RESUMO
RESUMEN El coronavirus SARS-CoV-2 produce la enfermedad llamada COVID-19, actualmente propagándose en una pandemia de rápida evolución. Puede transmitirse por contacto, gotas y aerosoles, y ha sido aislado en secreciones gastrointestinales y heces. Durante la endoscopía digestiva podría ocurrir la transmisión por cualquiera de estos mecanismos. Se recomienda limitar la endoscopía digestiva a casos de hemorragia digestiva, disfagia severa, cuerpo extraño en tracto digestivo, obstrucción biliar con dolor intratable o colangitis, pseudoquiste o necrosis pancreática encapsulada complicada, obstrucción gastrointestinal, y casos con riesgo de deterioro en el tiempo. Se recomienda tamizar a los pacientes en base a la temperatura, síntomas, y factores epidemiológicos para clasificarlos según su riesgo de infección. Para procedimientos en pacientes de riesgo bajo el personal debe usar bata descartable, guantes, protector ocular o facial, mascarilla quirúrgica estándar, gorro descartable, cubiertas descartables para zapatos. En casos de riesgo intermedio o alto, o COVID-19 confirmado, se debe incrementar la protección usando bata descartable impermeable, respirador N95 o similar, y doble guante. En caso de escasez puede ser necesario reutilizar los respiradores N95 hasta un máximo de 5 usos, siguiendo las recomendaciones de CDC sobre la colocación, retiro y almacenamiento para prevenir la contaminación secundaria por contacto. Asimismo todo el equipo de protección debe colocarse y retirarse siguiendo las recomendaciones del CDC. La presencia de personal en la endoscopía debe limitarse al mínimo indispensable. Dicho personal debe tener control diario de temperatura y si ésta es mayor a 37,3 ºC se debe proceder a la evaluación correspondiente. Después de cada procedimiento se debe desinfectar apropiadamente la camilla y superficies de la sala. La desinfección de alto nivel de los endoscopios elimina el SARS-CoV-2.
ABSTRACT The SARS-CoV-2 coronavirus produces the disease called COVID-19, currently spreading in a rapidly evolving pandemic. It can be transmitted by contact, drops and aerosols, and has been isolated from gastrointestinal secretions and faeces. During digestive endoscopy, transmission by any of these mechanisms could occur. It is recommended to limit digestive endoscopy to cases of digestive bleeding, severe dysphagia, foreign body in the digestive tract, biliary obstruction with intractable pain or cholangitis, pseudocyst or complicated encapsulated pancreatic necrosis, gastrointestinal obstruction, and cases at risk of deterioration over time. It is recommended to screen patients based on temperature, symptoms, and epidemiological factors to classify them according to their risk of infection. For procedures in low risk patients, personnel must wear a disposable gown, gloves, eye or face shield, standard surgical mask, disposable hat, disposable shoe covers. In cases of intermediate or high risk, or confirmed COVID-19, protection should be increased using disposable waterproof gown, N95 respirator or similar, and double glove. In case of shortage it may be necessary to reuse N95 respirators for up to 5 uses, following CDC recommendations for donning, removing and storing to prevent secondary contact contamination. Likewise, all protective equipment should be put on and removed according to CDC recommendations. The presence of personnel in endoscopy should be limited to the bare minimum. Said personnel must have daily temperature control and if it is above 37.3ºC, the corresponding evaluation must be carried out. After each procedure, the stretcher and room surfaces should be properly disinfected. High-level disinfection of endoscopes eliminates SARS-CoV-2.
Assuntos
Humanos , Pneumonia Viral , Endoscopia Gastrointestinal , Transmissão de Doença Infecciosa do Paciente para o Profissional , Infecções por Coronavirus , Pandemias , Equipamento de Proteção Individual , Peru , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Desinfecção , Fatores de Risco , Endoscopia Gastrointestinal/instrumentação , Endoscopia Gastrointestinal/métodos , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pandemias/prevenção & controle , Betacoronavirus , Gastroenteropatias/diagnóstico , SARS-CoV-2 , COVID-19RESUMO
In lower gastrointestinal bleeding (LGIB), it is very important to stratify the risk of LGIB for a proper management. OBJECTIVE: Identity the independent risk factors to mortality and severity (require critical care, prolonged hospitalization, reebleding, re hospitalization, politrasfusion, surgery for bleeding control) in LGIB. MATERIALS AND METHODS: It is an analytic prospective cohort study, performed between June 2016 and April 2018 in a tertiary care hospital. Independent factors were determined using binomial logistic regression. RESULTS: A total of 98 patients were included, of which 13 patients (13,3%) died, and 56 (57,1%) met severity criteria. The independent risk factor for mortality was Glasgow scale under 15, and for severe bleeding were: Systolic blood pressure under 100 mm Hg, albumin lower than 2,8 g/dL. CONCLUSIONS: The frequency of mortality and severe LGIB is high in our population, the principal risk factors were systolic blood pressure under than 100 mm Hg, Glasgow score lower than 15, albumin lower than 2,8 g/dL. Identifying these associated factors would improve the management of LGB in the emergency room.
Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/mortalidade , Enteropatias/diagnóstico , Enteropatias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
En hemorragia digestiva baja (HDB) es muy importante estratificar el riesgo de la misma para brindar un manejo adecuado. Objetivo: Identificar los factores predictores de mortalidad y severidad en pacientes con HDB (definida como: requerimiento de unidad de cuidados críticos, control de hemorragia en sala de operaciones, estancia prolongada mayor a 9 días, resangrado, reingreso, o politransfusión más de 5 paquetes globulares). Materiales y métodos: Es un estudio observacional analítico de cohorte prospectivo, realizado entre junio del 2016 y abril del 2018 en un hospital de nivel III. Se determinó los factores predictores de mortalidad y severidad. Se evalúo la sobrevida hasta los 30 días Resultados: Se incluyó un total de 98 pacientes de los cuales 13 pacientes (13,3%) fallecieron y 56 (57,1%) cumplen criterios de severidad. El factor predictor independiente de mortalidad fue escala de Glasgow menor a 15 y los factores independientes de severidad fueron un valor de albúmina menor a 2,8 g/dl y la presión arterial sistólica menor a 100 mmhg. Conclusiones: La frecuencia de mortalidad y HDB severa es alta en nuestro estudio. La presión arterial sistólica, la escala de Glasgow y la albúmina sérica son evaluaciones que pueden permitirnos predecir durante la primera evaluación en emergencia el riesgo de severidad y mortalidad de un paciente con HDB.
In lower gastrointestinal bleeding (LGIB), it is very important to stratify the risk of LGIB for a proper management. Objective: Identity the independent risk factors to mortality and severity (require critical care, prolonged hospitalization, reebleding, re hospitalization, politrasfusion, surgery for bleeding control) in LGIB. Materials and methods: It is an analytic prospective cohort study, performed between June 2016 and April 2018 in a tertiary care hospital. Independent factors were determined using binomial logistic regression. Results: A total of 98 patients were included, of which 13 patients (13,3%) died, and 56 (57,1%) met severity criteria. The independent risk factor for mortality was Glasgow scale under 15, and for severe bleeding were: Systolic blood pressure under 100 mm Hg, albumin lower than 2,8 g/dL. Conclusions: The frequency of mortality and severe LGIB is high in our population, the principal risk factors were systolic blood pressure under than 100 mm Hg, Glasgow score lower than 15, albumin lower than 2,8 g/dL. Identifying these associated factors would improve the management of LGB in the emergency room.
RESUMO
BACKGROUND: The predictors proposed by the American Society of Gastrointestinal Endoscopy (ASGE) are commonly used topredict the presence and management of choledocholithiasis. OBJECTIVE: To evaluate the performance and precision of thepredictors of choledocholithiasis proposed by ASGE. MATERIALS AND METHODS: Prospective and longitudinal study performed ata third level hospital during January 2015 to June 2017. All patients with high and intermediate probability of choledocholithiasiswho underwent endoscopic retrograde cholangiopancreatography (ERCP) were included according to the criteria proposedby the ASGE. RESULTS: A total of 246 patients with suspected choledocholithiasis were analyzed. Of the 228 patients withhigh probability criteria 144 (63.2% = performance) had choledocholithiasis in ERCP with an accuracy of 62% (sensitivity:94.1% and specificity: 9.7%). Among the 18 patients with intermediate probability criteria, 9 (50% = performance) hadcholedocholithiasis with an accuracy of 38% (sensitivity: 5.9% and specificity: 90.3%). In the multivariate analysis, the presenceof stone in the bile duct by ultrasonography (OR: 1.937, 95% CI 1.048-3.580, p=0.035) and age 55 and over (OR: 2.121, 95%CI, 1.101-4.088, p=0.025) were the strongest predictors for choledocholithiasis. CONCLUSIONS: The application of the criteriaof the ASGE to predict the probability of choledocholithiasis, in our population has a performance greater than 50%, however,it is necessary to improve these parameters to avoid an unnecessary performance of ERCP.
Assuntos
Coledocolitíase/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Tomada de Decisão Clínica , Endoscopia Gastrointestinal , Feminino , Hospitais Públicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peru , Estudos Prospectivos , Sensibilidade e Especificidade , Sociedades Médicas , UltrassonografiaRESUMO
Antecedentes: Habitualmente se utilizan los predictores propuestos por la Sociedad Americana de Endoscopía Gastrointestinal (ASGE) para predecir la presencia y manejo de coledocolitiasis. Objetivo: Evaluar el rendimiento y precisión de los predictores de coledocolitiasis propuestos por la ASGE. Materiales y métodos: Estudio prospectivo y longitudinal realizado en un hospital de tercer nivel desde enero del 2015 hasta junio del 2017. Se incluyeron a todos los pacientes con probabilidad alta e intermedia de coledocolitiasis y que fueron sometidos a colangiopancreatografía retrógrada endoscópica (CPRE) según los criterios propuestos por la ASGE. Resultados: Se analizó un total de 246 pacientes con sospecha de coledocolitiasis. De los 228 pacientes con criterios de alta probabilidad, 144 (63,2% = rendimiento) tenían coledocolitiasis en la CPRE con una precisión de 62% (sensibilidad: 94,1% y especificidad: 9,7%). Entre los 18 pacientes con criterios de probabilidad intermedia: 9 (50% = rendimiento) tenían coledocolitiasis con una precisión de 38% (sensibilidad: 5,9% y especificidad: 90,3%). En el análisis multivariado la presencia de cálculo en el colédoco por ecografía (OR: 1,937; IC 95% 1,048- 3,580; p=0,035) y la edad mayor de 55 años (OR: 2,121; IC 95% 1,101-4,088; p=0,025) fueron los predictores más fuertes para coledocolitiasis. Conclusiones: La aplicación de los criterios de la ASGE para predecir probabilidad de coledocolitiasis, en nuestra población tiene un rendimiento mayor del 50%; sin embargo, se necesita mejorar estos parámetros para evitar una realización innecesaria de CPRE.
