Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru最新文献

{"title":"Differences in the detection of gastric premalignant conditions and its correlation with gastric cancer after a negative esophagogastroduodenoscopy in a low-risk gastric cancer country.","authors":"Pedro Genaro Delgado-Guillena, Víctor Jair Morales-Alvarado, Beatriz De-Riba-Soler, Gemma Llibre-Nieto, Indira Armas-Ramírez, Terry Guillena-Castañeda, Ivana Levy-Ríos, Mireya Jimeno-Ramiro, Joaquim Rigau-Cañardo, Albert García-Rodríguez, Esteve Llargués Rocabruna, Henry Córdova, Gloria Fernández-Esparrach","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Gastric cancer (GC), with nearly 90% being sporadic adenocarcinomas, is preceded by gastric premalignant conditions (GPC). Accurate detection of GPC during esophagogastroduodenoscopy (EGD) can enhance the identification of high-risk patients and improve early GC diagnosis. However, GPC detection rates during EGD vary among endoscopists, potentially leading to differences in GC rates after a negative EGD (GC post-EGD).</p><p><strong>Objective: </strong>This study aimed to assess the correlation between the GPC detection rate and the rate of GC post-EGD among endoscopists.</p><p><strong>Materials and methods: </strong>We conducted an observational study of EGDs at a community hospital between 2010 and 2019. GPC were defined as glandular atrophy, intestinal metaplasia, and dysplasia. EGDs were categorized into three groups: (i) benign, (ii) GPC, and (iii) malignant findings. GC post-EGD was defined as a diagnosis of gastric adenocarcinoma within three years of an EGD negative for malignancy. GPC detection rates and GC post-EGD were calculated for each endoscopist.</p><p><strong>Results: </strong>A total of 18,635 EGDs were performed by nine endoscopists. Gastric biopsies were obtained in 2,415 (13%) EGDs, identifying 533 GPCs (2.9%). The GC post-EGD rate was 1.26 per 1,000 EGDs. The detection rate of GPC varied between 1.8% and 5.8%, while GC post-EGD rates ranged from 0 to 3.36 per 1,000 EGDs. A negative correlation trend was observed between GC post-EGD and GPC detection rate (rs=-0.65, p=0.057), which was statistically significant for dysplasia (rs=-0.69, p=0.037).</p><p><strong>Conclusion: </strong>The detection rate of GPC-particularly dysplasia-showed a negative correlation with GC post-EGD in a community hospital within a low-risk setting during the period from 2010 to 2019.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"109-119"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Case report: uveal melanoma with gastric metastases].","authors":"Carmelo Blasco, Carolina Miranda, Sergio Morínigo, Maisa Vallejos, Angélica Caballero","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Uveal melanoma is the most common ocular cancer in adults, originating from melanocytes in the uvea. Although rare, its high metastatic potential, primarily to the liver, poses a significant challenge to patient prognosis. Gastric metastasis, though infrequent, may indicate advanced disease, with an incidence of up to 60% in post-mortem studies. We present the case of a 47-year-old patient with a history of uveal melanoma who developed gastric and hepatic metastases, as well as brain lesions, ultimately leading to her death within a short period.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"198-201"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical practice guideline for the evaluation and management of upper gastrointestinal bleeding in EsSalud: 2024 Update].","authors":"Luis Cervera-Caballero, Ana Brañez-Condorena, Alejandro Piscoya, Nelly Vásquez-Valverde, Ericson Arcana-López, Javier Contreras-Turin, Daniel Vargas-Blácido, Alvaro Taype-Rondan, Joan Caballero-Luna, Fabiola Huaroto-Ramírez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>This article summarizes the clinical practice guideline (CPG) for the evaluation and management of upper gastrointestinal bleeding (UGIB) in the Social Security of Peru (EsSalud).</p><p><strong>Methods: </strong>A guideline development group comprising medical specialists and methodologists, formulated clinical questions addressed by CPG. Systematic evidence searches were conducted for each question during 2024. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of the evidence and formulate the recommendations. The CPG was approved through Resolution No. 000022-IETSI-ESSALUD-2024.</p><p><strong>Results: </strong>This CPG addressed 11 clinical questions, divided into four topics: risk assessment, initial management, variceal UGIB management, and non-variceal UGIB management. Based on these questions, 11 recommendations (7 strong recommendations and 4 weak recommendations), 24 good clinical practices, and 2 flowcharts were formulated. For the 2024 guideline update, no new evidence was found to change the recommendations' direction or strength.