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Introduction: The majority of cases of Clostridioides difficile infection (CDI) respond to antibiotic treatment. Fecal microbiota transplantation (FMT) has been accepted as an effective treatment in cases of recurrent CDI. Aim: Our aim was to describe the clinical results of FMT performed for the treatment of recurrent CDI. Material and methods: The study was conducted on patients with recurrent CDI treated with FMT through colonoscopy, within the time frame of January 2021 and December 2023. Demographic and clinical data were collected, including pre-FMT treatment data, the FMT success rate, and clinical progression during follow-up. Telephone surveys were carried out to evaluate satisfaction. Results: Thirteen patients with a mean age of 55 years underwent FMT (including 7 patients above 65 years of age and one pregnant woman). Patients presented with a median of 3 previous episodes of CDI (range 2-4). The median time interval from first episode of CDI to FMT was 4 months (range 3-10). The effectiveness of a single FMT session was 100%. During post-FMT follow-up (median of 11 months, range 3-32), 3 patients have presented with a new CDI episode, and a successful second FMT was performed on 2 of them. No adverse events were registered, and all patients had a positive perception of FMT. Conclusions: In the present study, despite its small size, FMT through colonoscopy was shown to be a safe, effective, and lasting therapy in cases of recurrent CDI, concurring with results from larger studies. Resumen: Introducción: La mayoría de los casos de infección por Clostridioides difficile (ICD) responden tratamiento antibiótico. El trasplante de microbiota fecal (TMF) ha sido aceptado como un tratamiento efectivo en casos de ICD recurrente. Objetivo: Describir resultados clínicos del TMF realizado para el tratamiento de la ICD recurrente. Material y métodos: Pacientes con ICD recurrente tratados con TMF mediante colonoscopia entre enero 2021 y diciembre 2023. Se recopilaron datos demográficos y clínicos, incluyendo detalles del tratamiento previo al TMF, la tasa de éxito del TMF y la evolución clínica durante el periodo de seguimiento. Se realizaron encuestas telefónicas para evaluar la satisfacción. Resultados: Fueron sometidos a TMF 13 pacientes (siete pacientes mayores de 65 años y una mujer embarazada) con una mediana de edad de 55 años. Los pacientes presentaron una mediana de tres episodios previos de ICD (rango 2-4). La mediana de la duración desde el primer episodio de ICD hasta el TMF fue de cuatro meses (rango 3-10). La efectividad con una sesión de TMF fue de 100%. Durante el periodo de seguimiento pos-TMF (mediana de 11 meses, rango 3-32), tres pacientes han presentado un nuevo episodio de ICD, y en dos casos se llevó a cabo con éxito un segundo TMF. No se registraron eventos adversos. Todos los pacientes tuvieron una percepción positiva del TMF. Conclusiones: El TMF mediante colonoscopia, si bien es una serie pequeña, concuerda con estudios de mayor envergadura, como una terapia segura, efectiva y duradera en casos de ICD recurrente.

Background and Study Aims: Positron emission tomography/computed tomography (PET/CT) with 2-[18F]FDG (FDG) has been increasingly used to detect or monitor neoplasms. Gastrointestinal tract (GIT) is one of the most common sites of FDG uptake, leading to increasing requests for endoscopic examinations. We aimed to evaluate the nature and significance of unexpected PET/CT-FDG findings in the GIT. Patients and Methods: We retrospectively analyzed 371 consecutive patients with incidental GIT findings on PET/CT-FDG between June 2016 and October 2021 who were subsequently referred to endoscopic examinations. Demographic data, PET/CT-FDG results, endoscopic findings, and histological analysis were analyzed. Results: Of 194 colonic incidental uptakes, 102 (52.6%) corresponded to at least premalignant lesions, being 57 (29.4%) advanced adenomas and 23 (11.9%) adenocarcinomas. Of 193 upper GIT incidental uptakes, there were 11 (13.8%) esophageal and 14 (14.4%) gastric malignant/premalignant lesions. The maximum standardized uptake value (SUVmax) significantly varied according to the nature of the lesion, being higher in malignant lesions (in the esophagus, stomach, and colon). However, an optimal SUVmax cutoff was only found for stomach (SUVmax 8.2; sensitivity of 79% and specificity of 76%). There was a significant association between the site of uptake and the nature of the lesion – left colon and gastric body uptake were associated with neoplastic origin whereas rectum and lower esophagus were associated with inflammatory or no endoscopic changes. Conclusions: Any incidental uptake in the lower GIT should be investigated provided that patients are suitable for further treatment. However, in the upper GIT the characteristics of uptake on 18F‐FDG‐PET/CT may allow to select those who need endoscopic examination.

In order to evaluate adherence to colorectal cancer (CRC) screening among members of the Health Plan of the Hospital Italiano de Buenos Aires in Argentina, we conducted a retrospective cohort study using secondary data from the electronic medical record. We included all members over 50 years of age during the period 2008-2022. We assessed the number and type of screening tests performed and the proportion of members covered for screening. We analyzed 112,112 participants, with a median age of 58.6 years and a follow-up time of 8.6 years. Colonoscopy was the most commonly used test. The maximum coverage reached was 47.1% in December 2022. In conclusion, adherence to CRC screening was suboptimal, as was the method used. This information can be used for the design of a multicomponent intervention. [ABSTRACT FROM AUTHOR]

A foreign body is defined as any object coming from outside, foreign to the human body. In dentistry, cases of accidental aspiration or ingestion of orthodontic appliances or fragments, as well as instruments used during dental practice, have been described. If a sharp object pierces the esophagus, the consequences can be serious. Food and other esophageal contents can enter the chest cavity (mediastinum) and cause a life-threatening inflammation (mediastinitis). Sharp objects can also cause perforation of the stomach, intestines, colon or rectum. The perforation allows food, digestive juices, or intestinal contents, to leak into the abdomen. This leak is a medical emergency, as it can cause peritonitis (inflammation of the abdominal cavity) with fatal consequences. It passes more frequently into the digestive tract than into the respiratory tract. The biggest problems occur at the level of the esophagus and stomach. Abdominal radiographic studies are the initial approach and are very useful in determining the location of ingested foreign bodies, in addition to fiber ingestion for i ntestinal motility. [ABSTRACT FROM AUTHOR]

Introducción: el objetivo de este estudio fue evaluar la profundidad de la resección mucosal endoscópica con asa fría, tanto en seco como bajo agua, en pacientes con neoplasias colorrectales no polipoides. Métodos: se realizó un estudio observacional y retrospectivo en el Centro Médico Docente La Trinidad, en pacientes mayores de 18 años con lesiones no polipoides observadas en colonoscopia y resecadas con asa fría. Se midió el espesor de la submucosa para evaluar la profundidad del corte. Resultados: se analizaron 87 pólipos en 64 pacientes con edades entre 35 y 86 años (promedio 62 años). La técnica en seco fue la más utilizada (68.97%). En lesiones de 5-20 mm, ambas técnicas mostraron efectividad para lograr resecciones mucosales completas. El 24% de las resecciones presentaron submucosa. El espesor promedio de la submucosa con la técnica en seco fue de 196.43 µm, frente a 166.67 µm con la técnica bajo agua. En relación al diagnóstico histológico, predominaron los adenomas en las lesiones resecadas. La resección mucosal endoscópica con asa fría, tanto en seco como bajo agua, resultó efectiva en lesiones planas ≤ 20 mm sin sospecha de displasia de alto grado o invasión submucosal. Conclusiones: estos hallazgos respaldan la estandarización de las prácticas endoscópicas, ya que el uso del asa fría es una técnica segura, sencilla, de bajo costo y sin necesidad de corriente electroquirúrgica, lo que reduce el riesgo de complicaciones.