Background: The predictors proposed by the American Society of Gastrointestinal Endoscopy (ASGE) are commonly used to predict the presence and management of choledocholithiasis. Objective: To evaluate the performance and precision of the predictors of choledocholithiasis proposed by ASGE. Materials and methods: Prospective and longitudinal study performed at a third level hospital during January 2015 to June 2017. All patients with high and intermediate probability of choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) were included according to the criteria proposed by the ASGE. Results: A total of 246 patients with suspected choledocholithiasis were analyzed. Of the 228 patients with high probability criteria 144 (63.2% = performance) had choledocholithiasis in ERCP with an accuracy of 62% (sensitivity: 94.1% and specificity: 9.7%). Among the 18 patients with intermediate probability criteria, 9 (50% = performance) had choledocholithiasis with an accuracy of 38% (sensitivity: 5.9% and specificity: 90.3%). In the multivariate analysis, the presence of stone in the bile duct by ultrasonography (OR: 1.937, 95% CI 1.048-3.580, p=0.035) and age 55 and over (OR: 2.121, 95% CI, 1.101-4.088, p=0.025) were the strongest predictors for choledocholithiasis. Conclusions: The application of the criteria of the ASGE to predict the probability of choledocholithiasis, in our population has a performance greater than 50%, however, it is necessary to improve these parameters to avoid an unnecessary performance of ERCP.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coledocolitíase/diagnóstico , Peru , Sociedades Médicas , Análise Multivariada , Estudos Prospectivos , Estudos Longitudinais , Endoscopia Gastrointestinal , Ultrassonografia , Sensibilidade e Especificidade , Colangiopancreatografia Retrógrada Endoscópica , Tomada de Decisão Clínica , Hospitais PúblicosRESUMO
We report the case of a male patient of 75 years old who presents with abdominal pain, hyporexia, early satiety, general malaise and watery stools, admitted in emergency for an episode of syncope. On physical examination, hepatomegaly of 6cm below the right costal margin was detected. CT scan showed multiple liver metastases. An upper endoscopy found multiple hyperpigmented lesions on the second portion of the duodenum. Histology and immunohistochemistry studies concluded it was duodenal melanoma. Skin and ocular examination did not reveal associated neoplastic lesions.
Assuntos
Neoplasias Duodenais/diagnóstico , Melanoma/diagnóstico , Idoso , Neoplasias Duodenais/complicações , Humanos , Masculino , Melanoma/complicaçõesRESUMO
Se presenta el caso de un paciente varón de 75 años que acude por dolor abdominal, hiporexia, llenura precoz, malestar general y deposiciones líquidas, ingresando a emergencia por un episodio de síncope. Al examen físico se palpa borde hepático 6 cm por debajo del reborde costal derecho. Por ello se solicita estudios de imagen, hallando lesiones compatibles con metástasis hepáticas múltiples. Posteriormente se solicita endoscopía digestiva alta, hallando lesiones hiperpigmentadas múltiples en la segunda porción duodenal. El estudio histopatológico e inmunohistoquímico concluyó melanoma duodenal. El examen físico no reveló lesiones neoplásicas dérmicas u oculares asociadas.
We report the case of a male patient of 75 years old who presents with abdominal pain, hyporexia, early satiety, general malaise and watery stools, admitted in emergency for an episode of syncope. On physical examination, hepatomegaly of 6cm below the right costal margin was detected. CT scan showed multiple liver metastases. An upper endoscopy found multiple hyperpigmented lesions on the second portion of the duodenum. Histology and immunohistochemistry studies concluded it was duodenal melanoma. Skin and ocular examination did not reveal associated neoplastic lesions
Assuntos
Idoso , Humanos , Masculino , Neoplasias Duodenais/diagnóstico , Melanoma/diagnóstico , Neoplasias Duodenais/complicações , Melanoma/complicaçõesRESUMO
OBJECTIVE: We present a descriptive analysis of our cases of sphincterotomy followed by papillary large balloon dilation in a single session (ES-LBD) in the management of difficult to extract calculi, with the objective of assessing rates of therapeutic success and complications in local experience. MATERIAL AND METHODS: ERCP procedures with ES-LBD performed for choledocholithiasis between January 2009 and December 2014 in patients older than 18 years and without preexistent sphincterotomy were selected from records of the Gastroenterology Service at Cayetano Heredia National Hospital. A descriptive analysis of therapeutic success and complications was performed. RESULTS: 73 procedures in 73 patients were included (65.8% female, 34.2% male). Patient's average age was 59.4±19.8 years. Average diameter of calculi was 14.6±3.3mm. Average diameter of dilations was 14.6±2.27 mm. In 8 cases mechanical lithotripsy was performed. Complete calculi extraction was achieved in 56 procedures (76.7%). Complications occurred in 4 cases (5.5%). There were no deaths. CONCLUSION: Our figures of therapeutic success and complications with ES-LBD for difficult to extract calculi are similar to those reported in literature. ES-LBD is an effective and safe technique for management of choledocholithiasis.