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Resumen Introducción: Los pólipos gástricos suelen ser hallazgos en la endoscopia digestiva alta. Objetivo: Realizar una revisión de los pólipos gástricos más frecuentes y presentar un caso de manejo de estos con gastrectomía total laparoscópica según el protocolo fast track. Caso clínico: Se presenta el caso de un paciente hombre de 46 años, sin antecedentes mórbidos con poliposis difusa del estómago sintomática, en el que se realiza una gastrectomía total laparoscópica siguiendo el protocolo fast track, siendo dado de alta al cuarto día posoperatorio. Discusión: Los pólipos gástricos más frecuentes son los hiperplásicos, de glándula fúndica, adenomas e inflamatorios. Es fundamental obtener biopsias de estos ya que su histología comandará su manejo y pronóstico. En algunos casos, la gastrectomía total es la indicación debido a su riesgo de malignidad o sintomatología. El protocolo fast track ha demostrado ser una modalidad de manejo posoperatorio que disminuye el tiempo de estadía hospitalaria y presenta una recuperación precoz en comparación con la práctica habitual, sin comprometer la seguridad del paciente.
Introduction: Gastric polyps are commonly found incidentally on upper gastrointestinal endoscopy. Objective: Review the most common gastric polyps and present a case of symptomatic polyps managed with laparoscopic total gastrectomy following the fast track protocol. Clinical case: Patient with symptomatic diffuse gastric polyps who had a total laparoscopic gastrectomy following the fast track protocol, who is discharged at home at fourth day post-surgery. Discussion: The most common are hyperplastic polyps, fundic gland polyps, adenomas and inflammatory fibroid polyps. Is very important to obtain biopsies to assess the histology and malignant potential. In certain cases a total gastrectomy is recommended. The fast track rehabilitation protocol is a safe method to decrease hospital stay and improve recovery.
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Humanos , Masculino , Persona de Mediana Edad , Pólipos/cirugía , Gastropatías/cirugía , Laparoscopía/métodos , Gastrectomía/métodos , Pólipos/diagnóstico , Gastropatías/diagnóstico , Factores de TiempoRESUMEN
INTRODUCTION: Gastric polyps are usually asymptomatic lesions incidentally discovered during endoscopy. OBJECTIVE: To study the frequency of different types of gastric polyps in our population and their possible association with other factors. PATIENTS AND METHODS: Retrospective study of gastroscopies performed in a tertiary hospital over a ten-year period. Demographics, medical history, indication for gastroscopy and morphological and histological characteristics of polyps were collected. RESULTS: Gastric polyps were found in 827 out of 41253 (2%) reviewed gastroscopies, corresponding to 709 patients. Mean age was 65.6 years, and 62% were female. 53.9% of patients had multiple polyps. The most common location was the fundus and 83.3% were smaller than 1cm. Histopathology was obtained in 607 patients: hyperplastic polyps were the most common (42.8%), followed by fundic gland polyps (37.7%). Factors independently associated with hyperplastic polyps were age and single polyp, size ≥6mm and location other than fundus. In contrast, fundic gland polyps were associated with reflux and multiple polyps, size <6mm and located in fundus. Adenomas were independently associated with single polyp. CONCLUSIONS: Fundic gland and hyperplastic polyps are the most common in our population and have characteristic features that can guide histological diagnosis. With single polyps it is advisable to take biopsies to rule out adenoma.