Introduction: The quality of a colonoscopy is a key factor in clinical outcomes and largely depends on the bowel cleanliness achieved through proper preparation. The type of agent, adherence, and tolerability are factors that can influence the quality of bowel preparation and, consequently, the results of the procedure. This study aims to evaluate the factors that determine the choice of preparation agent and its impact on the quality of colonoscopy. Methodology: A cross-sectional observational study was conducted with a sample of 530 patients. Agents evaluated included polyethylene glycol (PEG), sodium picosulfate, and sodium-potassium-magnesium sulfate (Na-K-Mg sulfate), with their continuous and split-dose regimens, depending on the case. The reasons for selection and tolerability were assessed through a survey. Bowel cleanliness was determined by the endoscopist using the Boston scale. Results: The average age was 52.7 years (±13.4), with 60% being women. The most selected agent was PEG (81.9%) in the full-dose regimen (74.5%). The main determining factor was the availability of the drug, at 42.6%. Unwanted symptoms were reported in 62.6% of patients, however, 99.4% achieved adequate preparation (Boston =6). Conclusion: The primary factor related to the selection of the bowel preparation agent is availability. Objective tolerability does not significantly affect the quality of bowel cleanliness or the success of the procedure. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El aumento de los costos sanitarios y financieros de las enfermedades, las discapacidades y las disparidades respalda la aceleración mundial de los intereses y las inversiones en IA (inteligencia artificial) sanitaria para lograr soluciones sanitarias mejores, más baratas, más rápidas y justas a escala mundial y local. Sin embargo, no existe un consenso sobre la aplicación práctica de los principios de la IA responsable en diversos sectores, estados y sistemas de creencias de todo el mundo. Este estudio de prueba de concepto utiliza el marco ético pluralista global (el Contrato Social Personalista) para proporcionar, por tanto, el primer análisis conocido de ética computacional (AiCE, por sus siglas en inglés) y política basado en IA aumentada bayesiana que integra análisis clínicos, de rentabilidad y de disparidades en la atención sanitaria con datos representativos a nivel nacional para estimar el costo global de las disparidades en la atención sanitaria en la colonoscopia (CS, por sus siglas en inglés) y el ahorro de la CS habilitada por IA para reducirlas. El estudio sugiere que revertir las disparidades raciales, en particular entre hispanos y asiáticos, puede ahorrar a los sistemas sanitarios estadounidenses 17.610 millones de dólares al año, con un ahorro potencial de 625,40 millones de dólares para los hispanos y 289 millones de dólares para los asiáticos en particular (con un ahorro similar para las comunidades vulnerables en países de ingresos medios y bajos). Los resultados anteriores respaldan el imperativo de ahorro de costos que supone la inversión estratégica y de capacitación en estas medidas impulsadas por la IA para mejorar los objetivos estratégicos de sostenibilidad, eficacia, eficiencia y equidad (SEEE) de la atención sanitaria. Estos resultados empíricos informan el argumento bioético global más amplio de las dimensiones gemelas de la dignidad y la seguridad humanas (arraigadas en el relato personalista, multicultural y metafísico de la persona como miembro de la familia humana global) para destacar el imperativo ético de la IA para optimizar el rendimiento del ecosistema sanitario digital global. Semejante fin instrumental es un medio decisivo para avanzar hacia el fin último del bien común, en el que se salvaguarda el bien individual de cada persona y en el que éste encuentra su realización trabajando hacia él.

Antecedentes y objetivos: las tasas de cáncer gástrico (CG) o cáncer colorrectal (CCR) posendoscopia (CGPE) o poscolonoscopia (CCRPC) (de intervalo) han sido poco estudiadas en nuestro medio. Los datos de estudios en el exterior informaron tasas de CGPE y CCRPC de 7%-26%. Nuestro objetivo fue determinar y comparar las tasas y características del CGPE y CCRPC locales. Pacientes y métodos: con datos de tres centros oncológicos de cuarto nivel se identificaron, de forma ambispectiva, pacientes diagnosticados con CG y CCR entre 2012 y 2021, en quienes se investigó el antecedente de endoscopias o colonoscopias en los tres años previos. Los cánceres diagnosticados entre 6 y 36 meses después de un estudio endoscópico reportado como normal se definieron como cánceres de intervalo. En este estudio se comparan las características clínicas, endoscópicas y de sobrevida entre ambas cohortes de cánceres posendoscopia y poscolonoscopia. Resultados: de 828 pacientes diagnosticados con CG, 66 tuvieron CGPE (tasa: 7,3%), mientras que en 919 pacientes con CCR, 68 pacientes presentaron CCRPC (tasa: 6,9%). No hubo diferencias significativas en la edad o el sexo, aunque predominó el masculino (2:1) en el CGPE (0,09). El hallazgo de lesiones premalignas fue similar en ambos grupos (p = 0,260). La ubicación anatómica mostró ser más proximal (colon derecho) en el CCRPC que en el CGPE (cardias/fondo) (p = 0,002). Las neoplasias gástricas fueron más mal diferenciadas (58%) que las de colon (26%) (p = 0,001). No hubo diferencias en los cánceres tempranos, pero el estado tumoral fue más avanzado en el CGPE (p < 0,01). El Kaplan-Meier mostró una peor sobrevida para el CCRPC que para el CCR detectado, sin diferencias en el CG y el CGPE, que mostraron una pobre sobrevida. Conclusiones: la tasa de cánceres de intervalo es de 7,3% y 6,9%, y se encontraron diferencias entre los CGPE y el CCRPC, ubicaciones proximales de las lesiones, grado de diferenciación, estado del tumor y una pobre sobrevida para el CCRPC. Se hace necesario establecer medidas para lograr la meta de la Organización Mundial de Endoscopia de

La lesión de Dieulafoy es una lesión vascular de 1-3 mm en la submucosa y representa del 1%-2% del total de hemorragias digestivas; 80% se localiza en el estómago y 15% en el duodeno, mientras que su hallazgo en el resto del tubo digestivo representa < 5%. En el siguiente trabajo se presenta el caso de un paciente masculino de 79 años que presentó choque hipovolémico por sangrado de tubo digestivo secundario a lesión de Dieulafoy rectal con manejo endoscópico inicial y posteriormente quirúrgico.

