Risks and benefits of colonoscopy in patients aged 80 and older: a prospective study

OBJECTIVE: this study aims to compare colonoscopy results in patients aged 50-79 and those aged 80 and older. PATIENTS AND METHODS: a total of 533 diagnostic colonoscopies performed from August 2011 to January 2012 were evaluated in a prospective study analyzing age, ASA classification, comorbidities, endoscopic findings, time to reach the cecum, number of complete examinations, difficulties and complications. Chi-square test was used to compare categorical data whereas Student's t test to compare means. A p value < 0.05 was considered significant. RESULTS: 479 patients were in Group A - age 50 to 79, whereas 54 were in Group B, 80 versus older. The following results are shown for Group A and B, respectively: age 63 &#177; 8 versus 84 &#177; 4 years. ASA 1 difficult examination: 58 (21 %) versus 12 (27%) p > 0.05, ASA > 2 difficult examination: 41 (20%) versus 6 (60%) p < 0,05. Comorbidities 255 (53%) versus 36 (66%) p > 0.05. Complete colonoscopy in 450 (94%) versus 45 (83%), p < 0.01. Difficulties in 99 (20%) versus 32 (40%), p < 0.01. Complications in 1 (0.2%) versus 3 (5%) p < 0.01. Diverticulitis/ sequelae in 3 (0.6%) versus 3 (5%) p < 0.01. CRC in 42 (8.7%) and 10 (18.5%), p < 0.05. Adenoma in 130 (27 %) versus 15 (27%), p > 0.05 Time to reach the cecum was 39 &#177; 10 minutes for difficult procedures and 13 &#177; 9 for the easy ones. CONCLUSION: age 80 and older is associated with more adverse events during colonoscopy

Aspectos clínicos e diagnósticos da microsporidiose intestinal em pacientes com infecção pelo HIV e diarréia crônica, no Rio de Janeiro, Brasil

The objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5%) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.Os objetivos deste estudo foram determinar a prevalência e o prognóstico clínico da infecção por microsporídios em uma coorte de 40 pacientes com infecção pelo HIV e diarréia crônica na cidade do Rio de Janeiro, Brasil. Cada paciente teve suas fezes e fragmentos de intestino examinados para a pesquisa de CMV, bactérias e parasitos. A prevalência de microsporidiose foi de 27,5% (n=11). Esporos de microsporídios foram encontrados com maior frequência no exame direto das fezes do que em biópsias de intestino delgado. A microscopia eletrônica de transmissão e a reação de polimerase em cadeia (PCR) identificaram Enterocytozoon bieneusi, respectivamente, em 3 e 6 amostras examinadas, confirmando a espécie como único agente causal. Nenhum outro microrganismo patogênico, além dos microsporídios, foi detectada em 5 dos pacientes com diarréia. Outros parasitos foram encontrados no trato digestivo de 21 pacientes, enquanto que em 8 a etiologia da diarréia não foi definida. Concluímos que a infecção por microsporídios pode ser freqüentemente encontrada em indivíduos infectados pelo HIV no Rio de Janeiro

A 3-YEAR FOLLOW-UP OF A BRAZILIAN AIDS PATIENT WITH PROTRACTED DIARRHEA CAUSED BY Enterocytozoon bieneusi

Enterocytozoon bieneusi is the most prevalent microsporidian parasite that causes gastrointestinal infection in persons with AIDS. Microsporidia are increasingly recognized as important opportunistic pathogens all over the world but in Brazil only few cases have been reported due either to the non awareness of the clinical presentation of the disease or to difficulties in the laboratory diagnosis. We report a 3-year follow-up of a Brazilian HIV-positive patient in whom microsporidial spores were detected in stools and were identified as E. bieneusi using electron microscopy and PCR. The patient presented with chronic diarrhea, CD4 T-lymphocytes count below 100/mm3 and microsporidial spores were consistently detected in stools. Albendazole was given to the patient in several occasions with transient relief of the diarrhea, which reappeared as soon as the drug was discontinued. Nevertheless, a diarrhea-free period with weight gain up to 18 Kg occurred when a combination of nucleoside and protease inhibitors was initiated as part of the antiviral treatment