</p><p><strong>Conclusion: </strong>This article summarizes the methodology and evidence-based conclusions from the CPG for evaluating and managing UGIB in EsSalud.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"202-212"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Risk factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas].","authors":"Javier Targarona, Sebastián Legua-Pérez, Guillermo Coayla, Gilbert Roman, Eduardo Morales, Alexia Venturo, Luis Rivero, Diego Rivas, Roberto Carrasco","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to analyze the main clinical and epidemiological factors related to the risk of malignancy in intraductal papillary mucinous neoplasia of the pancreas in a cohort of patients seen at a referral clinic in Lima, Peru, based on the criteria of the IAP/Fukuoka guidelines.</p><p><strong>Materials and methods: </strong>This is a retrospective cohort study, which evaluated patients diagnosed with pancreatic IPMN from December 2015 to August 2023. They were classified according to involvement of the main branch, side branch, and mixed pancreatic ducts, considering aspects such as high-risk stigmata, concerning factors, age, sex, medical history, and others.</p><p><strong>Results: </strong>A total of 253 patients with pancreatic IPMN were included, 71.2% had side branch IPMNs, 9% had main branch IPMNs, and 19.8% were mixed. 49 patients (19.4%) underwent surgery at the time of diagnosis due to high-risk stigmata or factors concerning for malignancy. The remaining 204 patients were enrolled in a follow-up program for a mean of 31 months (6-100 months). During follow-up, a decision was made to operate on 38 of them. Of the 87 patients operated on, 36.7% presented invasive cancer and 11.4% high-grade dysplasia. The presence of a mural nodule greater than 5 mm increased the probability of malignancy 11.21 times; jaundice increased the risk of malignancy by more than 5 times. Wirsung duct dilation between 5 and 9.9 mm had a prevalence ratio (PR) of 2.12, and for dilation greater than 10 mm, a PR of 4.69 (p<0.05). The presence of three or more risk factors showed a PR of 6.77 in the bivariate analysis, and an adjusted prevalence ratio (aPR) of 17.11 in the multivariate analysis.</p><p><strong>Conclusion: </strong>Diagnosis and periodic monitoring of IPMNs allow for early detection of potentially malignant lesions, allowing for timely, often curative, surgery. However, there is currently no reliable way to diagnose and identify which cystic lesions already present or are likely to present malignant characteristics, thus providing clear indications for surgical intervention in these patients.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"120-130"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived quality of life using IMPACT-III in a sample of Colombian children with IBD in remission: a cross-sectional study.","authors":"Viviana Parra-Izquierdo, Juan Sebastián Frías-Ordoñez, Fabián E Puentes M, Consuelo Romero-Sánchez, Diana Mora, Fernando Sarmiento, Johon Francisco Garcés Camacho, Carlos Cuadros, Melquisedec Vargas, Carolina Samper, Manuel Alonso Ardila-Báez, Mariastella Serrano","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>No data on quality of life (QoL) in paediatric IBD in Colombia. The aim of this study was to determine QoL using the IMPACT-III questionnaire in a sample of patients from different centres.</p><p><strong>Materials and methods: </strong>Cross-sectional study of paediatric IBD patients followed in 3 centres in different cities, between June and November 2022. Eligible subjects were identified, information was collected on different dates, and the IMPACT-III questionnaire (score ranges from 35 to 175, with higher scores indicating better QoL) was administered once.</p><p><strong>Results: </strong>33 patients were included. 23/33 (69.7%) female, mean age 14.9 (range 6-17.9) years. 94% with inactive or mild disease. 20 patients with ulcerative colitis (UC), 13 with Crohn's disease (CD). The median score in UC was 147 (122-152), while in CD it was 126 (105-135). Systemic symptoms and emotional functioning were most affected, with median scores of 13 (12-14) and 27 (20-31) in UC and 11 (9-11) and 23 (20-26) in CD. No statistically significant differences were observed.</p><p><strong>Conclusions: </strong>The quality of life of children with IBD is challenging due to several factors. More support and education is needed for these patients.