Objective: Colonoscopy is a handy tool in preventing and diagnosing colorectal cancer. Its optimal performance requires adequate preparation for good visualization of the mucosa. In our endoscopy unit, we use the Boston scale to evaluate the quality of bowel preparation. The present work intends to assess whether or not an additional intervention with an educational video on the Internet could improve the result of preparation using the Boston scale for colonoscopy to enhance the visualization and detection of adenomas. Methods: A double-masked, randomized clinical trial. One group of patients received printed instructions on colonoscopy preparation, and another group received the same preparation plus the form contained a link and instructions to access and view a colonoscopy video posted on YouTube. Results: A highly significant difference was observed between the means of the Boston preparation score for the group that watched the video versus the group that did not (8.16 vs. 6.75; p < 0.0001). A significant difference was also found in the Boston score by segments of the colon: right (2.6 vs. 1.9; p < 0.001), transverse (2.7 vs. 2.3; p < 0.0001), and left (2.8 vs. 2.5; p < 0.0001). Concerning the adenoma detection rate, it was higher in the group that watched the video (28%) than in the group that did not (21%); however, the difference was not significant (p = 0.33). Conclusion: Watching an educational video significantly improves the quality of colonoscopy preparation through the Boston scale and the detection of adenomas; however, this difference was not significant, possibly due to a lack of a larger sample. [ABSTRACT FROM AUTHOR]

Presentation: The NordICC study aimed to evaluate the long-term effects, with a 10-year follow-up, of inviting individuals aged 55 to 64 years to undergo a single colonoscopy screening for colorectal cancer (CC) compared to those who were not invited and did not undergo screening. Study findings: The group that received the colonoscopy screening invitation had lower risk of CC in comparison to the group that did not undergo screening. Critical commentary: The study's eligibility criteria closely resembled real-life scenarios. However, the inclusion of participants with CC risk factors and the potential differential effects in this subgroup remain unclear. The invitation for a single colonoscopy screening did not result in clinically important benefits in terms of CC risk, CC mortality, and all-cause mortality. On the other hand, complications associated with the screening procedure were infrequent or negligible. It is important to note a high risk of bias in the blinding-related domains. [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Gastroenterología is the property of Asociacion Colombiana de Gastroenterologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To present the latest recommendations for the suspicion, diagnosis and medical and surgical treatment of Ogilvie syndrome. Materials and methods: Descriptive, retrospective, observational study; in clinical case format and review of the current literature, through PubMed, Scielo and other search engines for scientific articles Discussion and Conclusions: Acute colonic pseudo-obstruction or Ogilvie syndrome consists of a severe adynamic ileus and massive dilatation of the colonic loops in the absence of mechanical obstruction. It occurs in post-surgical or severely ill patients. They have a risk of perforation of approximately 3% and a mortality of 50%, most patients respond to conservative medical management. Colonoscopic decompression may be necessary in patients who do not respond to supportive medical treatment and drug decompression with neostigmine. Different degrees of colonic ischemia and / or perforation require urgent surgical resolution in some cases, which defines morbidity and mortality. Clinical suspicion of this syndrome is important to avoid possibly fatal complications. [ABSTRACT FROM AUTHOR]

Introduction and aims: Any alarm symptoms in patients with irritable bowel syndrome (IBS) should be carefully evaluated. Colonoscopy is a standard diagnostic procedure for evaluating the colonic mucosa and ruling out probable diseases responsible for patient symptoms. We analyzed the colonoscopy findings in patients with and without IBS. Material and methods: Ninety-six patients with IBS and 101 without IBS were consecutively enrolled in the study. All the patients in the IBS group met the Rome IV criteria, and underwent colonoscopy due to the appearance of red flags. The colonoscopy findings were compared between the 2 groups of patients. Results: The main indications for colonoscopy in the IBS group were progressive abdominal pain (36.7%), rectal bleeding with fresh blood (17.7%), and occult blood in stool (12.5%). In the non-IBS group, the most prevalent indicators were rectal bleeding with fresh blood (37.6%), colorectal cancer surveillance (21.8%), and abdominal pain (13.9%). The most common macroscopic findings in the 2 groups were hemorrhoids, polyps, and anal fissure. There were no statistically significant differences with respect to the microscopic and macroscopic findings between groups. Conclusions: We concluded that the prevalence of organic lesions in the colon of patients with IBS was the same as that in the patients without IBS. The Rome IV criteria accurately predicted IBS. Additional evaluation through colonoscopy in IBS should be based on the presence of alarm features. Resumen: Introducción y objetivos: Cualquier síntoma alarmante debe evaluarse cuidadosamente en los pacientes con síndrome del intestino irritable (SII). La colonoscopia es un procedimiento de diagnóstico estándar para evaluar la mucosa del colon y descartar probables enfermedades responsables de los síntomas de los pacientes. Analizamos los hallazgos colonoscópicos en pacientes con SII y pacientes sin SII. Material y métodos: Noventa y seis pacientes con SII y 101 sin SII fueron registrados en el estudio de forma consecutiva. Todos los pacientes del grupo con SII cumplieron los criterios de Roma IV y se sometieron a una colonoscopia debido a la aparición de signos alarmantes. Los hallazgos de la colonoscopia se compararon entre los grupos de pacientes. Resultados: Los principales indicadores para colonoscopia en el grupo con SII fueron dolor abdominal progresivo (36.7%), sangrado rectal fresco (17.7%) y sangre oculta en heces (12.5%). En el grupo sin SII, los indicadores de mayor prevalencia fueron sangrado rectal fresco (37.6%), vigilancia del cáncer colorrectal (21.8%) y dolor abdominal (13.9%). En ambos grupos, los hallazgos macroscópicos más comunes fueron hemorroides, pólipos y fisura anal. No hubo diferencias estadísticamente significativas entre los grupos en los hallazgos macroscópicos y microscópicos. Conclusiones: Concluimos que la prevalencia de lesiones orgánicas en el colon de pacientes con SII es la misma que en pacientes sin SII. Los criterios de Roma IV predijeron el SII con precisión. La evaluación colonoscópica adicional en el SII debe basarse en la presencia de signos de alarma.

El melanoma anorrectal primario es una neoplasia melanocítica maligna poco frecuente, su principal manifestación es el sangrado rectal. Tiene un pronóstico ominoso con una tasa de sobrevida del 10% a 5 años. Se presenta el caso de una mujer de 56 años con rectorragia y sensación de masa rectal. Durante la colonoscopia se documentó una lesión polipoide en el recto distal, que se resecó por vía transanal. El estudio histológico confirmó la presencia de un melanoma anorrectal primario.

