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OBJECTIVES: Confocal lasser endomicroscopy (CLE) is an optical technique that enables in vivo cytological characterization of a tissue. Previous studies have shown it useful in the evaluation of urinary and respiratory tracts for a better characterization of mucosal lesions, showing a high concordance between in vivo and final histopathological results. Recently, the use of CLE has been proposed for the study of transitional cell carcinoma of the upper urinary tract (UUT) during ureteroscopy, because it enables real time information about tumor grade and supplements the information of ureteroscopic biopsies, which may understimate the grade and stage of the lesion up to 43% of the cases due to its limitiations. METHODS: We performed a systematic review of the literature in the Pubmed/Medline database following the PRISMA standard. We selected 20 articles that complied with the inclusion criteria for evidence synthesis. RESULTS: Equipment miniaturization has enabled CLE as part of the diagnostic options in upper urinary tract tumors. This technique performs in vivo cytological characterization of the evaluated tissue, accomplishing differentiation between tumor and normal tissue, as well as tumor grade identification. Its communicated sensitivity and specificity reach 79%/78% respectively for low grade tumors and 67%/79% for high grade, with a substantial inter observer concordance (surgeon/pathologist; k = 0.64). No complications have been communicated in the literature with the use of fluorescein or confocal laser microscopy probes in patients undergoing this technique. CONCLUSIONS: CLE represents a useful and safe tool, capable of providing cytological real time information of UUT tumors that enables tumor grade identification with substantial concordance between in vivo tumor typifying and the final histopathological analysis. For this, CLE is currently considered a tool for conservative management of UUT transitional cell carcinoma in the European Association of Urology (EAU) guidelines.

OBJETIVOS: La endomicroscopía láser confocal (CLE) es una técnica óptica que permite la caracterización citológica en vivo de un tejido. Estudios previos en lesiones del tracto digestivo y respiratorio han mostrado una alta concordancia entre el resultado en vivo y el resultado histopatológico. Recientemente, se ha propuesto el uso de la CLE en el estudio del tracto urinario superior (TUS) durante la ureteroscopia, ya que permite obtener información a tiempo real del grado tumoral y complementa la información de las biopsias ureteroscópicas, que dadas sus limitaciones, pueden infraestimar el grado y el estadío de la lesión hasta en un 43% de los casos.MÉTODOS: Se llevó a cabo una revisión de la literatura en la base de datos Pubmed/Medline siguiendo las normas PRISMA. Se utilizaron 21 artículos que cumplieron los criterios de inclusión para la síntesis de la evidencia. RESULTADOS: La sensibilidad y especificidad descrita, alcanza el 79%/78% y 67%/79% para tumores de bajo y alto grado respectivamente, con una concordancia sustancial entre observadores (cirujano/anatomopatólogo; K = 0,64). No se han reportado complicaciones asociadas a la utilización de la fluoresceína ni sondas de CLE. CONCLUSIONES: La CLE representa una herramienta útil y segura, capaz de proporcionar información citológica de tumores del TUS en tiempo real que permite la identificación del grado tumoral con sustancial grado de acuerdo entre la tipificación en vivo y su análisis histopatológico final. Por este motivo, actualmente, la CLE es considerada como una herramienta en el manejo conservador del carcinoma del TUS en las guidelines de la European Association of Urology (EAU).

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ABSTRACT Objective: To analyze the main endoscopic findings in patients under 40 years of age and the main indications for colonoscopy in these patients. Methods: A retrospective study with 362 reports of patients under 40 years of age who underwent colonoscopy from January 2014 to June 2017 at the colonoscopy service of the General Hospital Roberto Santos. Colon preparation was performed with mannitol and the patients underwent sedation as the anesthetist criteria. Results: Of the 362 patients analyzed, 192 (53%) were female. The mean age was 25 years (25.58 ± 11.95). The most frequent indications were inflammatory bowel disease in 24.3% (88) of the patients, bleeding in the lower digestive tract in 24% (87), and chronic diarrhea in 20.2% (73). The main colonoscopic findings were polyposis in 21.3% (77) of the patients and inflammatory alterations in 20.7% (75). Conclusion: With the analysis of the data provided by the colonoscopies, it was possible to conclude that, when the investigation is adequate and the examination is well indicated, even under the age of 40, colonoscopy can help in the diagnostic and treatment of several pathologies, including those that may increase the risk of colorectal cancer.