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"131-138"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Perioperative and adjuvant chemotherapy on survival in advanced gastric cancer following gastrectomy with D2 lymphadenectomy].","authors":"Cesia J Luna-Córdova, Juan Alberto Díaz-Plasencia, Edgar Fermín Yan-Quiroz, José Richard Tenazoa-Villalobos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To describe the effectiveness of perioperative chemotherapy and adjuvant chemotherapy in the survival of patients with gastric carcinoma after gastrectomy with D2 lymphadenectomy (T2-T4a) and to determine the association between the intervening factors of the study and the survival of this group.</p><p><strong>Materials and methods: </strong>Observational study, retrospective cohorts, in patients who received perioperative or adjuvant chemotherapy at a Peruvian cancer institute from January 2007 to December 2022. To determine actuarial survival, the Kaplan-Meier method and the log-rank test were used to compare 2 survival curves.</p><p><strong>Results: </strong>A total population of 82 patients was evaluated, of which 46 received adjuvant chemotherapy and 36 perioperative chemotherapy, with the most commonly used regimen being CAPOX and EOX/EOX, respectively. Clinical characteristics did not significantly influence overall survival and only the primary tumor (T) had a statistically significant association, with T4a being more frequent in the perioperative chemotherapy group than in the adjuvant modality group (80.6% vs 47.8%; p=0.002). When comparing both therapeutic modalities, it was evident that patients who received perioperative chemotherapy had a longer survival at 5 years (53.2%), however, this was not statistically significant (p=0.230).</p><p><strong>Conclusions: </strong>Perioperative chemotherapy presented greater survival compared to adjuvant chemotherapy at 12, 36 and 60 months; however, these differences were not statistically significant.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"139-146"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interventional management of gastrointestinal and uterine bleeding in a patient with acute myeloid leukemia on induction therapy: case report].","authors":"Juan Sebastian Frias Ordoñez, Pablo Andrés Aux-Chaves, Wilmer Aponte Barrios, Fabian Enrique Neira-Escobar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bleeding involves morbidity and mortality in patients with acute myeloid leukemia (AML) receiving induction therapy. The concomitant presentation of gastrointestinal and uterine bleeding is rare as described in the literature, and its approach is not standardized. The following is an illustration of a case in which interventionism was effective and safe. A 44-year-old woman recently diagnosed with acute myeloid leukemia was started on induction therapy with cytarabine and idarubicin and presented 10 days after its initiation with rectorrhagia, melena and abnormal uterine bleeding. Due to clinical deterioration, she was transferred to the intensive care unit and required massive transfusion therapy. She needed angiotomography of the abdomen, with a probable area of active bleeding in the thin loop of the proximal jejunum, as well as contrasted resonance of the abdomen and pelvis, with multiple myomatosis and endometrial thickening. Abdominal arteriography was performed, requiring supra-selective embolization of the distal branch of the superior mesenteric artery supplying the jejunum. Subsequently, selective aorto-iliac arteriography was performed, proceeding to complete occlusion with coils of uterine arteries bilaterally. Post-procedure evolution, without new signs of bleeding. Imaging control ruled out complications. She completed the induction scheme and was discharged on the 45th day of hospitalization to continue the chemotherapy maintenance scheme on an outpatient basis. Early arteriography and embolization are viable, safe and effective procedures both for the management of gastrointestinal and uterine bleeding in patients with AML receiving induction therapy.