Copyright of Revista Colombiana de Gastroenterología is the property of Asociacion Colombiana de Gastroenterologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: colonic polyps affect up to 1% of the school age population, which usually cause lower digestive bleeding and pain; however, large ones can cause intussusception. Case presentation: nine-year-old female patient, previously healthy. She presents abdominal pain of 40 days duration, associated with rectal bleeding in recent days. Through imaging studies, she was diagnosed with colo-colic intussusception (CCI). Hydrostatic reduction was unsuccessful, so reduction was performed by laparotomy. The polyp was subsequently resected by colonoscopy. According to histopathological report, it was a juvenile polyp. Conclusions: CCI can be secondary to large or giant polyps. [ABSTRACT FROM AUTHOR]

La espiroquetosis intestinal se define como la colonización del epitelio colorrectal por espiroquetas anaerobias del género Brachyspira. Se identifica con mayor frecuencia en países en vías de desarrollo o cuando las condiciones de salubridad son subóptimas. Puede afectar a cualquier persona, aunque es más común en hombres homosexuales particularmente infectados por virus de la inmunodeficiencia humana (VIH). Su síntoma más frecuente es la diarrea crónica acuosa. La colonoscopia puede ser normal. Se presenta el caso clínico de un paciente masculino joven con diarrea crónica de varios años de evolución que se resuelve al brindar tratamiento específico. Además, se realiza, una revisión de la literatura sobre esta enfermedad. [ABSTRACT FROM AUTHOR]

Introduction: Good bowel preparation is essential for a quality colonoscopy. Thus, evaluating the risk factors associated with poor preparation is necessary. This problem has not been widely addressed in Colombia. Aim: To identify the factors associated with poor intestinal preparation. Materials and methods: Observational, analytical, cross-sectional, multicenter study in patients > 18 years of age who underwent colonoscopy and attended gastroenterology services between January and June 2020 in Bogotá. A Boston scale > 6 was defined as good preparation, and a Boston scale = 6 was defined as poor preparation. Results: 265 patients were included, of whom 205 (77.4%) were well prepared and 60 (22.6%) had inadequate preparation. Factors associated with poor bowel preparation were age older than 60 years (odds ratio [OR]: 1.359; 95% confidence interval [CI]: 1.059-1.745; p = 0.026); male sex (OR: 1.573; 95% CI: 1.128-2.194; p = 0.012); obesity (BMI > 30 kg/m2; OR: 2.539; 95% CI: 1.388-4.645; p = 0.002); constipation (OR: 1.924; 95% CI: 1.154-3.208; p = 0.014); the use of antidepressants (OR: 2.897; 95% CI: 1.199-6.997; p = 0.014) and calcium antagonists (OR: 2.445; 95% CI: 1.292-4.630; p = 0.005), and having abdominopelvic surgeries (OR: 1.325 95% CI: 1.042-1.684, p = 0.034). Regarding the procedure, there was less polyp detection per patient (p = 0.04) and less minute (p = 0.020) and flat (p = 0.047) polyp detection in the poor bowel preparation group. Conclusions: This is the first study in Colombia in which the factors associated with poor intestinal preparation are described and include variables not explored in other studies. The results found are similar to those reported in the literature. These studies should be promoted with more patients, establishing a score for predicting poor preparation. [ABSTRACT FROM AUTHOR]

Objective: Report of two cases in which foreign bodies ingested orally were extracted through the anal route with colonoscopy. Material and Method: Discussion of the clinical picture, images, and management. In both cases, after imaging confirmation of the presence of foreign bodies in the lower digestive tract, they were extracted with colonoscopy. Results: Both cases presented in an unusual way, the presence and location of the foreign bodies were confirmed with imaging and colonoscopy. Endoscopic removal was performed without incident. Discussion: Our two cases are unusual, with little evidence in the international literature, in both cases important complications could have occurred and surgery was required. Fortunately they could be resolved endoscopically. Conclusion: Orally ingested foreign bodies in the lower digestive tract are rare; imaging and clinical suspicion are essential for correct diagnosis and therapeutic planning. We believe that extraction with colonoscopy is a strategy to consider in these cases. [ABSTRACT FROM AUTHOR]

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La asociación entre la endocarditis infecciosa (EI) por Streptococcus gallolyticus y las lesiones malignas del tracto gastrointestinal está bien descrita. Asumimos que otros microorganismos enteropatógenos, como el Streptococcus viridans y Enterococcus faecalis también pueden estar relacionados con la enfermedad colorrectal. Nuestro objetivo fue determinar la frecuencia de depósitos focales de la [18F]FDG en localización colorrectal, sugestivos de lesiones tumorales, y su correlación con la enfermedad de colon y recto en pacientes con infección causada por diferentes microorganismos comensales del tracto gastrointestinal. Examinamos retrospectivamente 61 pacientes con diagnóstico de bacteriemia y de EI (posible o concluyente) según los criterios de Duke y causada por microorganismos enteropatógenos, y que fueron sometidos a una PET/TC de cuerpo entero con [18F]FDG en nuestra institución. Buscamos depósitos de la [18F]FDG en localización colorrectal, así como la presencia de lesiones morfológicas. A todos los pacientes con EI se les realizó una colonoscopia completa y los resultados histológicos se clasificaron según 4 grupos: lesión maligna, lesión premaligna, lesión benigna y ausencia de lesión. Se evaluó la correlación existente entre los hallazgos de la PET/TC con [18F]FDG y el diagnóstico histopatológico y el microorganismo implicado. La PET/TC detectó 20 depósitos de [18F]FDG en localización colorrectal (32,79%-OR: 47,28), 2 de ellos en pacientes con bacteriemia (16,7%) confirmados como lesiones malignas y premalignas y 18 en el grupo con EI (36,6%), 17 de ellos correspondientes a enfermedad colorrectal: 11 lesiones malignas, 5 premalignas y una benigna. En el subgrupo con EI la colonoscopia detectó lesiones colorrectales en el 51,02% de los pacientes: 11 malignas, 8 premalignas y 6 benignas. En el subgrupo de Streptococcus spp. se detectó una mayor incidencia de depósitos de [18F]FDG en localización colorrectal. En cuanto a los hallazgos anatomopatológicos del colon, hubo un predominio de pacientes afectados por S. viridans , seguido de E. faecalis y S. gallolyticus. Los pacientes estudiados mediante PET/TC por una infección sistémica, especialmente EI, causada por S. viridans o E. faecalis , además de la conocida asociación del S. gallolyticus , muestran una mayor probabilidad de presentar depósitos incidentales de FDG colorrectal, correspondiendo en su mayoría a lesiones de carácter maligno o premaligno. De este modo, y como conclusión principal, consideramos necesario realizar una investigación exhaustiva de posibles focos colorrectales detectados en el estudio PET/TC. Association between Streptococcus gallolyticus infective endocarditis (IE) and malignant lesions of the gastrointestinal tract is well described. We hypothesize that other enteropathogenic microorganisms, such as Streptococcus viridans and Enterococcus faecalis are also related with colorectal pathology. Our aim is to determine the frequency of focal colorectal FDG deposits, suggestive of tumoral lesions and their correlation with colorectal pathology, in patients with infection caused by different commensal microorganisms of the gastrointestinal tract. We retrospectively examined 61 patients diagnosed with bacteremia (BSI) and IE (possible or definite) according to Duke's criteria, caused by enteropathogenic microorganisms, who underwent a full-body [18F]FDG-PET/CT in our institution. We looked for colorrectal FDG deposits and morphological lesions. All IE patients underwent a complete colonoscopy and the histological results were classified into four groups: malignant lesion, premalignant lesion, benign lesion and no lesion. We evaluated the correlation between the findings of the [18F]FDG-PET/CT with the histopathological diagnosis and the involved microorganism. PET/CT detected 20 colorectal FDG deposits (32.79%-OR: 47.28), 2 within bacteriemic patients (16.7%) confirmed as malignant and premalignant lesions and 18 in IE group (36.6%), 17 of them corresponding to colorrectal pathology: 11 malignant, 5 premalignant and 1 benign lesions. In the IE subgroup, the colonoscopy detected colorectal lesions in 51.02% of the patients: 11 malignant, 8 premalignant and 6 benign. We found a higher incidence of colorectal FDG deposits in Streptococcus spp. subgroup. Regarding the anatomopathological colonic findings there was a predominance of patients affected by S. viridans , followed by E. faecalis and S. gallolyticus. Patients studied by PET/CT for systemic infection, especially IE, caused by S. viridans or E. faecalis , in addition to S. gallolyticus , show a greater probability of presenting incidental colorectal FDG deposits, mostly corresponding to malignant or pre-malignant lesions. Therefore, it is necessary to carry out an exhaustive search of possible colorectal foci in these exams. [ABSTRACT FROM AUTHOR]