Colonoscopia com polipectomia: análise crítica de fatores de risco e complicações Colonic snare polipectomy: critical analysis of risk factors and complications

Objetivo: Analisar complicações de polipectomia com alça ditérmica em cólon. Pacientes e Métodos: Estudo retrospectivo de polipectomias em colonoscopias realizadas em dois hospitais de 2001 a 2007. Teste t de Student foi usado para média, desvio padrão e qui-quadrado para números absolutos. P< que 0,05 foi considerado significativo. Resultados: Foram 1687 polipectomias em 8447 colonoscopias. Sangramento imediato em 24 (11,8%) em pólipos maiores do que 2 cm contra 1 (0,07%) em menores p<0,01. Somente 1, maior que 2 cm, (0,49%) necessitou de cirurgia para controle do sangramento p<0,01. Sangramento tardio em 7 (3,4%), todos maiores que 2 cm p<0,01. Perfuração em 6 (2.9%), todas em cólon direito. Não houve necessidade de cirurgia. A idade foi 59,8±6,7 para sangramento imediato, 60±9,8 para tardio e 63,8±16,3 para os que não sangraram p>0,05. Síndrome pós-polipectomia em 6 (0,35%). Ressecção fatiada somente em maiores que 2 cm, 89/116 (77%) sésseis e 11/87 (13%) pediculados p<0,01. Carcinoma invasivo em 40 adenomas maiores que 2 cm (19,7%). Conclusão: Polipectomia com alça é segura, sangramento a complicação mais comum, relacionada ao tamanho da base. Perfuração vem a seguir. Ambas tem tratamento endoscópico prioritário.<br>Purpose: The aim of this study was to evaluate adverse events from snare polypectomy. Methods: We retrospectively analysed the rate of complications of 1687 snare polypectomies carried out in 8447 colonoscopies between 2001 and 2007 at two Medical Institutions. Student t test was used for statistical analysis of mean and chi-square to compare absolute numbers. A significant p-value was defined as < 0,05. Results: Of the 1687 colonoscopic polypectomies 203 were performed in polyps larger than 2 cm in diameter ( range 2-10 cm ). In this group 24 (11,8%) had immediate bleeding, against 1 ( 0,07%) smaller than 2 cm p<0,01. Only one, larger than 2 cm, needed surgery to control bleeding episod p<0,01. Delayed bleeding occurred in 6 (0,35%).None required surgery. The age group for bleeding post-polypectomy did not differ, being 59,8±6,7 for immediate bleeding, 60±9,8 for delayed and 63,8±16,3 for no bleeding p>0,05.Post-polypectomy syndrome occurred in 6 patients (0,35%). In polyps larger than 2 cm, piecemeal resection was performed more often in sessile than in pedunculated ones 89/116 ( 77%) versus 11/87 (13%) p<0,01. Invasive carcinoma was present in 40 adenoma larger than 2 cm (19,7%). Conclusion: Snare polypectomy is safe procedure, being bleeding the most common complication, related with polyp size mainly its base, treated most of the time endoscopically. Perforation being the next, treated too without surgery

Índice de massa corpórea, obesidade abdominal e risco de neoplasia de cólon: estudo prospectivo Body mass index (BMI), abdominal obesity and risk of colorectal carcinoma: a retrospective study

