Comparación de 2 tipos de preparación intestinal para la realización de colonoscopia en un hospital de tercer nivel

ResumenAntecedentesLa colonoscopia es el método para evaluar el colon. La preparación con polietilenglicol (PEG) es utilizada para la limpieza colónica. Sin embargo, la tolerabilidad y efectos adversos son frecuentes.ObjetivoComparar la eficacia mediante la escala de Boston y Harefield, y la tolerabilidad con la escala visual análoga, en 2 tipos de preparación colónica: grupo 1=PEG 4L (PEG 4L) y grupo 2=30ml de aceite de oliva (OL) más PEG en 2l de agua (30 OL+PEG 2L).MetodologíaEnsayo clínico, prospectivo, aleatorizado, unicéntrico. Los sujetos fueron aleatorizados en 2 grupos: PEG 4L, y 30 OL+PEG 2L. Se valoró la tolerancia de la preparación mediante escala visual análoga y la calidad de la limpieza con las escalas de Boston y Harefield.ResultadosSe incluyeron 42 pacientes, 22 (52.38%) se trataron con PEG 4L y 20 (47.62%) con 30 OL+PEG 2L. Veintidós (52.38%) fueron hombres y 20 (47.62%) mujeres. El resultado más frecuente de la tolerabilidad de la preparación del grupo 1 y 2 fue tolerancia parcial en 18 (42.9%) y 23 (54.76%) pacientes respectivamente, sin ser estadísticamente significativo. PEG 4L tuvo un promedio de calificación de Boston de 6.04 puntos, y la de 30 OL+PEG 2L fue de 6.65 puntos, p=0.9. La calificación de Harefield fue exitosa en 35 pacientes (83.3%).ConclusionesLa preparación colónica con 30 OL+PEG 2L al tener resultados de limpieza similares a la dosis de PEG 4L podría utilizarse en aquellos pacientes que no toleren dosis altas de líquidos.AbstractBackgroundColonoscopy is the method to evaluate the colon. The preparation with polyethylene glycol (PEG) is used for colonic cleansing. However, tolerability and side effects are common.ObjetiveTo compare effectiveness through Boston Bowel Preparation Scale (BBPS) and Harefield Cleasing Scale (HCS), and tolerability with the visual analog scale in 2 types of colonic preparation: group 1=PEG 4liters (4L PEG) and group 2=30ml olive (OL) plus PEG in 2 liters of water (30 OL+2L PEG).MethodologyClinical, prospective, randomized, single-center trial. The subjects were randomized into 2 groups: 4L PEG, and 30 OL+2L PEG. Preparation tolerance was evaluated with visual analog scale and preparation quality with the BBPS and HCS.ResultsForty two patients were included. Twenty two (52.38%) were included with 4L PEG, and 20 (47.62%), with 30 OL+2L PEG. 22 (52.38%) were men and 20 (47.62%) were women. The most frequent answer was partial tolerance in 18 (42.9%) and 23 (54.76%) patients, respectively, without statistical significance. The comparison in both preparations, 4L PEG had an average score of 6.04 points, and 30 OL+2L PEG 6.65 points by BBPS (P=.9). HCS was successful in 35 patients (83.3%).ConclusionsThe administration of 30 OL+2L PEG has similar cleansing results compared with the standard bowel preparation, which may be an alternative used in patients who are intolerable to high doses of liquids

Assessment of the Role of a Second Evaluation of Capsule Endoscopy Recordings to Improve Diagnostic Yield and Patient Management