Réplica à Carta às Editoras de Autoria de Pablo Salomón Montes-Arcón

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Introduction and aims: Colonoscopy quality is measured by the degree in which the examination increases the likelihood of obtaining adequate results on health. Our aim was to develop an instrument for evaluating the quality of screening colonoscopies, taking into account the performance of endoscopists and endoscopy units. Materials and methods: Mixed methodology was employed. The first stage (qualitative) consisted of a Medline search, from which a group of experts developed the quality score items. The second stage (quantitative) utilized a modified Delphi technique to reach consensus (3 rounds). We evaluated the psychometric properties of the instrument (reliability and construct validity) in elective screening colonoscopies (in patients ≥ 50 years of age), performed within the January–April 2017 time frame. Results: A final instrument with 8 items was produced: (1) the Boston Bowel Preparation Scale score; (2) cecal intubation rate; (3) colonoscopy withdrawal time; (4) image documentation; (5) adenoma detection rate; (6) endoscopic surveillance planning; (7) perforation rate, and (8) continuous improvement programs. The instrument was evaluated in 323 colonoscopies performed by 31 endoscopists and found to be one-dimensional and reliable (Cronbach’s alpha 0.76). Performance was compared between endoscopists (center 1) and an expert endoscopist from another center (center 2): Boston Bowel Preparation Scale score 8.3 vs. 7.36 (P

Introduction: Primary eosinophilic colitis (PEC) is an inflammatory disease caused by the infiltration of eosinophils into the mucosa of the colon, determined after having ruled out other possible causes. It is characterized by abdominal pain and diarrhea and its prevalence is unknown. Aims: To know the prevalence of PEC in patients with chronic diarrhea and in those with clinical criteria for diarrhea-predominant irritable bowel syndrome (IBS-D). Patients and methods: All patients with chronic noninflammatory diarrhea that were consecutively seen over a decade were studied through colonoscopy, with systematic biopsy. Patients with a known or decompensated organic disease, alarm features, abnormal minimal laboratory test results, and factors associated with eosinophilia were excluded. Patients with the clinical criteria for IBS-D (Rome III) were selected from the general group. Eosinophilic colitis was defined as the presence of > 35 eosinophils/100 epithelial cells per field in any of the segments. Results: From the 683 patients seen, a total of 545 patients (361 women) were included in the study. Twenty-two cases of PEC were detected, resulting in a prevalence of 4.0%. A total of 343 patients had IBS-D criteria (223 women), with 16 cases of PEC detected, for a prevalence of 4.7%. Colonoscopy was normal, or almost normal, in all the PEC cases detected. Conclusions: The prevalence of PEC was 4.0% in the patients with chronic diarrhea and 4.7% in the patients with IBS-D. Peripheral eosinophilia appeared to be the main distinctive clinical characteristic, but systematic biopsy was essential for making the diagnosis. Resumen: Introducción y objetivos: La colitis eosinofílica primaria (CEoP) es una enfermedad inflamatoria causada por infiltración de eosinófilos en la mucosa del colon, sin otras posibles causas identificadas, que se caracteriza por dolor abdominal y diarrea. Su prevalencia se desconoce. Objetivos: Conocer la prevalencia de CEoP en pacientes con diarrea crónica y en aquellos con criterios clínicos del síndrome del intestino irritable con predominio de diarrea (SII-D). Pacientes y métodos: Todos los pacientes con diarrea crónica no inflamatoria, atendidos en forma consecutiva durante una década, fueron estudiados mediante colonoscopia con toma sistemática de biopsias. Se excluyeron aquellos con enfermedad orgánica conocida o descompensada, con datos de alarma, estudios de investigación limitada anormales y factores asociados a eosinofilia. Del grupo general, se seleccionaron aquellos con criterios clínicos de SII-D (Roma III). Colitis eosinofílica se definió como la presencia de > 35 eosinófilos/100 células epiteliales por campo en cualquiera de los segmentos. Resultados: Fueron atendidos 683 pacientes. Se incluyeron 545 enfermos (361 mujeres), entrequienes se detectaron 22 casos de CEoP, para una prevalencia del 4.0%. Trescientos cuarentay tres sujetos tenían criterios de SII-D (223 mujeres), entre los que se detectaron 16 casos deCEoP, para una prevalencia del 4.7%. La colonoscopia fue normal o casi normal en todos loscasos detectados. Conclusiones: La prevalencia de CEoP fue de 4.0% de los enfermos con diarrea crónica y en 4.7% en aquellos con SII-D. La eosinofilia periférica parece ser la principal característica clínica distintiva, pero la toma sistemática de biopsias es indispensable para establecer el diagnóstico.

Introducción: la neumatosis quística intestinal es una entidad infrecuente, caracterizada por la presencia de quistes o burbujas de aire en la pared intestinal, usualmente asintomática. Sus formas no complicadas son manejadas conservadoramente y las graves requieren intervención quirúrgica. La presencia de neumoperitoneo es un hallazgo radiológico inquietante, pero no es indicador de intervención quirúrgica. Caso clínico: hombre de 23 años con pérdida de peso, diarrea y rectorragia, la colonoscopia mostró múltiples quistes violáceos localizados en el sigmoide y descendente que colapsaron tras la punción y biopsias, la tomografía axial computarizada (TAC) confirmó el diagnóstico y la presencia de un neumoperitoneo encapsulado. La ausencia de signos de potencial letalidad permitió un tratamiento conservador con remisión clínica durante los primeros 8 meses de seguimiento. Discusión: la fisiopatología de la neumatosis quística intestinal no está bien definida. En el paciente presentado el diagnóstico se realizó de forma incidental al realizar una colonoscopia por una rectorragia. El neumoperitoneo asintomático encapsulado debe interpretarse como un signo importante pero no determinante de intervención quirúrgica y su presencia junto con los antecedentes médicos, examen físico, bioquímico, endoscópico e imagenológico puede evitar cirugías innecesarias.

