RESUMEN
OBJECTIVES: The Sengstaken-Blakemore (SB) tube is used in cases of uncontrolled variceal bleeding. Because of the complexity of the procedure and the lack of visualization, various techniques have been described to avoid blind placement. We report an innovative and simple technique for placement of the SB tube under direct endoscopic visualization. METHODS: A grasp-and-place technique for endoscopic placement of SB tubes is described and a retrospective cohort study chart review of endoscopies done for variceal bleeding in our medical center is reported. All patients with uncontrolled variceal bleeding who required placement of an SB tube from July 1, 2013 through December 31, 2015 were included. The primary outcome analyses were technical success of tube placement and achievement of hemostasis. RESULTS: Of 143 endoscopies done for variceal bleeding, 10 were managed with SB tubes placed endoscopically after initial endoscopic therapy was unsuccessful. Successful placement of the tube was achieved in all of the patients. Hemostasis was achieved in 9 of the 10 patients. CONCLUSIONS: We propose a new grasp-and-place technique for endoscopic placement of SB tubes. Review of our experience shows that massive variceal bleeding can be managed effectively with this technique.
Asunto(s)
Várices Esofágicas y Gástricas/complicaciones , Hemorragia Gastrointestinal , Hemostasis Endoscópica/métodos , Intubación Gastrointestinal , Estudios de Factibilidad , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Humanos , Intubación Gastrointestinal/instrumentación , Intubación Gastrointestinal/métodos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de SaludRESUMEN
BACKGROUND: Calculating the adenoma detection rate (ADR) is a complex process in contrast to the polyp detection rate (PDR) that can be easily calculated. The average adenoma to polyp detection rate quotient (APDRQ) was proposed as a conversion factor to estimate the ADR for individual endoscopists from the endoscopist's PDR. However, this conversion factor was not validated in different practice settings. GOAL: To validate the use of the proposed conversion factor in a practice setting with a predominantly Hispanic population. STUDY: We conducted a retrospective, cross-sectional study (December 2007 to November 2012) of screening colonoscopies at a university practice setting with an 86.9% Hispanic population. The actual ADR and PDR were calculated for all endoscopists. The weighted average of ADR to PDR ratio for each endoscopist was used to obtain APDRQ. The APDRQ was used as a conversion multiplier to estimate each endoscopist's ADR using the single endoscopist's PDR. RESULTS: A total of 2148 screening colonoscopies were included. The average PDR for the whole group was 36.9% (range, 11% to 49%). The actual ADR was estimated as 25.5% (range, 11% to 37%). The average APDRQ for our group was 0.68. The estimated ADR was 25.48% (range, 8% to 33%). There was a high correlation between actual ADR and the estimated ADR (Pearson correlation=0.92). CONCLUSIONS: In a practice setting with a predominantly Hispanic population, a conversion factor can be used to estimate ADR from PDR providing a high degree of correlation with the actual ADR.
Asunto(s)
Adenoma/diagnóstico , Pólipos del Colon/diagnóstico , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Hispánicos o Latinos , Tamizaje Masivo/estadística & datos numéricos , Anciano , Estudios Transversales , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no Paramétricas , TexasRESUMEN
OBJECTIVES: We aimed to evaluate the polyp recurrence rate after endoscopic mucosal resection (EMR) and factors contributing to increased recurrence. METHODS: MEDLINE (from 1966 to 2013), the Cochrane Central Register of Controlled Trials, and the Scopus database were searched in December 2013. Studies evaluating the polyp recurrence rate after colonic EMR were included. All of the articles were assigned a quality score. Standard forms were used to extract data regarding study design, outcome measures, and adverse effects by two independent reviewers. We performed a meta-analysis with a random effects model. Separate analyses were performed for each main outcome by using odds ratio (OR) and risk difference. Heterogeneity was assessed by I(2) measure of inconsistency. RESULTS: For the recurrence rate of colorectal lesions, 30 articles were included, with a total of 3404 patients. The polyp recurrence rate after EMR was 13.1%. Piecemeal resection was associated with a higher recurrence rate compared with en bloc resection (OR 4.39, 95% confidence interval 2.05-9.41; 14 studies). The use of argon plasma coagulation did not affect the polyp recurrence rate (OR 1.23, 95% confidence interval 0.39-3.88). Significant heterogeneity was present among studies. CONCLUSIONS: The recurrence rate of colorectal polyps after EMR is reasonably low; however, piecemeal resection was associated with a higher recurrence rate than en bloc resection after EMR.