Introduction: The diagnostic yield (DY) of small-bowel capsule endoscopy (SBCE) varies considerably according to its indication. Some strategies have been used to increase DY with varying results. The intention of this study was to identify whether evaluation of the SBCE recordings by a second reviewer can increase DY and change patient management. Methods: One hundred SBCEs with different indications, already read by an endoscopist were read by a second blinded endoscopist. When the results of the 2 readings were different, the images were discussed by the endoscopists; if no consensus was reached, they took the opinion of a third endoscopist into account. All the participating endoscopists had experience in reading SBCEs (i.e., >50 per year). The SBCE findings were divided into positive (vascular lesions, ulcers, and tumors), equivocal (erosions or red spots), and negative. The interobserver agreement and the increase in DY were assessed as well as the percentage of false-negatives (FNs) in the first evaluation. Results: The indications for SBCE were small-bowel bleeding (SBB) in 48 cases, Crohn’s disease (CD) in 30, and other causes (iron-deficiency anemia, small-bowel tumors, and diarrhea) in 22. There was substantial interobserver agreement between evaluations (κ = 0.79). The findings in the first evaluation were positive in 60%, equivocal in 20% and, negative in 20%. In the second evaluation, 66% were positive, 18% were equivocal, and 16% were negative. The increase in DY with the second reading was 6% (p = 0.380), i.e., 6.3% for SBB, 4.4% for CD and 9.2% for other indications, resulting in a change in management of 4% of the patients. FNs in the first SBCE reading were found in 4% of the SBCEs. Discussion: A second evaluation of the SBCE recordings identified significant pathology that the first evaluation had missed, resulting in a nonsignificant 6% increase in DY and a change in the management of 4% of the patients

Resultados del tratamiento endoscópico en fugas biliares. Experiencia del Centro Médico Nacional Siglo XXI IMSS

ResumenLas lesiones o fugas biliares ocurren posterior a la colecistectomía abierta o laparoscópica con una incidencia del 0.1-1%, entre otras causas. La fuga biliar (Strasberg A-C) se trata mediante colangiopancreatografía retrógrada endoscópica (CPRE). La esfinterotomía y colocación de endoprótesis biliar disminuyen la presión del conducto biliar al duodeno, y promueven el flujo biliar transpapilar, con una respuesta del 70-90%.ObjetivosDescribir las características de las fugas biliares benignas tratadas mediante CPRE, las complicaciones asociadas, así como evaluar los resultados del tratamiento endoscópico.Material y métodosEstudio descriptivo, retrospectivo. Se analizaron los reportes de CPRE de los años 2011-2013 con diagnóstico de fuga biliar de causa benigna.ResultadosSe revisaron 560 reportes. Ochenta y dos (14.64%) se sometieron a CPRE. El antecedente más común fue la colecistectomía laparoscópica en 62 (75.6%). Cincuenta y tres pacientes (64.6%) tuvieron fuga biliar de bajo y alto gasto en un34.1% y un 30.5%, respectivamente. El sitio de fuga más frecuente: muñón cístico un 29.3% y hepatocolédoco un (20.7%). A todas se realizó esfinterotomía y en las de alto gasto se colocó endoprótesis biliar, resolviéndose la fuga al mes en el 95.1% y a los 6 meses en el 100% de los pacientes. Otras complicaciones relacionadas con la fuga biliar fueron coledocolitiasis y estenosis biliar benigna en 18 pacientes (22%).ConclusionesEl tratamiento endoscópico es resolutivo en la mayoría de los pacientes con fugas biliares postoperatorias ya sea mediante la técnica de esfinterotomía o la combinada con colocación de prótesis biliar.AbstractInjuries or bile leaks, among other causes, occur after open or laparoscopic cholecystectomy with an incidence of 0.1-1%. These bile leaks (Strasberg A-C) are treated by endoscopic retrograde cholangiopancreatography (ERCP). Sphincterotomy and placement of biliary stent decreases bile duct pressure to the duodenum, and promotes transpapillary bile flow, with a 70-90% response.ObjetivesTo describe the characteristics of benign bile leaks treated by ERCP and their associated complications, as well as to evaluate the results of endoscopic treatment.Material and methodsA descriptive, retrospective study was conducted by performing an analysis on ERCP reports from2011-2013, with a diagnosis of benign bile leakage.ResultsA total of 560 reports were reviewed, of which 82 (14.64%) underwent ERCP. The most common history was laparoscopic cholecystectomy in 62 (75.6%). A low biliary leakage (30.5%) and a high output (30.5%) was observed in 53 (64.6%) patients. The most common leakage site was cystic in 29.3%, and hepatobiliary stump in 20.7%. A sphincterotomy was performed on all of them, and a biliary stent was inserted in those with high output, with the leak being resolved in 95.1% of patients at 1 month, and in 100% at 6 months. Other complications related to biliary leakage were choledocholithiasis and benign biliary stenosis in 18 (22%) patients.ConclusionsThe endoscopic treatment using the sphincterotomy technique, or combined with biliary stent placement is effective in most patients with bile leaks

Adherence to recommendations for endoscopy practice during COVID-19 pandemic in Latin America: how are we doing it?