RESUMO Objetivo: Analisar os principais achados endoscópicos nos pacientes com idade inferior a 40 anos e as principais indicações para realização das colonoscopias. Métodos: Estudo retrospectivo, com análise de 362 laudos de pacientes com idade inferior a 40 anos submetidos à colonoscopia, no período de Janeiro de 2014 até Junho de 2017 no serviço de coloproctologia do Hospital Geral Roberto Santos. Foi realizado preparo de cólon com manitol e os pacientes foram submetidos à sedação á critério do anestesista. Resultados: Dos 362 pacientes analisados, 192 (53%) eram do sexo feminino. Em relação à idade: média de 25 anos (25,58 ± 11,95). As indicações mais frequentes foram doença inflamatória intestinal em 24,3% (88) dos pacientes, sangramento digestivo baixo em 24% (87); e diarreia crônica 20,2% (73). Os principais achados colonoscópios foram polipose em 21,3 (77) dos pacientes e alterações inflamatórias em 20,7% (75). Conclusão: Com análise dos dados fornecidos pelos exames colonoscópios e suas indicações foi possível concluir que quando a investigação é adequada e o exame é bem indicado, mesmo abaixo dos 40 anos, a colonoscopia pode auxiliar no diagnóstico e tratamento de diversas patologias, inclusive as que podem aumentar o risco de câncer colorretal.

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Microscopic colitis is a generic term that includes 2 main forms, collagenous colitis and lymphocytic colitis, and describes a form of inflammatory bowel disease with a chronic and relapsing course. The incidence of microscopic colitis is between 2 and 8 times higher in women than in men, although age, more than sex, increases the risk of collagenous colitis (odds ratio [OR] 8.3 for age ≥65 vs. <65 and OR 2.8 for women). The main symptom is chronic non-bloody watery diarrhoea. Other common symptoms include abdominal pain (50%-70%), with the result that many patients with microscopic colitis meet criteria for irritable bowel syndrome. Colonoscopy with multiple colonic biopsies is currently recommended, as histological changes are the main characteristic feature. The colonic mucosa is macroscopically normal, although certain minimal endoscopic abnormalities have been described.

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Se realizó un estudio descriptivo y retrospectivo de 989 pacientes con diagnóstico endoscópico de gastritis crónica, cuyas biopsias habían sido procesadas en el Departamento de Anatomía Patológica del municipio de Palma Soriano, en Santiago de Cuba, durante el período 2008-2014, con el objetivo de determinar la incidencia de la infección por Helicobacter pylori, para lo cual además se consideraron las variables: edad, sexo, tipos de gastritis, presencia del microorganismo y su asociación con neoplasias malignas. En la serie predominaron el grupo etario de 40-49 años (26,7 por ciento) y el sexo femenino (69,0 por ciento); asimismo, resultó más frecuente la gastritis superficial (57,8 por ciento) y se halló la bacteria en 70,5 por ciento de la muestra, donde solo 0,5 se asoció a neoplasias malignas(AU)

A descriptive and retrospective study of 989 patients with endoscopic diagnosis of chronic gastritis whose biopsies had been processed in the Pathology Department of Palma Soriano in Santiago de Cuba, was carried out during 2008-2014, aimed at determining the incidence of the infection due to Helicobacter pylori, for which the variables: age, sex, gastritis types, presence of the organism and its association with malignancies were also considered. In the series the 40-49 years age group (26,7 percent) and female sex (69,0 percent) prevailed; also, the superficial gastritis was more frequent (57,8 percent) and the bacteria was found in 70,5 percent of the sample, where only 0,5 was associated to malignancies(AU)

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Se realizó un estudio descriptivo y retrospectivo de 989 pacientes con diagnóstico endoscópico de gastritis crónica, cuyas biopsias habían sido procesadas en el Departamento de Anatomía Patológica del municipio de Palma Soriano, en Santiago de Cuba, durante el período 2008-2014, con el objetivo de determinar la incidencia de la infección por Helicobacter pylori, para lo cual además se consideraron las variables: edad, sexo, tipos de gastritis, presencia del microorganismo y su asociación con neoplasias malignas. En la serie predominaron el grupo etario de 40-49 años (26,7 %) y el sexo femenino (69,0 %); asimismo, resultó más frecuente la gastritis superficial (57,8 %) y se halló la bacteria en 70,5 % de la muestra, donde solo 0,5 se asoció a neoplasias malignas

A descriptive and retrospective study of 989 patients with endoscopic diagnosis of chronic gastritis whose biopsies had been processed in the Pathology Department of Palma Soriano in Santiago de Cuba, was carried out during 2008-2014, aimed at determining the incidence of the infection due to Helicobacter pylori, for which the variables: age, sex, gastritis types, presence of the organism and its association with malignancies were also considered. In the series the 40-49 years age group (26,7 %) and female sex (69,0 %) prevailed; also, the superficial gastritis was more frequent (57,8 %) and the bacteria was found in 70,5 % of the sample, where only 0,5 was associated to malignancies

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La mucosa gástrica heterotópica en esófago cervical (MGHEC) es una condición probablemente subdiagnosticada. La gran mayoría de los pacientes son asintomáticos y su detección es un hallazgo incidental. En los pacientes sintomáticos, las manifestaciones se asocian con cambios no neoplásicos o neoplásicos, que permiten categorizarlos en cinco tipos. A la categoría tipo III corresponde el caso presentado del paciente, con disfagia y globus faríngeo por MGHEC de compromiso circunferencial con estenosis franqueable. Al momento de esta publicación, solo se encontraron siete casos similares en la literatura mundial. La detección de MGHEC (apoyada en nuevas tecnologías de imagen como la cromoendoscopia) puede ser un indicador de calidad en el desempeño endoscópico, similar a la detección de adenomas en colonoscopia.

Heterotopic gastric mucosa in the cervical esophagus is a condition that is probably underdiagnosed. The vast majority of patients are asymptomatic, and detection is an incidental finding. In symptomatic patients, manifestations are associated with non-neoplastic or neoplastic changes that allow categorization into five types. The case presented here is a patient who had Type III with dysphagia and pharyngeal globus due to heterotopic gastric mucosa in the cervical esophagus with circumferential presentation with stenosis. At the time of publication, only seven similar cases could be found in the literature. Detection, supported by new imaging technologies such as chromoendoscopy, may be an indicator of the quality of endoscopic performance in a manner that is similar to detection of adenomas in colonoscopy.

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Objetivo: Describir las características epidemiológicas de los sujetos con enfermedad ácido-péptica en un centro diagnóstico de primer nivel entre los años 1993 y 2007. Métodos: Estudio descriptivo retrospectivo analítico de series de pacientes. Resultados: Se incluyeron 12.638 registros de pacientes de 44,0 ± 16 años, 62,3% mujeres y 37,7% hombres. Los principales hallazgos fueron: esofagitis péptica 14,1%, úlcera gástrica 4,1%, úlcera duodenal 7,0% y duodenitis erosivas en el 10%. Entre las úlceras gástricas, las corporales fueron el 56,4% y las lesiones erosivas gástricas representaron el 21% de los casos. Solo la enfermedad ácido péptica duodenal redujo significativamente su frecuencia en el periodo examinado asociado al consumo aumentado de medicamentos inhibidores de la bomba de protones. Ninguna lesión presentó variación estacional. Conclusiones: 1. La enfermedad ácido péptica es frecuente en centros de diagnóstico médico de primer nivel, predominando en los varones. 2. La enfermedad ácido péptica duodenal presenta una reducción significativa en los últimos 14 años, probablemente asociado al mayor consumo de inhibidores de bomba de protones. 3. Se requieren estudios multicéntricos para corroborar los hallazgos descritos.

Objective: To describe epidemiological characteristics of individuals suffering from acid peptic disease found by a first level endoscopic diagnostic center from 1993 and 2007. Methods: A retrospective, descriptive and analytical study of series of patients. Results: 12,638 registers were included in the study. 62.3% of the patients women, 37.7% were men (mean 44.0 ± 16 years). Main endoscopy findings: peptic esophagitis 14.1%, gastric ulcer 4.1%, duodenal ulcer 7.0%, total acid peptic duodenal lesions 17%. Corporal gastric ulcers were most common (56.4%). Erosive gastric lesions represented 21% of cases. Only the frequency of duodenal acid peptic disease decreased significantly in the period observed. This was associated with increased consumption of proton pump inhibitors. No seasonal variation was observed in any of the lesions. Conclusions: 1. Acid peptic disease is frequently observed at the first level endoscopic center, most frequently in men. 2. We described a significant reduction in the frequency of duodenal acid peptic disease associated with increased consumption of proton pump inhibitors. 3. It is necessary to realize multi-centric studies to confirm our results.

