe ser la reducción de la mortalidad por CG. Se recomienda el uso de la clasificación OLGIM y determinar el subtipo de metaplasia intestinal (MI) para evaluar las LPCG. No se recomienda establecer cribado poblacional endoscópico de CG ni de Helicobacter pylori. Sin embargo, el documento establece una recomendación fuerte para el tratamiento de H.pylorisi se detecta la infección, y su investigación y tratamiento en individuos con antecedentes familiares de CG o con LPCG. En cambio, no se recomienda el uso de test serológicos para detectar LPCG. Se sugiere cribado endoscópico únicamente en los individuos con criterios de CG familiar. En cuanto a los individuos con LPCG, solo se sugiere vigilancia endoscópica ante MI extensa asociada a algún factor de riesgo adicional (MI incompleta y/o antecedentes familiares de CG) tras la resección de lesiones displásicas o en pacientes con displasia sin lesión visible tras una endoscopia digestiva alta de calidad con cromoendoscopia.

La pandemia por COVID-19ha conllevado la suspensión de la actividad programada en la mayoría de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscópica electiva de forma eficiente y segura.

Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines. The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy. This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking. A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p?=?0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19–0.97) and ADR (HR 0.94; 95% CI 0.89–0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89–0.99). Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.

Background Guidelines recommend surveillance colonoscopies based exclusively on findings at baseline colonoscopy. This recommendation leads to the paradox that the higher the baseline colonoscopy quality, the more surveillance colonoscopies will be indicated according to current guidelines.Objective The aim of this study was to evaluate the effect on follow-up findings of different quality metrics of the endoscopist performing the baseline colonoscopy.Methods This retrospective cohort study included individuals with advanced adenomas at baseline colonoscopy. Adenoma detection rate (ADR) and adenomas per colonoscopy rate (APCR) were determined for 44 endoscopists. Surveillance colonoscopies were checked after systematic tracking.Results A total of 574 individuals were diagnosed with advanced adenomas, of whom 270 received a surveillance colonoscopy. Patients whose baseline colonoscopy endoscopist had an ADR lower than the median of 33.8% had significantly higher rates of advanced neoplasia at follow-up (13.1% vs 4.0%; p= 0.001). On univariate analysis, high-risk advanced adenomas at baseline (HR 0.43; 95% CI 0.19–0.97) and ADR (HR 0.94; 95% CI 0.89–0.99) showed a significant relationship with advanced neoplasia at surveillance. In a multivariate Cox model, the ADR of the endoscopist who performed the baseline colonoscopy was the only independent predictor of risk for developing advanced neoplasia at follow-up (HR 0.94; 95% CI 0.89–0.99).Conclusions Our results suggest that the risk of identifying advanced adenomas at follow-up is closely related to the quality metrics of the endoscopist who performs the baseline colonoscopy.

Este documento resume el contenido de la Guía de resección mucosa endoscópicaelaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales.