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Digestive diseases are the fourth leading cause of outpatient care in Peruvian healthcare centers, with gastritis and peptic ulcers being the most common. This is a retrospective, cross-sectional, descriptive study of secondary analysis of medical record data to evaluate the prevalence of Helicobacter pylori in patients undergoing upper digestive endoscopy during 2019 at Clinica Delgado, Lima, Peru. An association between males (PRa 1.27, 95% CI 1.10-1.48, p<0.001), age categories and upper digestive endoscopy (PRa 2.53, 95% CI 2.16-2.97, p<0.001) was reported. Based on these findings, it is recommended that other causes of gastritis be identified, especially in young women with deep chronic gastritis. Furthermore, we present a review of the scientific literature of Peru on factors associated with the positivity of Helicobacter pylori in the results of superior digestive endoscopy.

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RESUMEN Las enfermedades digestivas representan la cuarta causa de atención ambulatoria en los centros sanitarios peruanos, siendo la gastritis y las úlceras pépticas las más comunes. El presente es un estudio retrospectivo, de corte transversal, de tipo descriptivo, de análisis secundario de datos de historias clínicas, para evaluar la prevalencia de Helicobacter pylori en pacientes sometidos a endoscopia digestiva alta durante el año 2019 en la Clínica Delgado, Lima, Perú. Asociación entre el sexo masculino (PRa 1,27, IC95% 1,10-1,48, p <0,001), categorías de la edad y resultado de endoscopia digestiva alta (PRa 2,53, IC95% 2,16-2,97, p<0,001) fueron reportados. Se recomienda, a partir de estos hallazgos, determinar otras causas de gastritis, especialmente en las mujeres jóvenes con gastritis crónica profunda. Además, presentamos una revisión de la literatura científica del Perú sobre los factores asociados a la positividad de Helicobacter pylori en los resultados de la endoscopia digestiva superior.

ABSTRACT Digestive diseases are the fourth leading cause of outpatient care in Peruvian healthcare centers, with gastritis and peptic ulcers being the most common. This is a retrospective, cross-sectional, descriptive study of secondary analysis of medical record data to evaluate the prevalence of Helicobacter pylori in patients undergoing upper digestive endoscopy during 2019 at Clinica Delgado, Lima, Peru. An association between males (PRa 1.27, 95% CI 1.10-1.48, p<0.001), age categories and upper digestive endoscopy (PRa 2.53, 95% CI 2.16-2.97, p<0.001) was reported. Based on these findings, it is recommended that other causes of gastritis be identified, especially in young women with deep chronic gastritis. Furthermore, we present a review of the scientific literature of Peru on factors associated with the positivity of Helicobacter pylori in the results of superior digestive endoscopy.

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OBJECTIVE: To evaluate the therapeutic success of the injection of N-butyl-2 cyanoacrylate in the treatment of gastric varices. METHODS: Cross-sectional study included 33 patients with gastric varices who only received cyanoacrylate endoscopic therapy between 2006 and 2010. Intravariceally, cyanoacrylate was injected in a 1:1 dilution with lipiodol until the obliteration of varices. The therapeutic situation was: active bleeding, varices with stigmata of recent bleeding and secondary prophylaxis. Treatment success was evaluated according to hemostasis, recurrent bleeding and obliteration. RESULTS: Of the 33 patients, 3 (9.1%) were for active bleeding, 20 (60.6%) with stigmata of recent bleeding and 10 (30.3%) as secondary prophylaxis. Gastric varices were GOV2, 17 (51.5%); IGV1, 14 (42.4%); GOV1, 2 (6.1%). Hemostasis was achieved in 21 (91.3%) and in 2 (66.7%) of 3 patients with active bleeding. Five (15.6%) patients had recurrent bleeding and 2 of them used cyanoacrylate with successful hemostasis. Obliteration was achieved. Four patients died and one for failure of control bleeding. A high severity of Child-Pugh classification was related to treatment endoscopic failure (p=0.034). The main complication was bleeding after the injection of cyanoacrylate. CONCLUSIONS: Our results support the use of cyanoacrylate in the treatment of gastric varices with few major complications.

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OBJETIVO: Evaluar el éxito terapéutico de la inyección de N-butil-2-cianoacrilato en el tratamiento de las várices gástricas. MATERIALES Y MÉTODOS: Estudio transversal que incluyó 33 pacientes con várices gástricas que sólo recibieron terapia endoscópica con cianoacrilato entre el 2006 al 2010. El cianoacrilato fue inyectado intravaricealmente en una dilución 1:1 con lipiodol hasta obtener la obturación de las várices. La situación terapéutica fue: Hemorragia activa, várices con estigmas de sangrado reciente y profilaxis secundaria. El éxito del tratamiento se evaluó según la hemostasia, recurrencia de sangrado y obturación. RESULTADOS: De los 33 pacientes, 3 (9.1%) fueron por hemorragia activa, 20 (60.6%) con estigmas de sangrado reciente y 10 (30.3%) como profilaxis secundaria. Las várices fueron GOV2, 17 (51.5%); IGV1, 14 (42.4%) y GOV1, 2 (6.1%). Se logró hemostasia total en 21 (91.3%) pacientes con sangrado agudo o reciente y en 2 (66.7%) de 3 sujetos con sangrado activo. En 5 (15.6%) pacientes hubo recurrencia de sangrado y 2 de ellos recibieron cianoacrilato con éxito de hemostasia. Se logró obturación en 25 (75.8%) del total de pacientes. Cuatro pacientes fallecieron, uno por fracaso del control de sangrado. La mayor severidad de clasificación Child-Pugh se relacionó con falla terapéutica (p=0.034). La complicación principal fue el sangrado post-inyección del cianoacrilato. CONCLUSIONES: Nuestros resultados favorecen el uso de cianoacrilato en el tratamiento de várices gástricas, con raras complicaciones mayores.

OBJECTIVE: To evaluate the therapeutic success of the injection of N-butyl-2-cyanoacrylate in the treatment of gastric varices. METHODS: Cross-sectional study included 33 patients with gastric varices who only received cyanoacrylate endoscopic therapy between 2006 and 2010. Intravariceally, cyanoacrylate was injected in a 1:1 dilution with lipiodol until the obliteration of varices. The therapeutic situation was: active bleeding, varices with stigmata of recent bleeding and secondary prophylaxis. Treatment success was evaluated according to hemostasis, recurrent bleeding and obliteration. RESULTS: Of the 33 patients, 3 (9.1%) were for active bleeding, 20 (60.6%) with stigmata of recent bleeding and 10 (30.3%) as secondary prophylaxis. Gastric varices were GOV2, 17 (51.5%); IGV1, 14 (42.4%); GOV1, 2 (6.1%). Hemostasis was achieved in 21 (91.3%) and in 2 (66.7%) of 3 patients with active bleeding. Five (15.6%) patients had recurrent bleeding and 2 of them used cyanoacrylate with successful hemostasis. Obliteration was achieved in 25 (75.8%). Four patients died and one for failure of control bleeding. A high severity of Child-Pugh classification was related to treatment endoscopic failure (p=0.034). The main complication was bleeding after the injection of cyanoacrylate. CONCLUSIONS: Our results support the use of cyanoacrylate in the treatment of gastric varices with few major complications.

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Female of 64 years old, who two years ago was hospitalized in another institution for treatment of an abscess in the right liver lobe. During that hospitalization, it was found a duodenal tumor by tomography; however, no further studies or follow up on this finding was done. Prior to actual hospitalization, she was seen in a private clinic and treated with antibiotics for a suggestive"organized abscess" in the pancreatic head diagnosed by tomography. She presented with fever, abdominal pain and a palpable abdominal tumor in the right upper quadrant for a month. We realized a three-phase multislice spiral tomography with pancreatic curved reconstruction, which allowed to identified an ovoid tumor of 80 x 60 mm, with an area of central necrosis and intense contrast enhancement (arterial phase), located between the second and third duodenal portion, near the head of the pancreas. An upper endoscopy showed an extrinsic compression of the third duodenal portion. The patient underwent tumor resection without complication and the histologic diagnosis of the surgical specimen revealed a duodenal stromal tumor (GIST) with extraluminal transmural growth. We presented this case because of its unusual presentation of this tumor.

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Paciente mujer de 64 años de edad, quien hace dos años estuvo hospitalizada en otra institución para el tratamiento de un absceso en el lóbulo hepático derecho. Durante esa hospitalización se diagnosticó un tumor duodenal por tomografía; sin embargo, no se completó el estudio sobre este hallazgo. Previa a la actual hospitalización, la paciente estuvo internada en una clínica privada, donde fue tratada con antibióticos por una imagen sugestiva de "absceso organizado" en la cabeza del páncreas. Desde hace un mes presentaba fiebre, dolor abdominal y una masa palpable en el cuadrante superior derecho del abdomen. Se le realizó una tomografía espiral multicorte trifásica, con reconstrucción curvada de páncreas que permitió reconocer una tumoración ovoidea de 80 x 60 mm, con área de necrosis central e intenso realce del contraste (fase arterial), localizada entre la segunda y tercera porción duodenal, próxima a la cabeza de páncreas. La endoscopía alta demostró una compresión extrínseca en la tercera porción duodenal. La paciente fue sometida a una resección tumoral sin complicaciones y la histología del espécimen quirúrgico reveló un Tumor Estromal Gastrointestinal (GIST) Duodenal, de crecimiento transmural extraluminal. Presentamos el caso por ser una inusual presentación este tipo de tumores.

Female of 64 years old, who two years ago was hospitalized in another institution for treatment of an abscess in the right liver lobe. During that hospitalization, it was found a duodenal tumor by tomography; however, no further studies or follow up on this finding was done. Prior to actual hospitalization, she was seen in a private clinic and treated with antibiotics for a suggestive "organized abscess" in the pancreatic head diagnosed by tomography. She presented with fever, abdominal pain and a palpable abdominal tumor in the right upper quadrant for a month. We realized a three-phase multislice spiral tomography with pancreatic curved reconstruction, which allowed to identified an ovoid tumor of 80 x 60 mm, with an area of central necrosis and intense contrast enhancement (arterial phase), located between the second and third duodenal portion, near the head of the pancreas. An upper endoscopy showed an extrinsic compression of the third duodenal portion. The patient underwent tumor resection without complication and the histologic diagnosis of the surgical specimen revealed a duodenal stromal tumor (GIST) with extraluminal transmural growth. We presented this case because of its unusual presentation of this tumor.

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The Vater's ampulla neoplasias are not very frequent lesions. The ampullectomy consists on the total resection of the Vater's ampulla and part of the duodenal wall with the later reconstruction and anastomosis of the common bile duct and the Wirsung's duct to the duodenum. The local resection of the ampulla is an alternative to the duodenopancreatectomy that has to be taken into account, especially in benign lesions as in the case of adenomas of the Vater's ampulla. Here we describe two cases one with adenoma of the Vater's ampulla, with a high degree dysplasia, who first underwent an ampullectomy and finally ended up in a duodenopancreatectomy due to the infiltration of the adenoma into the edge of section and other case of Lymphangioma of Vater's ampulla with no infiltration in the edge of section.

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Fibrovascular polyps are extremely rare benign neoplasias of the esophagus, which usually originate in the lower cricoid area. They do not produce any discomfort in the patient for a long time, however it may make itself evident by the patient's regurgitation of the polyp, producing asphyxia or, more frequently, dysphagia. The case of a 58 year old male patient is presented herein, with a 9 month record of dysphagia, weight loss and intermittent melena. The barium x-ray showed a distended esophagus, with a tumor running from the upper esophageal sphincter to the cardia. The endoscopy confirmed the presence of a pediculated tumor, implanted in the cervical esophagus. Surgeons suspected the potential malignancy of the tumor and performed a transhiatal esophagectomy. The final pathologic diagnosis was giant fibrovascular esophageal polyp.

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Dieulafoy lesion is an unsual source of upper astrointestinal bleeding with a frequency ranging from 0.3 to 6.7% of the reported literature, although at present it is more frequently diagnosed. It usually begins abruptly with massive bleeding and hemodynamic involvement. The higher prevalence is found in older people and because this group of patients is generally affected by other diseases, Dieulafoy lesion may be life threatening. A thick arterial blood vessel flows through the mucosa and submucosa and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required.There are different types of endoscopic treatment but combined methods seem to be the consense, epinephrine injection followed by thermal coagulation, rubber banding, or recently, hemoclips is being reported. The injection of sclerosing agents is also useful as has been published in later reports. The treatment must be aggressive to obliterate the bleeding vessel. The rate of complications reported with endoscopic approach, mainly perforation, is very low.Initial hemostasis is accomplished in 82% to 96% of cases and a complete one is achieved in 60% to 91% of the events. Recurrence can be treated in the same way as the first episode, but frequently massive bleeding or failure of an initial attempt to obliterate the vessel makes surgery mandatory. The prevalence rate of surgical treatment is between 2% to 36%, being local excision a better approach than the simple suture of the lesion. Before endoscopic age, the mortality rate was as high as 80% but it has been reduced, values range now from 0% to 22%. Long term follow - up after an initial successful endoscopic procedure has decreased the incidence of recurrency of the bleeding episode, being at present as low as 0% to 4.7%

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Gastrointestinal bleeding in childhood is an uncommon problem, althought when it happens it maybe an emergency. Upper bleeding predominates, and when we consider lower bleeding, the principal cause are polyps. Recent evidence points out that polyps are responsible for bleeding in 77% of cases.We decided to study the clinical course, histologic characteristics and treatment in children with lower gastrointestinal bleeding. This investigation was held at Edgardo Rebagliati National Hospital during 1990 to 1996. Inclusion criteria were: younger than 14 years, gastrointestinal bleeding, and colonoscopy exam.100 colonoscopies were done in 74 children. Polyps were the cause for gastrointestinal bleeding in 71.6% of cases. In 14 children more than one colonoscopy was done. More than one polyp in 16 children were found. Ulcerative colitis was diagnosed in two cases, and intestinal tuberculosis in other two cases. Average age was 8.8 years, and 100% presented rectorragia and anemia.Polyps were located principally in rectum and sigmoid. Polipectomy was done in 94.34% of the cases, and it was technically succesful. We had only one complication (snare wire was trapped) but with no morbidity.Histological examination demonstrated that juvenile polyp was the most frequent type (56.66%), followed by tubular adenoma (11.32%), and Peutz-Jegher polyp in 3.77%. Treatment was polipectomy in all cases. Eleven procedures were done in the surgical room, and 19 in the endoscopy unit, with no complications in any of the cases.CONCLUSION: In children the main cause for lower gastrointestinal bleeding are polyps. All cases present with rectorragia or anemia, and juvenile polyps are the most frequent type. Colonoscopy is a safe method for diagnosis and treatment, which can be done in the endoscopy unit with mild sedation and with an anesthesist or pediatrician as assistants.

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La hemorragia digestiva constituye un tercio de las hospitalizaciones de nuestro servicio. A veces es difícil diferenciar clínicamente la localización del sitio de sangrado. Se ha señalado que la relación urea/creatinina puede ayudar a definir el sitio de sangrado, pero que existe una gran superposición de resultados. Estudiamos 154 pacientes con hemorragia digestiva en forma prospectiva. Tuvieron hemorragia digestiva alta 123 (79.9 por ciento) pacientes con una relación urea/creatinina promedio de 62.27ñ29.13 y hemorragia digestiva baja 31 (20.1 por ciento) con una relación urea/creatinina de 39.49ñ13.83, diferencia estadísticamente significativa pero con una gran superposición de resultados. Definiendo hemorragia digestiva alta cuando existe una relación urea/creatinina mayor de 60, encontramos una gran especificidad (96.77 por ciento) pero una sensibilidad baja (51.22 por ciento); cuando tomamos los casos de enterorragia, que generalmente son los que pueden dar problema de diagnóstico, la especificidad alcanza 96.42 por ciento y la sensibilidad 46.15 por ciento. En conclusión, un valor de urea/creatinina mayor de 60 nos indica generalmente una hemorragia del tracto digestivo alto, pero un valor por debajo de 60 no es de valor diagnóstico.

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Gastrointestinal bleeding constitutes a third part of the hospitalizations in our service. Some times is difficult to clinically distinguish the site of bleeding. It was pointed that the urea/creatinine ratio can help to define the site of bleeding, but there is a lot of superposition in the results. We studied prospectively 154 patients with gastrointestinal bleeding. 123 (79.9%) patients had upper gastrointestinal bleeding with an urea/creatinine ratio of 62.27 +/- 29.13 and 31(20.1%) patients had lower gastrointestinal bleeding with an urea/creatinine ratio of 39.49 +/- 13.83. This difference is statistically significant but has a lot of overlap results. Defining gastrointestinal bleeding as an urea/creatinine ratio greater than 60, we found a great specificity (96.77%) but a low sensibility (51.22). In addition, when we only took hematochezia cases, that usually is a diagnostic problem, the specificity was 96.42% and the sensitivity 46.15%. In conclusion, an urea/creatinine ratio greater than 60 usually indicate us an upper gastrointestinal bleeding, but values below of 60 isn't of diagnostic value.

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El paciente que ingieere una sustancia cáustica sigue contituyendo un problema de manejo médico y quirúrgico. La severidad y extensión del daño químico va a depender fundamentalmente, de la concentración y cantidad del cáustico ingerido; igual se puede dañar el esófago y el estómago cuando se toma una sustancia ya sea álcali o ácido de concentración fuerte, pudiendo la lesión extenderse al duodeno, y en algunos casos al yeyuno e incluso comprometer órganos adyacentes, con una alta morbimortalidad. La graduación de la severidad de la lesión puede definirse, sin mayor riesgo, con la endoscopía flexible y correlaciona bien con la intensidad del daño en el tejido, pudiendo ello decidir la conducta de manejo y tiene valor pronóstico. Un grado superficial(1 ó 2a), no va a requerir mayor tratamiento y va a evolucionar sin secuela. Cuando en la endoscopía se define lesiones ulceradas circunferenciales, profundas, o con fondo necrótico(grado 2b, y 3), estos pacientes requerirán internamiento, nutrición enteral o parenteral, y cobertura antibiótica. Vigilancia por la probabilidad de desarrollar perforación o hemorragia, y en ocasiones se hará necesario un tratamiento quirúrgico de urgencia. el uso de corticoide ha demostrado ser ineficaz en prevenir la estenosis y es potencialmente peligroso. La secuela tardía más frecuente es el desarrollo de estenosis esofágica(se desarrollan en el 50-70 por ciento de los 2b y en todos los 3 que sobreviven) y antral. Las estenosis esofágicas son tributarias de dilataciones con bujías; una opción para evitar la estenosis sobre todo en niños, es la colocación de tubos plásticos cortos en forma temporal. En caso de que no haya buena respuesta a las dilataciones, o las estenosis son largas o múltiples, será necesaria la cirugía con interposición de colon o yeyuno. El desarrollo de estenosis gástrica usualmente requiere cirugía. También se puede producir como secuela alteraciones motoras y reflujo gastroesofágico, y tardíamente, mayor riesgo de desarrollar c 0ncer escamoso.

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Se reporta el caso de un paciente cirrótico, sometido previamente a escleroterapia de várices esofágicas y gastrectomía total, que presentó una hemorragia activa de várice yeyunal, en quien el tratamiento con escleroterapia y posterior endoligadura fue exitoso resolviendo el problema variceal.

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Every patient that ingests any caustic substance still constitutes a medical and surgical. The severity and extension of the chemical damage will basically depend on the concentration and quantity of the caustic substance ingested. Likewise, when a highly concentrated alkali or acid substance is ingested, the esophagus and stomach will be damaged, and this lesion could also spread to the duodenum, and in some cases to the jejunum. Furthermore, it may compromise adjacent organs with a high morbimortality. The severity degree of the lesion can be determined with no risk by a flexible endoscopy, and correlates well with the intensity of tissue damage, enabling us to decide the manner in which this lesion is to be handled, with a prognosis value. A superficial grade (1 or 2a),will require no treatment and it will evolve without sequela. However, upon the determination of deep, ulcerated circumferential lesions, or with necrotic fundus by endoscopy (Grade 2b, and 3), patients shall be hospitalized and shall receive enteral or parenteral nutrition, as well as antibiotic protection. Careful attention should be given due to the risk of perforation or hemorrhage, and ocasionally, urgent surgical treatment will be necessary.The use of corticosteroids has proved to be innefective in preventing stenosis and is potentially dangerous. The most frequent late sequela is the developing of esophageal stenosis (developing in 50-70% of the 2b, and in all of the 3 who survive), and antral stenosis. The esophageal stenosis are tributaries of dilatations with bougies. An option to avoid stenosis, specially in children, is the placement of short plastic tubes, temporarily. In cases where there is no good response to the dilatations. or when the stenosis are long and multiple, surgery with interposition of colon or jejunum will be necessary. Usually, the development of gastric stenosis requires surgery. Motor alterations and gastroesophageal reflux as sequela may also be present, and belatedly, a greater risk to develoop squamous cancer.

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A case of jejunal bleeding is reported. A 68-year-o1d man, who suffered previous gastrectomy and sclerotherapy for esophageal varices presented jejunal variceal bleeding. These varices were sclered and banded with good results.

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Objetivos: Fueron dos, 1)Determinar la eficacia de la terapia de inyección endoscópica (TIE) en pacientes con sangrado por úlcera péptica con .alto riesgo de recurrencia, y 2)Reconocer los factores de riesgo clínico-endoscópicos que influyen en la recurrencia de hemorragia y la mortalidad por esta patología. Métodos: Es un estudio retrospectivo que incluye 121 pacientes admitidos a una unidad especializada en el manejo de hemorragia digestiva debido a una úlcera péptica con sangrado activo o vaso visible no sangrante, entre Marzo de 1994 y Febrero de 1996, y a los que se les realizó TIEcon adrenalina. Resultados: Se logró éxito en la hemostasia endoscópica inicial en 119 pacientes (99.1 por ciento), en un paciente la hemorragia persistió (0.9 por ciento), y en otro no se pudo realizar la TIE por inaccesibilidad. La hemostasia definitiva se alcanzó en 93 pacientes (77.5 por ciento), y hubo recurrencia en 28 (23.5 por ciento).Se remitió a cirugía a 26 pacientes (21.5 por ciento). El examen univariado demostró que la recurrencia de la hemorragia estuvo relacionada con la presencia de shock (p=0.002), hematemesis (p=0.02),edad mayor de 60 años (p=0.009), número de unidades transfundidas (p=O.OOOOO) y tamaño de la úlcera mayor de 2cm (p=0.018). La mortalidad global en nuestros pacientes fue de 10 por ciento, y la mortalidad operatoria de 34.6 por ciento. Los factores asociados significativamente con la mortalidadfueron la recurrencia de la hemorragia (p=0.000003), presencia de enfermedad concomitante (p=0.05), la presencia de úlcera gástrica (p=0.021), además de la edad (mayores de 60años), presencia de.shock y tamaño de la úlcera mayor de 2cm (P=0.05). Conclusiones: La TIE es un procedimiento útil en el tratamiento de la hemorragia por úlcera péptica con alto riesgo de recurrencia (hemorragia activa o vaso visible), habiéndose obtenido la hemostasia definitiva en el 77.5 por ciento...

Background: Objectives were two. (1) to determine the efficiency of the endoscopic injection therapy (EIT) in patients suffering from bleeding caused by peptic ulcer disease with high risk of recurrence, and (2) to recognize clinical and endoscopical risk factors that influence recurrence of hemorrhage and mortality from this pathology. Methods: This is a retrospective study that included 121 patients, who were admitted by a unit specialized in managing gastrointestinal hemorrhage owing to peptic ulcer with active bleeding or non-bleeding visible vessel, and who underwent EIT with epinephrine between March, 1994 and February, 1996. Results: Initial success was achieved in 119 patients who underwent EIT (99.1 per cent). Bleeding persisted in one patient (0.9 per cent), and in another one, EIT was not successful because of inaccessible location. Definite hemostasis was achieved in 93 patients (77.5 per cent) and there was recurrence in 28 cases (23.5 per cent). Twenty-six patients underwent surgical therapy (21.5 per cent).The univariable analysis showed that hemorrhage recurrence was related to the presence of shock (p=0.002), hematemesis (p=0.2), age over 60 (p=0.009), number of blood units transfused (p=O.OOOOO) and ulcer diameter larger than 2 cm (p=0.018). The global mortality in our patients was of 10 per cent, and surgical mortality was of 34.6 per cent. Factors significantly related to mortality were hemorrhage recurrence (p=0.000003), presence 01concomitant disease (p=0.05), and presence of gastric ulcer (p=0.021), in addition to age (over 60), presence of shock and ulcer diameter larger than 2 cm (p=0.05). Conclusion: EIT is a valuable procedure for the treatment of hemorrhage caused by peptic ulcer with high risk of recurrence (active hemorrhage or visible vessel), with a definite hemostasis of 77.5 per cent...

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BACKGROUND: Objectives were two. (1) to determine theefficiency of the endoscopic injection therapy (EIT) in patients suffering from bleeding caused by peptic ulcer disease with high risk of recurrence, and (2) to recognize clinical and endoscopical risk factors that influence recurrence of hemorrhage and mortality from this pathology. METHODS: This is a retrospective study that included 121 patients, who were admitted by a unit specialized in managing gastrointestinal hemorrhage owing to peptic ulcer with active bleeding or non-bleeding visible vessel, and who underwent EIT with epinephrine between March, 1994 and February, 1996.RESULTS: Initial success was achieved in 119 patients who underwent EIT (99,1%). Bleeding persisted in one patient (0,9%), and in another one, EIT was not sucessful because of inaccessible location. Definite hemostasis was achieved in 93 patients (77,5%) and there was recurrence in 28 cases (23,5%). Twenty-six patients underwent surgical therapy (21,5%). The univariable analysis showed that hemorrhage recurrence was related to the presence of shock (p = 0,002), hematemesis (p = 0,2), age over 60 (p = 0,009), number of blood units transfused (p = 0,00000) and ulcer diameter larger than 2 cm (p = 0,018). The global mortality in our patients was of 10%, and surgical mortality was of 34,6%. Factors significantly related to mortality were hemorrhage recurrence (p = 0,000003), presence of concomitant disease (p = 0,05), and presence of gastric ulcer (p = 0,021), in addition to age (over 60), presence of shock and ulcer diameter larger than 2 cm (p = 0,05).CONCLUSION: EIT is a valuable procedure for the treatment of hemorrhage caused by peptic ulcer with high risk of recurrence (active hemorrhage or visible vessel), with a definite hemostasis of 77,5%. The presence of shock, hematemesis, age over 60, transfusion requirements of more than 3 blood units, and ulcer diameter of more than 2 cm are factors that increase the probability of hemorrhage recurrence after EIT. Mortality is significantly related to the presence of hemorrhage recurrence, concomitant diseases and gastric ulcer in addition to clinical and endoscopical factors mentioned above, with the exception of hematemesis and transfusion requirement. A prompt surgery after detection of a major bleeding recurrence in patients with the risk factor already described and a coordinate action with a surgery team experienced in digestive hemorrhage would influence favorably the mortality rate of this disease.

RESUMEN

Reportamos un estudio clínico- endoscópico sobre cáncer colorectal en 365 pacientes de ambos sexos, que se distribuyeron entre 26 y 95 años de edad, a los que se les hizo el diagnóstico mediante colonoscopia, en el período de 1974 a 1992. Los resultados mostraron que 61,92% fueron hombres y 38,08% mujeres; en 92,60% la lesión ocurrió a partir de la cuarta década de edad; 13,42% tuvieron historia personal de enfermedad maligna, tales como cáncer colorectal, cáncer de útero, mama, y próstata; 13,97% refirieron antecedentes personales benignos como adenoma colorectal, y colecistectomía de 15 años de antigüedad. Los síntomas y signos más importantes fueron el dolor abdominal, la alteración del hábito intestinal, y la hemorragia, acompañados de síndrome general de grado variado, pero con características clínicas que hicieron sospechar la localización de la lesión en el recto-colon. En el 62,57% de los casos hubo hemoglobina de 10,0 g% o menos, y en 85,23%, el test de sangre oculta en heces fue positivo. En 199 pacientes el simple enema de bario fue positivo sólo en 66,33%, en tanto que en este grupo la colonoscopia diagnosticó la lesión en 96,49% de los casos durante la primera instrumentación, identificando otras neoplasias no detectadas por el enema de bario. La colonoscopia fue excelente para el diagnóstico de la lesión primaria en 98,08% de los casos, en la primera instrumentación, incluyendo la identificación de lesiones síncronas. La localización de los cánceres fue: 57,63% en colon izquierdo (49,47% en recto y sigmoide), 34,21 % en colon derecho, y 8,16% en colon transverso. La patología demostró que 95.23% fueron adenocarcinomas, 1,06% carcinoma mucoide, 1,06% carcinoma epidermoide, y 2,65% fueron linfomas. En 32,05% de casos, hubieron lesión síncronas, de las cuales en 3,01% hubo otro cáncer; y en 14,79% hubieron 112 pólipos, de los cuales 62,50% fueron adenomas, 6,25% adenomas con adenocarcinoma no invasivo o invasivo, y 31,25 pólipos hiperplásicos...