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"192-197"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intestinal ultrasound in inflammatory bowel disease: When and how use it efficiently?]","authors":"Viviana Parra Izquierdo, Hugo Cedron, Marjorie Argollo, Joana Torres, Kenneth Ernest-Suárez","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In Latin America, the prevalence of Inflammatory Bowel Disease (IBD) has increased in recent years, creating a growing need for diagnostic tools both for its detection and for ongoing monitoring. Intestinal ultrasound (IUS) has become a well-established, non-invasive, accurate, and well-tolerated tool to evaluate IBD activity in real time-even during the same medical consultation. Available evidence supports its usefulness in accurately determining inflammatory activity and identifying associated complications. At the time of diagnosis and initiation of treatment, IUS has proven to be the ideal non-invasive study for close monitoring, assessing therapeutic response, and making early treatment adjustments. Multiple systematic reviews and meta-analyses have shown that its diagnostic accuracy is comparable to that of colonoscopy or magnetic resonance imaging. Additionally, IUS allows for therapeutic monitoring and prognosis assessment in a more accessible, non-invasive way, with greater patient adherence compared to other diagnostic modalities. This review article aims to analyze the optimal use of IUS and its current role in the management of patients with IBD.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"155-175"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vanek's tumor as an uncommon cause of digestive bleeding].","authors":"Sergio Morínigo, Maisa Vallejos, Sebastián Díaz Duba, Sebastián Burró, Carolina Miranda, José Villarejo, Jesús Ortiz Villalba","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Gastrointestinal tract polyps exhibit a wide range of characteristics, from benign to potentially malignant lesions. Vanek's polyp, a rare entity, is characterized by its inflammatory infiltrate and vascular alterations, often leading to confusion with adenomatous lesions. We present the case of a 77-year-old woman with a one-month history of rectal bleeding, requiring hospitalization during one of the episodes. Colonoscopy revealed a pedunculated polyp, which was resected without complications. Histopathological analysis showed a lymphoplasmacytic infiltrate, multiple vessels with fibrinoid necrosis, and no neoplastic atypia. Due to the nonspecific nature of the report, immunohistochemical studies were performed, revealing CD34 positivity in the vessels and vimentin positivity in mesenchymal cells. These findings suggest a differential diagnosis from inflammatory fibroid polyps. Vanek's polyps are uncommon lesions that require accurate diagnosis and appropriate management. Recent trends show an increase in the identification of these polyps, likely due to advancements in diagnostic techniques.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"184-187"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Frequency of juxtapapillary diverticulum detected during endoscopic retrograde cholangiopancreatography].","authors":"Yhonny Castillo Arrieta, Diego Castillo Ayala, José Romero Urdaneta, Rosargelis Parra Graterol, Luis Traviezo Valles","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The weakest part of the duodenal wall is the ampulla of Vater, since here the circular arrangement of the duodenal musculature is destructured to integrate the sphincter of Oddi. This characteristic could be the reason why most duodenal diverticula appear in the juxtapapillary region, even including the papilla inside.</p><p><strong>Objective: </strong>The objective of the research was to determine the patients diagnosed with juxtapapillary diverticulum (JD) after endoscopic retrograde cholangiopancreatography (ERCP), who were confused with different previous diagnoses.</p><p><strong>Materials and methods: </strong>Retrospective study with intentional sample, where ERCP was performed on a universe of 12,686 patients who were referred with different previous gastrointestinal pathologies, therefore, they required diagnosis or treatment with this procedure.</p><p><strong>Results: </strong>Of the 12,686 patients who underwent ERCP, between 01/07/2014 and 28/06/2024, a total of 872 (6.9%) presented a confirmatory diagnosis of juxtapapillary diverticulum, a diagnosis that differed partially or totally from the one presented before the procedure.</p><p><strong>Conclusions: </strong>The prevalence detected was one of the highest reported for Latin America. DY is generally asymptomatic, affecting mostly elderly patients, but when it is symptomatic, they present different signs and symptoms, which simulate a wide variety of diagnoses, where the clinical and previous imaging studies do not provide sufficient clues for a correct analysis, therefore, ERCP is the perfect tool for the timely diagnosis and treatment of DY, clearing previous diagnostic doubts.</p>","PeriodicalId":35807,"journal":{"name":"Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru","volume":"45 2","pages":"147-154"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}