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/terapia , Dilatação/métodos , Esfinterotomia Endoscópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Coledocolitíase/diagnóstico por imagem , Terapia Combinada , Dilatação/instrumentação , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the clinical-radiological characteristics and explore the association between therapeutic success in patients undergoing ERCP and age in Cayetano Heredia Hospital, Lima, Peru. MATERIALS AND METHODS: Retrospective, descriptive study based on the review of records of patients undergoing ERCP between the years 2008 to 2014. These were divided into two groups: greater than or equal to 60 years (group 1) and less than 60 years (group 2). Indications of ERCP, radiological finding, therapeutic success, diagnostic and complications were documented. RESULTS: A total of 450 patients were studied, the group 1 consisting of 164 and group 2 of 286 patients. The most frequent indication for ERCP in both groups was choledocholithiasis. The most common radiological finding in both groups was bile duct dilatation (p=0.155). The most common diagnosis was choledocholithiasis in both groups, predominantly in group 2. We achieved a complete cleaning of the bile duct in 185(78.75%) patients with choledocholithiasis, finding more patients in group 2 (p=0.008) (OR=0.46; CI 95%: 0.25-0.87). The most frequent complication was pancreatitis in both groups (p=0.01). CONCLUSIONS: Choledocholithiasis and pancreatitis were the diagnosis and the most frequent complication. We found that the therapeutic success in patients who presented choledocholithiasis is associated with an age less than 60 years.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pancreatite/etiologia , Peru , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To assess the BISAP and APACHE II scores in predicting severity according to the 2012 Atlanta classification and whether the obesity factor added to these scores improves prediction. MATERIAL AND METHODS: A prospective study between January 2013 and April 2014 including all patients with acute pancreatitis was performed according to the new Atlanta 2012 classification. ROC curves were fabricated for BISAP, BISAP-O, APACHE-II scores and Apache O and appropriate cutoffs were selected to the sensitivity, specificity, PPV, NPV, RPP and RPN. RESULTS: We studied 334 patients. 65.27% were overweighted or obese. The biliar etiology was 86.53%. Only 8.38% had severe pancreatitis and 1.5% died. Areas under the ROC curve and cut points selected were: BISAP: 0.8725, 2; BISAP-O: 0.8246, 3; APACHE-II: 0.8547, 5; APACHE-O: 0.8531, 6. Using these cutoffs the sensitivity, specificity, PPV, NPV, RPP and RPN were BISAP: 60.71%, 91.83%, 40.48%, 96.23 %, 7.43, 0.43; BISAP-O: 60.71%, 86.93%, 29.82%, 96.03%, 4.76, 0.45; APACHE-II: 85.71%, 76.14%, 24.74%, 98.31%, 3.6, 0.19; APACHE-O: 82.14%, 79.41%, 26.74%, 97.98%, 4, 0.22. CONCLUSIONS: BISAP, BISAP-O, APACHE-II and APACHE-O systems can be used to identify patients at low risk of severity because of its high NPV, however their use should be cautious considering that the RPP and RPN do not reach optimal levels indicating that their value in predicting severity is limited. On the other hand adding the obesity factor did not improve their predictive ability.
Assuntos
Pancreatite/diagnóstico , Índice de Gravidade de Doença , APACHE , Doença Aguda , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Pancreatite/complicações , Estudos Prospectivos , Curva ROC , Sensibilidade e EspecificidadeRESUMO
Comparar características clínico-radiológicas y explorar la asociación entre el éxito terapéutico y edad en pacientes sometidos a CPRE en el Hospital Cayetano Heredia, Lima, Perú. Materiales y métodos: Estudio retrospectivo, descriptivo basado en la revisión de registros de pacientes sometidos a CPRE durante los años 2008 al 2014. Estos se dividieron en dos grupos: mayor o igual a 60 años (grupo 1) y menores de 60 años (grupo 2). Se documentaron las indicaciones de CPRE, hallazgo radiológico, éxito terapéutico, diagnóstico posterior a la CPRE y complicaciones. Resultados: Se revisaron un total de 450 registros, el grupo 1 compuesto de 164 y el grupo 2 de 286 pacientes. La indicación de CPRE más frecuente fue certeza de colédoco-litiasis y el hallazgo radiológico más frecuente fue dilatación de la vía biliar (p=0,155). El diagnóstico más común fue colédoco-litiasis a predominio del grupo 2. Se logró una limpieza completa de la vía biliar en 185 (78,75%) pacientes con diagnóstico de coledocolitiasis, a predominio del grupo 2 (p=0,008) (OR=0,46; IC95%: 0,25-0,87). La complicación más frecuente fue pancreatitis (p=0,01). Conclusiones: Colédoco-litiasis y pancreatitis fueron el diagnóstico y la complicación más frecuente. Encontramos que el éxito terapéutico en los pacientes que presentaron coledocolitiasis está asociado a una edad menor de 60 años...
To compare the clinical-radiological characteristics and explore the association between therapeutic success in patients undergoing ERCP and age in Cayetano Heredia Hospital, Lima, Peru. Materials and methods: Retrospective, descriptive study based on the review of records of patients undergoing ERCP between the years 2008 to 2014. These were divided into two groups: greater than or equal to 60 years (group 1) and less than 60 years (group 2). Indications of ERCP, radiological finding, therapeutic success, diagnostic and complications were documented. Results: A total of 450 patients were studied, the group 1 consisting of 164 and group 2 of 286 patients. The most frequent indication for ERCP in both groups was choledocholithiasis. The most common radiological finding in both groups was bile duct dilatation (p=0.155). The most common diagnosis was choledocholithiasis in both groups, predominantly in group 2. We achieved a complete cleaning of the bile duct in 185(78.75%) patients with choledocholithiasis, finding more patients in group 2 (p=0.008) (OR=0.46; CI 95%: 0.25-0.87). The most frequent complication was pancreatitis in both groups (p=0.01). Conclusions: Choledocholithiasis and pancreatitis were the diagnosis and the most frequent complication. We found that the therapeutic success in patients who presented choledocholithiasis is associated with an age less than 60 years...