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Desde 1960 houve grande avanço tecnológico na observação do aparelho digestivo com o advento dos endoscópiosflexíveis, usados inicialmente para o trato digestivo superior e posteriormente também para o inferior, permitindo diagnósticos mais precisos e realização do tratamento em alguns casos. Mesmo em situações de urgência a colonoscopia pode ser utilizada como primeira escolha podendo ser diagnóstica e terapêutica. OBJETIVO: O presente estudo teve por objetivo avaliar quais foram os resultados principais das colonoscopias realizadas no Setor de Endoscopia Digestiva do Hospital Regional de Mato Grosso do Sul. MATERIAIS E MÉTODOS: Foram estudados 290 pacientes submetidos à colonoscopia no Serviço de EndoscopiaDigestiva do Hospital Regional do Mato Grosso do Sul, no período de novembro de 2006 a agosto de 2007. Foram analisadas as seguintes variáveis: sexo, idade, caráter de indicação do exame (urgência e eletiva) e diagnóstico. RESULTADOS: A idade média foi de 52 anos, variando de 15 a 92 anos. A maioria dos pacientes era do sexo feminino (56,5%). Dos 290 exames realizados no período foram constatados 48,5% (n=141) de colonoscopias com diagnóstico normal. Dentre os anormais houve uma prevalência de doença diverticular dos colos (n=56), seguido de pólipos (n=37), doenças inflamatórias (n=31), neoplasias (n=18) e angiodisplasia (n=7). Os pólipos apresentaram uma maior concentração em colo sigmóide (n=18) seguido pelo colo descendente e reto. Asdoenças inflamatórias apresentaram como diagnóstico colonoscópio, colite actínica (n=11) seguida por retite actínica (n=7) e retite inespecífica (n=7). Houve um maior número de procedimentos oriundos do ambulatório (73%) em contraste com internados(20%) e provenientes do Pronto Socorro (7%). CONCLUSÃO: A doença diverticular e os pólipos foram os diagnósticos preponderantes, pois a maior indicação foi a hemorragia digestiva...

Since 1960 it there was a great technological breakthrough, including the observation of the digestive system with the advent of flexible endoscopy. Initially used to the upper digestive tract and subsequently to the colon, allowing more accurate diagnoses and, in some cases, the complete treatment. Even in urgency situations, colonoscopy can be used as first choice and work as a diagnostic tool or eve the therapeutic procedure. AIM: This study analyzed the results of colonoscopy held in the Digestive Endoscopy unit at the Hospital Regional Rosa Pedrossian in Mato Grosso do Sul. MATERIALS AND METHODS: It was performed a colonoscopy in 290 patients at the unit of Digestive Endoscopy in the Hospital Regional of Mato Grosso do Sul, in during november 2006 until august 2007. The results were analyzed and verified the following variables: sex, age, solicitation as elective or emergency and diagnosis. RESULTS: The age of the patients ranged from 15 to 92 years old and the mean age was 52 years. Most of the patients were female (56.5%). The colonoscopy tests showed that 48.5% (n=141) were normal. Among the abnormal there were a prevalence of colon diverticulum (n = 56), followed by polyps (n = 37), inflammatory diseases (n = 31), cancer (n = 18) and angiodisplasy (n = 7). Polyps most usual place were in colorectal sigmoid (n = 18) followed by colorectal downward and rectum. The inflammatory diseases were shown as actinic colitis (n = 11) followed by actinic proctitte (n = 7) and nonspecific proctite (n = 7). There was a higherprevalence of procedures from the ambulatory 73%, interns 20% and from the emergency room 7%. CONCLUSION: The predominant diagnosis was diverticulum disease, followed by polyps. Digestive hemorrhage was the main signal noticed by the doctors who asked for the exam. With a high incidence of polyps, and mostly in sigmoid, just evidenced the how important the retosigmoidoscopy is...

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Objectivo. El objetivo de este estudio fue analizar la seroprevalencia de la población en tres centros hospitalarios, correspondientes a tres países; Venezuela, Cuba y República Dominicana. Métodos. El total de pacientes estudiados fueron 300, Se emplearon las técnicas Microwell ELISA de Diagnostic Automation INC (U.S.A.) y Pyloriset EIA-IIIG de Orion Diagnostic (Finland), para determinar la seroprevalencia de H. pylori (IgG) en los sueros obtenidos. La causa de las endoscopías en el 100 por ciento fue epigastralgias. El promedio de edad fue 46 años, con 127/300 (42 por ciento) hombres y 173/300 (58 por ciento) mujeres. Resultados. De acuerdo al diagnóstico endoscópico se obtuvieron los siguientes resultados: úlcera duodenal: 31/300 (10 por ciento); úlcera gástrica: 27/300 (9 por ciento); dispepsia no ulcerosa, incluyendo gastritis: 242/300 (81 por ciento). Del total de los 300 sueros testados, el 100 por ciento de estos fueron positivos para cada país, para anticuerpos IgG anti H. pylori. Conclusiones. Existe poca información acerca de la infección por Helicobacter pylori en los países de la región del Caribe y Latinoamérica, por lo que se requieren más estudios para completar la epidemiología de la infección a H.pylori en la región(AU)

Objective. Our aim was to determine the (Hp)-seroprevalence of the infection in a group of 300 consecutive adult subjects population submitted to upper digestive tract endoscopy clinics in three countries, Venezuela, Cuba and República Dominicana. Methods. The total patients (300). Serology (IgG) was performed using Microwell ELISA from Diagnostic Automation INC (U.S.A.) and Pyloriset E IA-IIIG de Orion Diagnostic (Finland). Patients had the following endoscopic Diagnosis: duodenal ulcer 31/300 (10 percent); gastric ulcer: 27/300 (9 percent); non ulcer dyspepsia, including chronic gastritis: 242/300 (81 percent). The mean age was 46 years with 127/300 (42 percent) men and 173/300 (58 percent) women. Results. Among the 300 serums tested, 100 percent were positive in Venezuela, Cuba and Dominican Republic. The (Hp)-seroprevalence of H. pylori infection in the symptomatic population of La Havana-Cuba, Caracas-Venezuela and Santo Domingo- República Dominicana. Conclusions. There is a great paucity of information about Helicobacter pylori infection in the countries of the Caribbean basin. These results indicate the importance for further studies to identify factors influencing the high prevalence of the infection with H. pylori in the region(AU)

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Objectivo. El objetivo de este estudio fue analizar la seroprevalencia de la población en tres centros hospitalarios, correspondientes a tres países; Venezuela, Cuba y República Dominicana. Métodos. El total de pacientes estudiados fueron 300, Se emplearon las técnicas Microwell ELISA de Diagnostic Automation INC (U.S.A.) y Pyloriset EIA-IIIG de Orion Diagnostic (Finland), para determinar la seroprevalencia de H. pylori (IgG) en los sueros obtenidos. La causa de las endoscopías en el 100 por ciento fue epigastralgias. El promedio de edad fue 46 años, con 127/300 (42 por ciento) hombres y 173/300 (58 por ciento) mujeres. Resultados. De acuerdo al diagnóstico endoscópico se obtuvieron los siguientes resultados: úlcera duodenal: 31/300 (10 por ciento); úlcera gástrica: 27/300 (9 por ciento); dispepsia no ulcerosa, incluyendo gastritis: 242/300 (81 por ciento). Del total de los 300 sueros testados, el 100 por ciento de estos fueron positivos para cada país, para anticuerpos IgG anti H. pylori. Conclusiones. Existe poca información acerca de la infección por Helicobacter pylori en los países de la región del Caribe y Latinoamérica, por lo que se requieren más estudios para completar la epidemiología de la infección a H.pylori en la región.

Objective. Our aim was to determine the (Hp)-seroprevalence of the infection in a group of 300 consecutive adult subjects population submitted to upper digestive tract endoscopy clinics in three countries, Venezuela, Cuba and República Dominicana. Methods. The total patients (300). Serology (IgG) was performed using Microwell ELISA from Diagnostic Automation INC (U.S.A.) and Pyloriset E IA-IIIG de Orion Diagnostic (Finland). Patients had the following endoscopic Diagnosis: duodenal ulcer 31/300 (10 percent); gastric ulcer: 27/300 (9 percent); non ulcer dyspepsia, including chronic gastritis: 242/300 (81 percent). The mean age was 46 years with 127/300 (42 percent) men and 173/300 (58 percent) women. Results. Among the 300 serums tested, 100 percent were positive in Venezuela, Cuba and Dominican Republic. The (Hp)-seroprevalence of H. pylori infection in the symptomatic population of La Havana-Cuba, Caracas-Venezuela and Santo Domingo- República Dominicana. Conclusions. There is a great paucity of information about Helicobacter pylori infection in the countries of the Caribbean basin. These results indicate the importance for further studies to identify factors influencing the high prevalence of the infection with H. pylori in the region.

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