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Pólipos/epidemiología , Gastropatías/epidemiología , Pólipos Adenomatosos/diagnóstico , Pólipos Adenomatosos/epidemiología , Pólipos Adenomatosos/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Comorbilidad , Femenino , Fundus Gástrico/patología , Reflujo Gastroesofágico/epidemiología , Gastroscopía , Humanos , Hiperplasia , Pólipos Intestinales/epidemiología , Masculino , Persona de Mediana Edad , Pólipos/diagnóstico , Pólipos/patología , Estudios Retrospectivos , España/epidemiología , Gastropatías/diagnóstico , Gastropatías/patología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Adulto JovenRESUMEN
OBJECTIVE: To investigate the incidence and associated demographical and clinical factors related to lower GI polyps and neoplasms in patients with upper GI polyps and neoplasms. METHODS: We investigated 99 patients who had upper GI polyps and neoplasms and who were screened with colonoscopy: the following data were collected: demographical and clinical data consisting of age, sex, smoking status, presence of H. pylori infection, placement of upper GI polyps or neoplasms, presence of gastric atrophy, usage of proton pump inhibitors (PPI), presence of lower GI polyp or neoplasm, type of colon polyp, pathological grade of colon polyp. The patients were grouped according to having/not having lower GI polyps and neoplasms; data was compared between groups. RESULTS: Smoking rate was significantly higher in patients with lower GI polyps and neoplasms (χ2: 4.35, p: 0.03). Furthermore, there was a signifant association between presence of lower GI polyps and neoplasms vs. smoking (OR: 2.44 CI: 1.01-5.84, p: 0.04). CONCLUSIONS: Patients with upper GI polyps and neoplasms who are smokers should be considered as candidates for having lower GI polyps and neoplasms and should be screened and followed more carefully. Additionally, we believe that large sampled and prospective studies are needed to higligt the association between upper GI polyps and presence of lower GI polyps and neoplasms.
OBJETIVO: investigar a incidência, demografia associada e fatores clínicos relativos a pólipos e neoplasias gastrointestinais distais em pacientes com pólipos e neoplasias do trato gastrointestinal superior. MÉTODOS: Foram investigados 99 pacientes que apresentaram pólipos ou neoplasias gastrointestinais superiores selecionados através de colonoscopia: os seguintes dados foram coletados: dados demográficos e clínicos consistentes em idade, sexo, tabagismo, presença de infecção por H. pylori, a presença de pólipos ou neoplasias gastrointestinais proximais, presença de atrofia gástrica, uso de inibidores da bomba de prótons (IBP), presença de pólipo ou neoplasia gastrointestinal distal, tipo de pólipo de cólon, grau patológico de pólipo de cólon. Os pacientes foram agrupados de acordo com ter/não ter pólipos ou neoplasias distais; os dados foram comparados entre os grupos. RESULTADOS: A taxa de tabagismo foi significativamente maior nos pacientes com pólipos e neoplasias distais (χ2: 4.35, p: 0,03). Além disso houve uma associação significante entre a presença de pólipos e neoplasias distais e tabagismo (OR: 2,44 CI: 1,01-5,84, p: 0,04). CONCLUSÕES: Os pacientes fumantes com pólipos e neoplasias do trato gastrointestinal superior devem ser considerados candidatos a pólipos e neoplasias distais e devem ser rastreados e seguidos com mais cuidado. Adicionalmente, grandes amostras e estudos prospectivos são necessários para esclarecer a associação entre pólipos gastrointestinais superiores e a presença de pólipos e neoplasias gastrointestinais distais.
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Humanos , Pólipos del Colon/epidemiología , Pólipos Intestinales/epidemiología , Neoplasias Gastrointestinales/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
O pólipo fibróide infamatório (PFI) é uma lesão benigna rara. Pode acometer qualquer parte do trato gastrintestinal (TGI), sendo o estômago o local mais atingido (88,5%), especialmente o antro (77%). Acomete principalmente indivíduos entre 60 e 70 anos e não há predomínio quanto ao sexo. Histopatologicamente, consiste de proliferação fibroblástica e pequenos vasos sanguíneos, associados a um infiltrado inflamatório com predomínio eosinofílico. Macroscopicamente, a lesão envolve mucosa e submucosa, é bem delimitada e é frequente na forma polipóide, sendo rara na fora pedunculada. A etiologia permanece indeterminada. O exame histopatológico é essencial para se avaliar a natureza inflamatória da lesão e a possível coexistência de adenocarcinoma ou adenoma da mucosa gástrica. Relatamos um caso de pólipo semipedunculado na grande curvatura do corpo gástrico, tratado com polipectomia endoscópica, cuja histopatologia mostrou pólipo fibróide inflamatório.