Assuntos
Humanos , Colangiopancreatografia Retrógrada Endoscópica , Terapêutica , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Objetivo: Valorar los puntajes BISAP y APACHE II en predecir severidad según la clasificación Atlanta 2012 y determinar si el factor obesidad añadido a dichos puntajes mejora su predicción. Material y métodos: Se realizó un estudio prospectivo entre enero de 2013 y abril de 2014 de todos los pacientes con pancreatitis aguda según la nueva clasificación Atlanta 2012. Se confeccionó curvas ROC para los puntajes BISAP, BISAP-O, APACHE-II y APACHE-O y se seleccionó puntos de corte apropiados con los que se calculó la sensibilidad, especificidad, VPP, VPN, RPP y la RPN. Resultados: Se estudió a 334 pacientes. El 65,27% presentó sobrepeso u obesidad. La etiología fue biliar en el 86,53%. Sólo 8,38% presentó pancreatitis severa y 1,5% falleció. Las áreas bajo la curva ROC y puntos de corte seleccionados fueron: BISAP: 0,8725, 2; BISAP-O: 0,8246, 3; APACHE-II: 0,8547, 5; APACHE-O: 0,8531, 6. Con dichos puntos de corte la sensibilidad, especificidad, VPP, VPN, RPP y la RPN fueron: BISAP: 60,71%, 91,83%, 40,48%, 96,23%, 7,43, 0,43; BISAP-O: 60,71%, 86,93%, 29,82%, 96,03%, 4,76, 0,45; APACHE-II: 85,71%, 76,14%, 24,74%, 98,31%, 3,6, 0,19; APACHE-O: 82,14%, 79,41%, 26,74%, 97,98%, 4, 0,22. Conclusiones: Los sistemas BISAP, BISAP-O, APACHE-II, y APACHE-O pueden usarse para identificar a los pacientes con bajo riesgo de severidad en razón de su alto VPN, sin embargo su uso debe ser prudente considerando que la RPP y RPN no alcanza niveles óptimos, indicando que su valor en la predicción de severidad es limitado. Por otro lado el añadir el factor obesidad no mejoró su capacidad predictiva.
Objective: To assess the BISAP and APACHE II scores in predicting severity according to the 2012 Atlanta classification and whether the obesity factor added to these scores improves prediction. Material and methods: A prospective study between January 2013 and April 2014 including all patients with acute pancreatitis was performed according to the new Atlanta 2012 classification. ROC curves were fabricated for BISAP, BISAP-O, APACHE-II scores and Apache O and appropriate cutoffs were selected to the sensitivity, specificity, PPV, NPV, RPP and RPN. Results: We studied 334 patients. 65.27% were overweighted or obese. The biliar etiology was 86.53%. Only 8.38% had severe pancreatitis and 1.5% died. Areas under the ROC curve and cut points selected were: BISAP: 0.8725, 2; BISAP-O: 0.8246, 3; APACHE-II: 0.8547, 5; APACHE-O: 0.8531, 6. Using these cutoffs the sensitivity, specificity, PPV, NPV, RPP and RPN were BISAP: 60.71%, 91.83%, 40.48%, 96.23 %, 7.43, 0.43; BISAP-O: 60.71%, 86.93%, 29.82%, 96.03%, 4.76, 0.45; APACHE-II: 85.71%, 76.14%, 24.74%, 98.31%, 3.6, 0.19; APACHE-O: 82.14%, 79.41%, 26.74%, 97.98%, 4, 0.22. Conclusions: BISAP, BISAP-O, APACHE-II and APACHE-O systems can be used to identify patients at low risk of severity because of its high NPV, however their use should be cautious considering that the RPP and RPN do not reach optimal levels indicating that their value in predicting severity is limited. On the other hand adding the obesity factor did not improve their predictive ability.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Trombose Venosa/epidemiologia , Estudos de Coortes , Incidência , Estudos Prospectivos , Embolia Pulmonar/sangue , Embolia Pulmonar/etiologia , Fatores de Risco , Traumatismos da Medula Espinal/sangue , Traumatismos da Medula Espinal/complicações , Taiwan/epidemiologia , Trombose Venosa/sangue , Trombose Venosa/etiologiaRESUMO
OBJECTIVE: Identify and establish risk factors associated with mortality secondary to upper gastrointestinal bleeding up to 30 days after the episode, at the Hospital Nacional Cayetano Heredia. MATERIAL AND METHODS: A retrospective analytic observational case-control study was made with a case: control proportion of 1:3, analyzing 180 patient from which 135 were the controls and 45 the cases. It was determined by biological plausibility as potential risk factors to 14 variables, with which were performed bivariate and multivariate logistic analyses. RESULTS: It was found in the bivariate logistic analysis as variables statistically related to mortality: age (OR=1.02), hematemesis (OR=2.57), in-hospital upper gastrointestinal bleeding (OR=4), cirrhosis (OR=2.67), malignancy (OR=5,37), admittance to intensive care unit/Shock-Trauma (OR=9.29), Rockall score greater than 4 (OR=19.75), rebleeding (OR=5.65), and number of packed red blood cell transfusions(OR=1.22). While in the multivariate logistic analysis, the only variables statistically related to mortality were: malignancy (OR=5.35), admittance to intensive care unit/Shock-Trauma (OR=8.29), and Rockall score greater than 4 (OR=8.43). CONCLUSIONS: The factors that increase the risk of mortality in patient with upper gastrointestinal bleeding are: Rockall score greater than 4, admittance to intensive care unit/Shock-Trauma, rebleeding, in-hospital upper gastrointestinal bleeding, cirrhosis, hematemesis, malignancy, the number of red blood cell transfusion, and age.