La sedación es una técnica que tiene como finalidad aliviar la ansiedad, evitar el malestar o dolor y la hipnosis de los pacientes durante los procedimientos colonoscópicos. El propofol se ha convertido en el primer fármaco sedante de elección para la colonoscopia debido a su acción rápida, vida media corta y rápida recuperación. Sin embargo, la depresión respiratoria, los eventos cardiovasculares han sido las complicaciones comunes relacionadas con este fármaco. La infusión intravenosa de lidocaína es segura y posee ventajas como la reducción de la necesidad de otros anestésicos, por lo que puede reducir los requerimientos de propofol durante estos procedimientos. Objetivo: evaluar el efecto de la lidocaína endovenosa sobre el consumo de propofol en sedación de pacientes sometidos a procedimientos colonoscópicos. Materiales y métodos: estudio experimental tipo ensayo clínico, aleatorizado, simple ciego. Muestra: 40 pacientes distribuidos en dos grupos de 20 tomados aleatoriamente, que fueron sometidos a procedimientos colonoscópicos; durante el período comprendido entre Agosto 2022 y Octubre 2022. Conclusiones: El estudio demostró que la adición de lidocaína al propofol en sedación para realizar procedimientos colonoscopicos tuvo como resultados; en primer lugar, la lidocaína intravenosa redujo el tiempo y consumo de propofol desde la infusión hasta pérdida de conciencia con un P (0,038), En segundo lugar, la dosis total de propofol utilizada disminuyo en el grupo al cual se le adiciono lidocaína con P (0,001). En tercer lugar, no hubo evidencia de efectos secundarios significativos relacionados con la adición de lidocaína.

Aim: The main objective was to determine whether in our population there was a difference in the rate of right colon cancer diagnosis for patients over 45 years of age in the 36 months following acute appendicitis compared to a control group. Patients and Methods: Retrospective cohort study with an exposed group of 300 patients with histological diagnosis of acute appendicitis and a control group of 300 patients operated on for benign pathology between January 2014 and August 2017. Electronic medical records and the Granada Cancer Registry database were cross-referenced. Results: 2/300 patients (0.7%) presented while 4/300 (1.3%) presented in the control group. Given these findings, there is no increased risk of developing colon carcinoma in patients with appendicitis (p > 0.05). Discussion: Acute appendicitis may be the first manifestation of right colon carcinoma, however, in our review we found no such association in our population. [ABSTRACT FROM AUTHOR]

Introduction: Colonoscopy is a frequent and routine procedure, and even though it is considered safe, it can have complications. The splenic traumatism is an infrequent complication, but potentially mortal. Clinical Case: Woman 75 years old, consulted for abdominal pain and distension after a colonoscopy. Physical examination revealed pain in epigastric and left hypochondrium without peritoneal irritation. Urgent TC scan reported a splenic hematoma of 10 x 2,6 cm, without active bleeding. She received non-operative treatment with a favorable evolution. Conclusion: The management depends on the hemodynamic stability, the grade of injury and the presence of and active bleeding. In selected cases, non-operative treatment is an option that avoids unnecessary surgeries, even if the patient must stay 48-72 h hospitalized in an Intensive Care Unit for a strict monitoring of vital signs. Although the splenic injury secondary a colonoscopy is an infrequent complication, it can be potentially mortal if it is not diagnosed. [ABSTRACT FROM AUTHOR]

Background: colorectal cancer (CRC) is one of the most frequent tumors in terms of incidence and mortality. Several elements, both inherited and environmental, have been related with its pathogenesis. Aims: to analyze the influence of age, gender and nutritional factors on the diagnosis of colonic polyps and CRC. Methods: a prospective, descriptive study over outpatients from the Health Area of León who took a colonoscopy between 09/09/2012 and 06/30/2013. Patients were asked to fill a semiquantitative food frequency questionnaire with data such a sociodemographic, toxic and dietetic facts. Differences in diagnosis according to sociodemographic and hygiene-dietetic data were analyzed with a multivariate analysis by forward stepwise logistic regression. Results: data were collected from 1390 patients. Mean age was 57.88 (15.17) years and 47.8 % were male. CRC was diagnosed in 5 % of colonoscopies, and polyps in 20.4 %, with 9.4 % of them being HRA. Risk of polyps and HRA was higher in males (26.9 % vs 14.5 %) and (12.6 % vs 6.3 %), respectively (p < 0.001). Mean age was significantly higher in patients who presented polyps (56.51 (15.45) vs 63.22 (12.69) years; p < 0.001). Among the group who reported intake of smoked and salted food, the risk of polyps doubled (2.9 % vs 6.7 %, p = 0.002). In relation to alcohol intake we found that subjects with daily alcohol consumption showed a higher incidence of polyps when compared to occasional drinkers and teetotallers (32 % vs 20 % vs 18.6 %, p = 0.002). Conclusions: age correlated with higher risk of polyps, HRA and CRC. Moreover, male gender also was associated with a high risk of polyps and HRA. Alcohol and red and processed meat intake increased polyp risk. [ABSTRACT FROM AUTHOR]

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Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Colorectal adenomas (CRAs) are at a higher risk of progressing to colorectal cancer (CRC) as their histological grade increases. Herein, this study investigated the relationship between the maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET/CT) and the histological grades of CRAs and constructed the optimal regression model for distinguishing between different histological grades., Methods: This study retrospectively analyzed the data of 153 patients with CRAs who had colorectal 18 F-FDG uptake incidentally found on PET/CT. The patients were categorized into low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia (HGIN) groups based on their histological grade. After the analysis of the relationship between SUVmax measured on preoperative 18 F-FDG PET/CT scans and histological grades, receiver-operating characteristic (ROC) curves were analyzed to determine the optimal cut-off values for distinguishing between the two groups. Common clinical and pathological factors were included and subjected to univariate and multivariate logistic regression analyses to identify independent risk factors. A diagnostic model integrating SUVmax and several risk factors was developed with the multivariate logistic regression analysis., Results: SUVmax was significantly different between the two groups (P < 0.001) and increased with an elevation in the malignancy degree. The area under the ROC curve (AUC) for identifying LGIN and HGIN was 0.796, and the AUC of the combination model was 0.822. Furthermore, SUVmax was an independent risk factor for distinguishing between different histological grades in pairwise comparisons., Conclusion: The regression model involving SUVmax on 18 F-FDG PET/CT can distinguish between histological grades of CRAs, which therefore can be used as a noninvasive tool for the accurate diagnosis of CRAs and assist in developing patient-specific treatment strategies before surgery., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (Copyright © 2024 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Patients should be closely monitored during procedures under sedation outside the operating room, but it is unclear which type of monitoring is best. We investigated the efficacy and safety of BIS monitoring vs conventional monitoring for sedation during colonoscopy., Methods: We performed a double-blind clinical trial in 180 patients undergoing elective colonoscopy. Patients were randomized to 1) the BIS group or 2) a control group, in which sedation was monitored with a BIS monitor or the Ramsay Sedation Score, respectively. The primary outcome was the rate of sedation-induced adverse events in both groups. Secondary outcomes were the characteristics of patients who developed adverse events, and time during colonoscopy when these events occurred, propofol and remifentanil dosage, and patient satisfaction., Results: Univariate analysis showed fewer cardiopulmonary complications in the BIS group (41.11% vs 57.78% in controls; p = 0.02). Multivariate analysis found a significantly higher risk of adverse events in older patients (95% CI, 1.013-1.091; p = 0.0087) and in men (95% CI, 1.129-7.668; p = 0.0272). These events were observed at the hepatic flexure. No significant differences between propofol or remifentanil dosage, use of rescue medication, and patient satisfaction were observed between groups., Conclusions: Our data suggest that BIS monitoring during sedation in scheduled colonoscopies reduces adverse respiratory events. Although its routine use in sedation does not appear to be warranted, clinicians should take steps to identify patients with a higher risk of complications who might benefit from this type of monitoring., (Copyright © 2024 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introdução: O câncer colorretal é a neoplasia mais frequente do trato gastrointestinal, sendo a segunda principal causa de morte por câncer no mundo. Objetivo: Traçar um perfil clínico-epidemiológico do câncer colorretal na Região Oeste do Paraná (Brasil), entre 2016 e 2018. Método: Estudo observacional analítico do tipo transversal, construído a partir da análise de resultados de exames anatomopatológicos, realizados entre 2016 a 2018. Realizaram-se análises por estatística descritiva, teste de associação qui-quadrado e U de Mann-Whitney. Adotou-se nível de significância de 5%. Resultados: A análise de 509 laudos positivos para câncer colorretal permitiu identificar o predomínio de pacientes do sexo masculino e a idade média de diagnóstico de 62 anos. A malignidade mostrou-se mais incidente na faixa etária de 61 a 70 anos (29,9%), e considerável número de casos ocorreu em pacientes abaixo de 50 anos (19,6%). Houve predomínio em cólon esquerdo e do tipo histológico adenocarcinoma infiltrativo moderadamente diferenciado. Verificou-se associação entre topografia da doença e sexo, com maior predominância do sexo feminino para tumores do cólon direito e do sexo masculino para tumores do cólon esquerdo (p=0,0081). Conclusão: A partir deste estudo, delineia-se um perfil clínico-epidemiológico do câncer colorretal na Região Oeste do Paraná, com maior incidência da doença em homens, sexagenários, além de predomínio de tumores em cólon esquerdo e do tipo adenocarcinoma infiltrativo moderadamente diferenciado. Tais achados são relevantes considerando a possibilidade de aplicação assertiva de protocolos internacionais de rastreio do câncer nessa população.