Background and aims Digestive endoscopy is considered a high-risk procedure for COVID-19. Recommendations have been made for its practice during the pandemic. This study was conducted to determine adherence to recommendations for endoscopy practice during the COVID-19 pandemic in Latin America (LA).Methods A survey was conducted of endoscopists from LA consisting of 43 questions for the evaluation of four items: general and sociodemographic features, and preprocedure, intraprocedure and postprocedure aspects.Results A response was obtained from 338 endoscopists (response rate 34.5%) across 15 countries in LA. In preprocedure aspects (hand washing, use of face masks for patients, respiratory triage area, training for the placement/removal of personal protective equipment (PPE) and availability of specific area for the placement/removal of PPE), there was adherence in <75%. Regarding postprocedure aspects, 77% (261/338) had reused PPE, mainly the N95 respirator or higher, and this was with a standardised decontamination procedure only in 32% (108/338) of the time. Postprocedure room decontamination was carried out by 47% on >75% of occasions. In relationship to intraprocedure aspects (knowledge of risk and type of endoscopic procedures, use of PPE, airway management in patients and infrastructure), there was adherence in >75% for all the parameters and 78% of endoscopists only performed emergencies or time-sensitive procedures.Conclusions Adherence to the recommendations for endoscopy practice during the COVID-19 pandemic is adequate in the intraprocedure aspect. However, it is deficient in the preprocedure and postprocedure aspects

A comprehensive systematic review and meta-analysis of risk factors for rebleeding following device-assisted enteroscopy therapy of small-bowel vascular lesions.

INTRODUCTION: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. METHODS: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. RESULTS: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. CONCLUSIONS: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding

Narrative Ethics: the importance of cinema for the virtual teaching of bioethics in Health Sciences

El cine ha demostrado ser una herramienta docente muy eficiente, ya que una escena de una película permite aproximar al estudiante ante circunstancias a las que ellos mismos se tendrán que enfrentar más adelante en su práctica clínica. Al observar las situaciones previamente y reflexionar sobre ellas, los alumnos pueden adquirir herramientas que podrán aplicar cuando se enfrenten a los problemas reales. Además, la variedad y amplitud de películas que podemos encontrar que tratan los problemas y desafíos más importantes de la atención sanitaria, permiten abordar los principales conflictos éticos a los que se enfrentarán los estudiantes como: el uso y abuso de la tecnología sanitaria, dificultades en la relación clínica, barreras en los procesos de comunicación, problemas con enfermos vulnerables, cuestiones sobre el inicio y final de la vida, la muerte, relación con la industria farmacéutica, problemas de justicia en la atención sanitaria, trasplantes, conflictos entre profesionales, investigación con seres humanos, genética, ayuda humanitaria, salud pública, pandemias… Con la ética narrativa se pretende aprovechar la potencia docente del cine para que los estudiantes de enfermería y medicina puedan analizar los problemas más importantes de la atención sanitaria y adquirir herramientas prácticas para afrontarlos.Cinema has proven to be a very efficient teaching tool, since a scene from a film allows the student to approach circumstances to which they themselves they will have to deal with later in their clinical practice. By observing situations beforehand and reflecting on them, students can acquire tools that they will be able to apply when confronted with real problems. In addition, the variety and breadth of films that we can find that deal with the major problems and challenges in health care, make it possible to address the main ethical conflicts that students will face such as: the use and abuse of health technology, difficulties in the clinical relationship, barriers in the processes of communication, problems with vulnerable patients, questions about the beginning and end of the life, death, relationship with the pharmaceutical industry, problems of justice in care health, transplants, conflicts between professionals, research with human beings, genetics, humanitarian aid, public health, pandemics... With narrative ethics, the aim is to take advantage of the teaching power of cinema so that Nursing and medical students can analyze the most important problems of health care and acquire practical tools to deal with them.Fac. de Enfermería, Fisioterapia y PodologíaFALSEsubmitte