Objetivo: Investigar a associação do excesso de peso e da obesidade abdominal como fator de risco para câncer colorretal/adenoma CCR/Ad. Pacientes e Métodos: De janeiro de 2007 a dezembro de 2008, 1287 pacientes com idade igual ou superior a 50 anos, sem fatores de risco para CCR, foram submetidos a colonoscopia total e avaliados quanto ao índice de massa corpórea IMC e razão cintura quadril RCQ. Teste t de Student foi usado para estudo da média e qui-quadrado para análise de números absolutos. P menor que 0,05 foi considerado significativo. Resultados: Neoplasia foi encontrada em 542 (42,1%), sendo 231 (50,7%) homens e 311 (37,3%) mulheres. IMC > 30 ocorreu em 43 (18,6%) de CCR/Ad masculino e 84 (27%) feminino P> 0,05. Em 188 (49,4%) homens com IMC < que 30 ocorreu CCR/Ad, nas mulheres em 227 (36%) P> 0,05. RCQ foi de 0,96±0,05 cm para homens com tumor e 0,94±0,07 sem tumor P< 0,01. Nas mulheres RCQ foi de 0,89±0,06 com tumor para 0,88±0,06 sem tumor P< 0,05. Conclusões: IMC não está associado a neoplasia de cólon, porem a obesidade abdominal seria fator de risco.<br>Purpose: To investigate the association of overweight and abdominal fat with CRC/Ad. Methods: From January 2007 to December 2008, 1287 patients over 50 years of age, without known risk factors for CRC/Ad (455 men and 832 women), were submitted to a complete colonoscopy and had the BMI and WHR calculated. Student t-test was used for statistical analysis of means and chi-square to compare absolute numbers. A significant P-value was defined as < 0,05. Results: Neoplastic lesions were found in 542 (42,1%) subjects, being 231 (50,7%) male and 311 (37,3%) female. BMI > 30 led to 43 (18,6%) CRC/Ad male and 84 (27%) female P> 0,05 Patients with BMI < 30 were found to have CRC/Ad 188 (49,4%) male and 227 (36%) female P> 0,05. WHR was 0,96±0,05 cm for male with tumor and 0,94±0,07 without tumor P< 0,01. For female WHR was 0,89±0,06 with tumor and 0,88±0,06 without tumor P< 0,05. Conclusions: These findings suggests that BMI was not associated with CRC/Ad but WHR could be a predictor for an increased risk of colon neoplasia

Clinical and diagnostic aspects of intestinal microsporidiosis in HIV-infected patients with chronic diarrhea in Rio de Janeiro, Brazil Aspectos clínicos e diagnósticos da microsporidiose intestinal em pacientes com infecção pelo HIV e diarréia crônica, no Rio de Janeiro, Brasil

The objectives of this study were to determine both the prevalence of microsporidial intestinal infection and the clinical outcome of the disease in a cohort of 40 HIV-infected patients presenting with chronic diarrhea in Rio de Janeiro, Brazil. Each patient, after clinical evaluation, had stools and intestinal fragments examined for viral, bacterial and parasitic pathogens. Microsporidia were found in 11 patients (27.5%) either in stools or in duodenal or ileal biopsies. Microsporidial spores were found more frequently in stools than in biopsy fragments. Samples examined using transmission electron microscopy (n=3) or polymerase chain reaction (n=6) confirmed Enterocytozoon bieneusi as the causative agent. Microsporidia were the only potential enteric pathogens found in 5 of the 11 patients. Other pathogens were also detected in the intestinal tract of 21 patients, but diarrhea remained unexplained in 8. We concluded that microsporidial infection is frequently found in HIV infected persons in Rio de Janeiro, and it seems to be a marker of advanced stage of AIDS.<br>Os objetivos deste estudo foram determinar a prevalência e o prognóstico clínico da infecção por microsporídios em uma coorte de 40 pacientes com infecção pelo HIV e diarréia crônica na cidade do Rio de Janeiro, Brasil. Cada paciente teve suas fezes e fragmentos de intestino examinados para a pesquisa de CMV, bactérias e parasitos. A prevalência de microsporidiose foi de 27,5% (n=11). Esporos de microsporídios foram encontrados com maior frequência no exame direto das fezes do que em biópsias de intestino delgado. A microscopia eletrônica de transmissão e a reação de polimerase em cadeia (PCR) identificaram Enterocytozoon bieneusi, respectivamente, em 3 e 6 amostras examinadas, confirmando a espécie como único agente causal. Nenhum outro microrganismo patogênico, além dos microsporídios, foi detectada em 5 dos pacientes com diarréia. Outros parasitos foram encontrados no trato digestivo de 21 pacientes, enquanto que em 8 a etiologia da diarréia não foi definida. Concluímos que a infecção por microsporídios pode ser freqüentemente encontrada em indivíduos infectados pelo HIV no Rio de Janeiro