El diagnóstico de pacientes con dispepsia representa un desafío ya que en la mayoría de los casos se requieren observaciones endoscópicas complejas y costosas. En este estudio, evaluamos el rol del diagnóstico de la calprotectina fecal en pacientes con dispepsia. Para ello, en el año 2019 se realizó un estudio observacional en 149 pacientes con dispepsia registrados en el Centro de Especialistas en Gastroenterología de la entidad privada Cuenca, Ecuador. Los datos disponibles abarcaron edad, sexo, signos de alarma, valores de calprotectina fecal (CF) y hallazgos endoscópicos. Los pacientes en el grupo de edad >65 años fueron los más representados, el 56.4% de la población eran del sexo femenino, el 48.57% eran CF positivos de los cuales el 86.8% poseían valores significativos de CF. CF+ se asoció significativamente con los hallazgos por EDA/colonoscopia (p

Introduction: Comfort during colonoscopy is an important condition if the patient is expected to accept repeated procedures. Therefore, good sedation that could combine analgesia with amnesia is needed. Objective: To describe the usefulness of balanced analgosedation with propofol/fentanyl in outpatient colonoscopy. Methods: A prospective, longitudinal, descriptive and observational study was carried out with patients who received outpatient colonoscopy at Dr. Gustavo Aldereguía Lima General University Hospital in the period between January 2017 and December 2018. Results: 34.2 % of the patients were between 50 and 59 years old, while 62.9 % were women. 73.3 % of patients were classified as ASA II, according to their physical status. The mean values for heart rate and mean arterial blood pressure had a slight decrease after anesthesia was applied and remained constant for the rest of the evaluated times. The mean values of hemoglobin–oxygen saturation remained relatively constant at all the evaluated times and were slightly higher on the patient’s arrival to recovery. The quality of sedation was adequate in 86.2 % of the patients. The quality of analgesia and recovery was good in 88.4 % and 96.2 %, respectively. Complications occurred in 16.5 % of the patients. Conclusions: Analgosedation with propofol and fentanyl proved to be a useful anesthetic alternative in patients undergoing outpatient colonoscopy, with high hemodynamic stability in the studied series.

Introduction and aims: The adenoma detection rate (ADR) is the most important quality indicator for the prevention of colorectal cancer but serrated polyps are also precursor lesions of the disease. The aim of our study was to compare the detection rate of proximal serrated polyps (PSPs) and that of clinically significant serrated polyps (CSSPs) between endoscopists and analyze the relation of those parameters to the ADR. Methods: An observational, prospective, cross-sectional study was conducted on all patients that underwent colonoscopy at the Policlínico Peruano Japonés within the time frame of July 2015 and August 2016. The ADR and PSP and CSSP detection rates between endoscopists were compared through multivariate logistic regression and the association between those parameters was calculated through the Pearson correlation coefficient. Results: The study included 15 endoscopists and 1,378 colonoscopies. The PSP detection rate ranged from 1.8-17% between endoscopists and had an almost perfect correlation with the CSSP detection rate (p = 0.922), as well as strongly correlating with the ADR (p = 0.769). Conclusions: There was great variability in the PSP detection rate between endoscopists. It also had an almost perfect correlation with the CSSP detection rate and strongly correlated with the ADR. Those results suggest a high CSSP miss rate at endoscopy and a low PSP detection rate. Resumen: Introducción y objetivos: La tasa de detección de adenomas (TDA) es el más importante indicador de calidad para la prevención del cáncer colorrectal. Sin embargo, los pólipos serratos también son lesiones precursoras de cáncer colorrectal. El objetivo del estudio fue comparar la tasa de detección de pólipos serratos proximales (PSP) y la tasa de detección de pólipos serratos clínicamente significativos (PSCS) entre endoscopistas, y analizar la relación entre estos parámetros y la TDA. Métodos: Estudio observacional, transversal y prospectivo. Se incluyeron a todos los pacientes que acudieron para colonoscopia al Policlínico Peruano Japonés entre julio del 2015 y agosto del 2016. Se utilizó regresión logística multivariada para comparar la TDA, la tasa detección de PSP y la tasa de detección de PSCS entre los endoscopistas. Se calculó la asociación entre estos parámetros mediante el coeficiente de correlación de Pearson. Resultados: Fueron incluidos 15 endoscopistas y 1378 colonoscopias. La tasa de detección de PSP estuvo en el rango de 1,8-17% entre los endoscopistas. La tasa de detección de PSP tuvo una correlación casi perfecta con la tasa de detección de PSCS (ρ = 0,922). La tasa de detección de PSP tuvo una fuerte correlación con la TDA (ρ = 0,769). Conclusiones: La tasa de detección de PSP tiene gran variabilidad entre endoscopistas, y tiene una correlación casi perfecta con la tasa de detección de PSCS, y una fuerte correlación con la TDA. Estos resultados sugieren una alta tasa de PSCS perdidos por los endoscopistas con una baja tasa de detección de PSP.