Assuntos
Hemorragia Gastrointestinal/mortalidade , Estudos de Casos e Controles , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Registros , Estudos Retrospectivos , Fatores de RiscoRESUMO
Objetivo: Demostrar la utilidad del score de Baylor en pacientes con hemorragia digestiva alta (HDA) por úlcera péptica, en términos de mortalidad y recidiva de hemorragia a 30 días de seguimiento. Material y método: Se recolectaron datos prospectivamente en un formato de registro de las historias clínicas. Los pacientes incluidos fueron aquellos que acudieron al Hospital Nacional Cayetano Heredia, Lima, Perú, durante el periodo de Junio del 2009 a Mayo del 2011, por hemorragia digestiva alta debido a úlcera péptica evidenciada por endoscopía. Se analizaron los datos con la curva ROC (Receiver Operating Characteristic). Resultados: Se incluyeron 181 de 380 pacientes con HDA (47,63%), 74% fueron varones con una edad promedio de 56 años, 20 pacientes fallecieron durante el seguimiento: 8 por hemorragia digestiva y 12 por otras causas, 10 pacientes presentaron recidiva de hemorragia durante el seguimiento. Al realizar el análisis de la curva de ROC con el score de Baylor y mortalidad, se reportó un valor de área bajo la curva de 0,89 IC 95% (0,83-0,95), con recurrencia de sangrado, un valor de 0,81 IC 95% (0,68-0,93) y necesidad de transfusión de más de dos paquetes globulares, un valor de 0,79 IC 95% (0,70-0,86). Conclusiones: El score de Baylor es un buen predictor de mortalidad y recidiva del sangrado durante los primeros 30 días después del primer episodio de hemorragia digestiva alta y en menor medida para la necesidad de transfundir más de dos paquetes globulares durante la hospitalización.
Objective: To demonstrate the usefulness of the Baylor score in patients with upper gastrointestinal bleeding (UGB) due to peptic ulcer, in terms of mortality and recurrent bleeding at 30 days follow-up. Material and methods: This study has collected information prospectively into a registration form from medical histories. Patients included were those who came to the Hospital Nacional Cayetano Heredia, Lima, Peru, in the period between June 2009 and May 2011, with UGB due to peptic ulcer demonstrated by endoscopy. The data was analyzed with the ROC curve (Receiver Operating Characteristic). Results: We included 181 from 380 patients with UGB (47.63%), 74% were male, mean age 56 years old; 20 patients died during follow-up: 8 due to gastrointestinal bleeding and 12 from other causes, 10 patients had recurrence of bleeding during a 30 days follow-up. When performing the analysis of the ROC curve with the Baylor score and mortality, it was reported IC 95% value of 0.89 (0.83-0.95), with recurrence of bleeding an IC 95% value of 0.81 (0.68-0.93) and need for transfusion of over two globular packages an IC 95% value of 0.79 (0.70-0.86). Conclusions: Baylor score is a good predictor of mortality and recurrence of bleeding during the first 30 days after a first episode of an upper gastrointestinal bleeding and an acceptable predictor of the need to transfuse more than two globular packages during hospitalization.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hemorragia Gastrointestinal/diagnóstico , Transfusão de Sangue , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hospitais , Úlcera Péptica/complicações , Peru , Prognóstico , Estudos Prospectivos , Curva ROC , Recidiva , Medição de Risco , Trato Gastrointestinal SuperiorRESUMO
Objetivo: Determinar y establecer los factores de riesgo asociados a la mortalidad por hemorragia digestiva alta (HDA) a los 30 días posteriores al episodio en el Hospital Nacional Cayetano Heredia, Lima, Perú. Materiales y métodos: Se realizó un estudio observacional analítico caso-control retrospectivo con una proporción caso: control de 1:3, analizando 180 pacientes, siendo 135 los controles y 45 los casos. Se determinó por plausibilidad biológica como posibles factores de riesgo a 14 variables, con las cuales se realizó un análisis logístico bivariado y multivariado. Resultados: Se encontró en el análisis logístico bivariado como variables relacionadas estadísticamente a la mortalidad: edad (OR=1,02), hematemesis (OR=2,57), hemorragia digestiva alta intrahospitalaria (OR=4), cirrosis (OR=2,67), neoplasia maligna (OR=5,37), ingreso a la unidad de cuidados intensivos/Shock-Trauma (OR=9,29), score de Rockall mayor a 4 (OR=19,75), resangrado (OR=5,65), y paquetes globulares transfundidos (OR=1,22). Mientras que en el análisis logístico multivariado se encontró solamente a las variables neoplasia maligna (OR=5,35), ingreso a la unidad de cuidados intensivos/Shock-Trauma (OR=8,29), y score de Rockall mayor a 4 (OR=8,43). Conclusiones: Los factores que aumentan el riesgo de mortalidad en pacientes con hemorragia digestiva alta son: un score de Rockall mayor a 4, ingreso a la unidad de cuidados intensivos/Shock-Trauma, resangrado, hemorragia digestiva alta intrahospitalaria, cirrosis, presencia de hematemesis, neoplasia maligna, número de paquetes globulares transfundidos y edad.
Objective: Identify and establish risk factors associated with mortality secondary to upper gastrointestinal bleeding up to 30 days after the episode, at the Hospital Nacional Cayetano Heredia. Material and methods: A retrospective analytic observational case-control study was made with a case: control proportion of 1:3, analyzing 180 patient from which 135 were the controls and 45 the cases. It was determined by biological plausibility as potential risk factors to 14 variables, with which were performed bivariate and multivariate logistic analyses. Results: It was found in the bivariate logistic analysis as variables statistically related to mortality: age (OR=1.02), hematemesis (OR=2.57), in-hospital upper gastrointestinal bleeding (OR=4), cirrhosis (OR=2.67), malignancy (OR=5,37), admittance to intensive care unit/Shock-Trauma (OR=9.29), Rockall score greater than 4 (OR=19.75), rebleeding (OR=5.65), and number of packed red blood cell transfusions(OR=1.22). While in the multivariate logistic analysis, the only variables statistically related to mortality were: malignancy (OR=5.35), admittance to intensive care unit/Shock-Trauma (OR=8.29), and Rockall score greater than 4 (OR=8.43). Conclusions: The factors that increase the risk of mortality in patient with upper gastrointestinal bleeding are: Rockall score greater than 4, admittance to intensive care unit/Shock-Trauma, rebleeding, in-hospital upper gastrointestinal bleeding, cirrhosis, hematemesis, malignancy, the number of red blood cell transfusion, and age.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Gastrointestinal/mortalidade , Estudos de Casos e Controles , Hospitais Públicos , Registros , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVES: To validate SODA (severity of dyspepsia assessment) questionnaire in our population for evaluating symptoms severity in patients with dyspepsia. MATERIALS AND METHODS: Content and appearance validity were measured, and then a modified questionnaire was developed. A pilot test was made and reliability, construct validity and responsiveness were measured. RESULTS: An adequate content and appearance validity were obtained. On the pilot test, reliability of the complete questionnaire and by components had Cronbach alpha values over 0,7. Construct validity of SODA was evaluated by correlating modified SODA results with SF-36 scores using Pearson test: -0.72 (p<0.001). When we compared results of modified SODA questionnaire and the score of a question about subjective perception of the disease using Spearman test we obtained similar results: 0.72 (p<0.001). Two means of SODA questionnaire scores, before and after treatment, were compared using Student's T test, and a significant difference was found, (p<0.001) with a drop mean of 5.70 ±5.33. CONCLUSION: Modified SODA questionnaire meets all criteria of validity and it could be used to measure dyspepsia severity and its evolution in a Peruvian population.
Assuntos
Dispepsia/diagnóstico , Inquéritos e Questionários , Avaliação de Sintomas , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Índice de Gravidade de Doença , Adulto JovemRESUMO
Objetivos: Validación del cuestionario SODA (severity of dyspepsia assessment) para evaluar la severidad de los síntomas en pacientes con dispepsia. Materiales y métodos: Se evaluó la validez de contenido y de apariencia, tras lo cual se elaboró un cuestionario modificado. Posteriormente se evaluó la consistencia interna, la validez de constructo y la sensibilidad al cambio. Resultados: Se obtuvo una validez de contenido y de apariencia adecuadas. Se obtuvo un α-Cronbach del cuestionario y por componentes superiores a 0,7. Al analizar la validez de constructo, la correlaciσn entre los valores del cuestionario SODA modificado y SF-36 fue de -0,72 (p<0,001) a través de la prueba de Pearson. Al evaluar la correlación entre el puntaje del cuestionario SODA modificado y el de percepción subjetiva de los síntomas se obtuvo un valor de 0,72 (p<0,001) mediante la prueba de Spearman. Se comparó las medias de los puntajes del cuestionario SODA modificado pre y post-tratamiento mediante la prueba de T-Student en el que se encontró una diferencia significativa (p<0,001) con un promedio de caída de 5,70±5,33. Conclusiones: El cuestionario SODA modificado cumple con los criterios de validez por lo que sirve para valorar la severidad de la dispepsia y su evolución.
Objectives: To validate SODA (severity of dyspepsia assessment) questionnaire in our population for evaluating symptoms severity in patients with dyspepsia. Materials and methods: Content and appearance validity were measured, and then a modified questionnaire was developed. A pilot test was made and reliability, construct validity and responsiveness were measured. Results: An adequate content and appearance validity were obtained. On the pilot test, reliability of the complete questionnaire and by components had Cronbach alpha values over 0,7. Construct validity of SODA was evaluated by correlating modified SODA results with SF-36 scores using Pearson test: -0.72 (p<0.001). When we compared results of modified SODA questionnaire and the score of a question about subjective perception of the disease using Spearman test we obtained similar results: 0.72 (p<0.001). Two means of SODA questionnaire scores, before and after treatment, were compared using Students T test, and a significant difference was found, (p<0.001) with a drop mean of 5.70 5.33. Conclusion: Modified SODA questionnaire meets all criteria of validity and it could be used to measure dyspepsia severity and its evolution in a Peruvian population.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dispepsia/diagnóstico , Inquéritos e Questionários , Avaliação de Sintomas , Peru , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To demonstrate the usefulness of the Baylor score in patients with upper gastrointestinal bleeding (UGB) due to peptic ulcer, in terms of mortality and recurrent bleeding at 30 days follow-up. MATERIAL AND METHODS: This study has collected information prospectively into a registration form from medical histories. Patients included were those who came to the "Hospital Nacional Cayetano Heredia", Lima, Peru, in the period between June 2009 and May 2011, with UGB due to peptic ulcer demonstrated by endoscopy. The data was analyzed with the ROC curve (Receiver Operating Characteristic). RESULTS: We included 181 from 380 patients with UGB (47.63%), 74% were male, mean age 56 years old; 20 patients died during follow-up: 8 due to gastrointestinal bleeding and 12 from other causes, 10 patients had recurrence of bleeding during a 30 days follow-up. When performing the analysis of the ROC curve with the Baylor score and mortality, it was reported IC 95% value of 0.89 (0.83-0.95), with recurrence of bleeding an IC 95% value of 0.81 (0.68-0.93) and need for transfusion of over two globular packages an IC 95% value of 0.79 (0.70-0.86). CONCLUSIONS: Baylor score is a good predictor of mortality and recurrence of bleeding during the first 30 days after a first episode of an upper gastrointestinal bleeding and an acceptable predictor of the need to transfuse more than two globular packages during hospitalization.
Assuntos
Hemorragia Gastrointestinal/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Peru , Prognóstico , Estudos Prospectivos , Curva ROC , Recidiva , Medição de Risco , Trato Gastrointestinal Superior , Adulto JovemRESUMO
UNLABELLED: Pancreatic pseudocyst develops as a complication in some cases of pancreatitis. Endoscopic drainage is one of the available therapies, but it has limitations when a visible compression over the gastric or duodenal wall is not present, or when portal hypertension exists. Endoscopic ultrasonography allows for a guided approach even in cases where external compression over the gastrointestinal tract is barely visible or non-existent, and it also helps to prevent vascular injury during puncture of the fluid collection. The most frequent early complications related to cystogastrostomy and cystoduodenostomy are bleeding and pneumoperitoneum, and late complications are stent migration or occlusion, and infection. We report the case of a patient who developed tense pneumoperitoneum immediately after endoscopic ultrasound guided drainage of a pancreatic pseudocyst, and was treated conservatively. This is a severe event, and can be managed by emergency decompression through paracentesis as first line therapy. Most cases of pneumoperitoneum can be managed without surgery,but close observation is mandatory in order to timely detect and treat conditions needing surgical intervention. KEY WORDS: pancreatic.
Assuntos
Drenagem/métodos , Endossonografia , Pseudocisto Pancreático/cirurgia , Pneumoperitônio/etiologia , Complicações Pós-Operatórias , Ultrassonografia de Intervenção , Feminino , Humanos , Pseudocisto Pancreático/diagnóstico por imagem , Pneumoperitônio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Adulto JovemRESUMO
El pseudoquiste pancreático (PQP) se presenta como complicación en algunos casos de pancreatitis. El drenaje endoscópico es una de las alternativas de tratamiento, pero tiene limitaciones cuando no existe compresión claramente identificable sobre el estómago o duodeno, o hay hipertensión portal. La ultrasonografía endoscópica (USE) permite el abordaje guiado incluso en casos en que la compresión extrínseca sobre estos órganos es menos evidente o inexistente, y contribuye además a evitar la lesión de vasos durante la punción. Las complicaciones más frecuentes relacionadas con la cistogastrostomía (CGE) o cistoduodenostomía endoscópica (CDE), inmediatas y mediatas, son sangrado, neumoperitoneo, migración u obstrucción de prótesis, e infección. Presentamos el caso de una paciente que luego del drenaje de PQP guiado por ultrasonido endoscópico desarrolló en forma inmediata neumoperitoneo a tensión, que fue tratado conservadoramente. Este es un evento severo que puede manejarse con paracentesis descompresiva de emergencia como primera alternativa. La mayoría de casos de neumoperitoneo pueden manejarse conservadoramente, pero el monitoreo debe ser estricto para detectar y tratar oportunamente situaciones que necesiten una intervención quirúrgica.
Pancreatic pseudocyst develops as a complication in some cases of pancreatitis. Endoscopic drainage is one of the available therapies, but it has limitations when a visible compression over the gastric or duodenal wall is not present, or when portal hypertension exists. Endoscopic ultrasonography allows for a guided approach even in cases where external compression over the gastrointestinal tract is barely visible or non-existent, and it also helps to prevent vascular injury during puncture of the fluid collection. The most frequent early complications related to cystogastrostomy and cystoduodenostomy are bleeding and pneumoperitoneum, and late complications are stent migration or occlusion, and infection. We report the case of a patient who developed tense pneumoperitoneum immediately after endoscopic ultrasound guided drainage of a pancreatic pseudocyst, and was treated conservatively. This is a severe event, and can be managed by emergency decompression through paracentesis as first line therapy. Most cases of pneumoperitoneum can be managed without surgery, but close observation is mandatory in order to timely detect and treat conditions needing surgical intervention.