We report a clinic-endoscopical study about 365 patients, both of sex, etween 26-95 years old, with colonoscopic diagnosis of colorectal cancer. Results showed that 61,92% were men and 38,08% women; in 92,60% the disease ocurred over 40 years old. 13,42% had malignant personal history -colorectal cancer, uterus and breast cancer, and others-; 13,97% had bening personal history-colorectal adenoma, cholecystectomy, and others-; Abdomina pain, change in intestinal habits, and bleeding were the moist frequent symptoms, with differencesdepending of thetumors localization inthecolon or rectum. 62,57% of patients had anemia under 10g% of hernoglobin; in 85,23% the fecal occult blood test was positive. On 199 patients, the simple barium enema diagnosed the tumor in 66,33% only; but in the same group, colonoscopy diagnosed the cancer in 96,49% at first examination. In all patients, colonoscopywas excellentfor diagnosis of the principal lesion, and for the identífication of synchronous neoplasia. On 365 patients, colonoscopy diagnosed the cancer in 98,08% at first examination. The localization of tumors was: 57,63% in left colon (49,47% in rectum and sigmoid colon); 34,21% in the right colon; and 8,16% in transverse. Pathology showed that adenocarcinoma was the most frequent tumor 95,23%; 1,06% mucoid carcinoma; 1,06% epidermoid carcinoma; and 2,65% lymphorna. In 32,05% of cases there were synchronous lesions; 3,01% had othercancer, and 54 patients had 112 polyps (62,50% adenomatous polyp, 6,25% adenoma with non invasive or invasive adenocarcinoma, and 31,25% hiperplastic polyp.

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RESUMEN

Se reporta el estudio de 318 adenomas colorectales extirpados mediante colonoscopía terapeútica a 200 pacientes de ambos sexos, entre los 25 y 88 años de edad; 60.50 por ciento hombres y 39.50 por ciento mujeres; 86.50 por ciento en total, tuvieron más de 50 años de edad. 64.50 por ciento de pacientes tuvieron adenomas únicos y en 35.50 por ciento fueron "adenomas múltiples"; el 72.64 por ciento se distribuyeron en el recto-sigmoides. La displasia fué severa especialmente en los adenomas mayores de 20 mm. de diámetro y en aquellos de tipo velloso y por consiguiente el porcentaje de malignidad se incrementó con el aumento progresivo de dichos parámetros: tamaño, grado de displasia y tipo histológico del adenoma. Este porcentaje fué: 1.61 por ciento en los adenomas menores de 10 mm; 8.49 por ciento en los de 10 mm a 19 mm; y 30.68 por ciento en los mayores de 20 mm de diámetro. El foco de adenocarcinoma creció de 1.69 por ciento en los adenomas menores de 10 mm de diámetro a 58.33 por ciento en aquellos de 40 mm de diámetro o más. Según el tipo histológico de malignidad fué 7.66 por ciento en el adenoma tubular, 22.22 por ciento en el túbulo-velloso, y 26.32 por ciento en el velloso; la incidencia de adenocarcinoma sobre el total de adenomas fué 11.95 por ciento

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