Introducción. El apéndice cecal invertido, inversión apendicular o intususcepción apendicular, corresponde a una condición anatómica descrita en 1859. La primera operación de invaginación apendicular se realizó en 1890, y desde entonces se han descrito diferentes técnicas quirúrgicas y endoscópicas para el tratamiento de esta alteración. Casos clínicos. Se presentan dos casos de pacientes a quienes se les indicó colonoscopia como parte de estudio de dolor abdominal y diarrea y se identificó una intususcepción apendicular completa y apendicitis y una inversión del muñón apendicular. Resultados. Mediante la colonoscopia se hizo el diagnóstico de apendicitis aguda en una de las pacientes, quien presentaba inversión apendicular completa tipo 5, que fue tratada con manejo farmacológico y seguimiento clínico. En la otra paciente hubo un hallazgo incidental de inversión del muñón apendicular tipo 3. Conclusiones. Durante la realización de estudios colonoscópicos, se debe tener en cuenta el diagnóstico de intususcepción apendicular o apéndice invertido, para evitar intervenciones erróneas, como polipectomías, que generen riesgo potencial en los pacientes.

Los tumores colorrectales son las neoplasias más comunes del tracto gastrointestinal y son responsables de una morbilidad y mortalidad significativas. El pronóstico de cáncer colorrectal esta directamente relacionado con el estadío de la enfermedad al tiempo del diagnóstico, así como la disponibilidad de las opciones terapéuticas. Aunque la endoscopía y el enema opaco tienen alta exactitud diagnóstica, ninguno permite valorar la profundidad de la infiltración tumoral o su extensión a órganos vecinos y a distancias. La tomografía computarizada (TC) de abdomen y pelvis permiten definir en forma precisa el grosor de la pared colónica, determinar la interrelación del colon con otros órganos abdominales y pélvicos, detección de metástasis a nódulos linfáticos, glándulas adrenales, hígado, estructuras óseas o musculatura adyacente. El propósito de este estudio es determinar el valor de TC enema de agua versus TC convencional como métodos diagnósticos en la estadificación del carcinoma colorrectal y establecer una correlación anatomopatológica. Se han revisado 100 pacientes con cáncer de colorrectal, 51 mujeres y 49 hombres, promedio de edad 58.8 años, diagnosticados con colonoscopía y/o enema opaco y estadificados con TC enema de agua y TC convencional de acuerdo a la clasificación modificada de Dukes. El estudio anatomopatológico se realizó en todos los caos. Se presentan dos grupos: el primero constituido por 46 pacientes sometidos a TC enema de agua que muestra: sensibilidad =100% para detección de invasión local, especificidad =89% y exactitud =83%. El segundo grupo lo constituyen 54 pacientes sometidos a TC convencional y se obtuvo: sensibilidad =100%, especificidad =21% y exactitud =24%. La TC enema de agua es un método que proporciona información útil sobre la extensión local del tumor colorrectal siendo de fácil aplicación.

Objetivos: en Colombia se ha venido implementando la sedación por médicos no anestesiólogos para procedimientos endoscópicos fuera del quirófano. Se describió la experiencia en la unidad de gastroenterología de una clínica de alto nivel de atención en Cali, Colombia. Materiales y métodos: estudio observacional, de tipo cohorte analítica para describir la frecuencia y el tipo de eventos adversos asociados a los procedimientos de sedación por médicos generales, y evaluar los factores asociados a su ocurrencia en pacientes que acudieron a la unidad de endoscopia de la Fundación Valle del Lili para la realización de estudios endoscópicos bajo sedación intravenosa que, por ser de bajo riesgo, fue aplicada por un médico no anestesiólogo entre noviembre de 2018 y junio de 2019. Se realizó análisis descriptivo, se calcularon mediana y rango intercuartílico para las variables numéricas, y frecuencias para las variables cualitativas. Resultados: se incluyeron 1506 participantes, 59,4 % ASA I y 40,6 % ASA II. En promedio, la dosis inicial de propofol fue de 60 mg y la dosis total, de 140 mg. Se registraron eventos adversos no serios en 46 pacientes (3,05 %) y el más común fue la desaturación transitoria (80,4 %). Ningún paciente presentó eventos adversos serios. El puntaje inicial promedio de la escala de Aldrete fue 8, mientras que al alta el puntaje promedio fue de 10. Conclusiones: la sedación para procedimientos endoscópicos dada por médicos no anestesiólogos es segura, siempre y cuando sea realizado por personal entrenado que realice una adecuada valoración de los antecedentes (cardiovasculares, gastrointestinales y neurológicos) y factores de riesgo del paciente dentro del marco de los lineamientos institucionales vigentes.

Resumo Objetivo: avaliar o efeito da educação aprimorada realizada por enfermeiros no preparo intestinal adequado e na taxa de intubação cecal. Método: estudo prospetivo, quasi-experimental e comparativo com abordagem quantitativa. Os pacientes no grupo de intervenção (n=150) receberam a educação aprimorada e telefonemas para lembrá-los do procedimento. O grupo de controle (n=156) recebeu as instruções padrão da clínica por escrito. As taxas de preparo intestinal adequado e outros indicadores da qualidade da colonoscopia foram comparadas entre os grupos. Resultados: as pontuações obtidas na Boston Bowel Preparation Scale e a taxa de preparo intestinal adequado foram maiores no grupo de intervenção do que no grupo de controle (6,76±2,1 vs. 5,56±2,4, p=0,000, e 80% vs. 69,2%, p=0,031). A taxa de intubação cecal foi mais alta no grupo de intervenção (80% vs. 67,3%, p=0,012). A taxa de intubação cecal malsucedida devido ao preparo intestinal inadequado foi de 0% no GI, enquanto que o GC obteve uma taxa de 17,6%. Além disso, a taxa de biópsia foi maior no grupo de intervenção (28% vs. 13,3%, p=0,002). Conclusão: a educação do paciente aprimorada e realizada por enfermeiros aumenta as taxas de preparo intestinal adequado e, consequentemente, as taxas de intubação cecal. Para alcançar os padrões de qualidade de colonoscopia recomendados nas diretrizes, recomendamos que a educação do paciente inclua diferentes ferramentas de treinamento e seja realizada por profissionais da saúde.

“Serrated polyps” is the term used for epithelial lesions of the colon and rectum that have a “sawtooth” pattern on the polyp's surface and crypt epithelium. The so-called serrated pathway describes the progression of sessile serrated adenomas and traditional serrated adenomas to colorectal cancer. Said pathway is well recognized as an alternative mechanism of carcinogenesis and accounts for 15-30% of the cases of colorectal cancer. It also explains a large number of the cases of interval colorectal cancer. Thus, due to their usually aggressive and uncertain behavior, serrated polyps are of the utmost importance in colorectal cancer screening. Our aim was to review the history, current nomenclature, pathophysiology, morphology, treatment, and surveillance of serrated polyps. Resumen: «Pólipos serrados» es el término utilizado para describir lesiones epiteliales del colon y recto que demuestran un patrón de «dientes de sierra» de la superficie y epitelio de las criptas. La llamada vía serrada describe la progresión de adenomas serrados sésiles y adenomas serrados tradicionales a cáncer colorrectal. Esta vía está bien reconocida como un mecanismo de carcinogénesis alternativo, el cual representa el 15-30% de los casos de cáncer colorrectal, explicando además una proporción significativa de los casos de cáncer colorrectal de intervalo. Por tal motivo, debido a su comportamiento incierto y usualmente agresivo, los pólipos serrados son un tema de suma relevancia en el cribado de cáncer colorrectal. Nuestro objetivo fue revisar la historia, nomenclatura actual, fisiopatología, características morfológicas, tratamiento y vigilancia de los pólipos serrados.

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