Aproximación a las causas del cáncer colorrectal de intervalo en colonoscopia en el área II del Servicio Murciano de Salud

Objetivos: Determinar la prevalencia de cáncer colorrectal (CCR) de intervalo o post-colonoscopia (CCR-PC) en el área II del Servicio Murciano de Salud (SMS). Conocer la sensibilidad de la colonoscopia en nuestra unidad de endoscopia mediante la Tasa de CCR-PC. Describir sus características histopatológicas y compararlas con un grupo control de CCR esporádico. Analizar los perfiles de expresión génica mediante arrays en los CCR-PC y compararlos con los de un grupo control de CCR esporádico. Evaluar los factores asociados a la aparición de CCR-PC, así como la relación entre éste y la capacidad técnica del endoscopista (Tasa de Detección de Pólipos). Material y Métodos: Se trata de un estudio observacional, descriptivo y retrospectivo, de casos y controles. La población a estudio son los mayores de 18 años diagnosticados de CCR entre el 1 de enero de 2012 y el 31 de diciembre de 2014. Se realizó el análisis histopatológico de los casos de CCR-PC y se comparó con el de un grupo control de CCR esporádico, emparejados por tipo histológico, grado de diferenciación y estadio tumoral. Del mismo modo, se realizó el estudio de funciones y perfil génico mediante arrays de los CCR-PC y se comparó igualmente con los de un grupo control de CCR esporádico. El resto de las variables registradas fueron la indicación de la colonoscopia índice, calidad de la preparación catártica, localización del tumor, comorbilidades del paciente, intubación cecal y tasa de detección de pólipos (TDP). Finalmente se estudió la relación entre la TDP de los endoscopistas agrupados en cuartiles y la aparición de CCR-PC. Resultados: Se identificaron 17 casos de CCR-PC de un total de 291 casos de CCR diagnosticados en el periodo de estudio. La tasa de CCR-PC fue del 0.0584 y la sensibilidad de la colonoscopia en el área II del SMS fue del 94.16%. La prevalencia de adenocarcinoma serrado y adenocarcinoma MSI-H fue mayor entre los casos de CCR-PC que en el CCR esporádico, pero sin alcanzar la significación estadística. Entre las características histopatológicas analizadas destaca la presencia de Infiltrado inflamatorio en todos los casos de CCR-PC y ausencia de éste en el 41.17% de los casos del grupo control de CCR esporádico (p = 0.011). El 47% de los CCR-PC presentó Respuesta Linfoide tipo Crohn frente al 5% de los casos del grupo control de CCR esporádico (p = 0.007). El diagnóstico de CCR sincrónico aumenta de forma significativa en el grupo de CCR-PC (11% frente a 0.37% en CCR esporádico). La indicación de la colonoscopia índice también varía de forma significativa para ambos grupos, siendo la anemia la indicación más habitual en CCR-PC y la rectorragia en CCR esporádico. Para comprobar si influye la calidad técnica del endoscopista en la aparición de CCR-PC se calculó la TDP del endoscopista y se agrupó a los endoscopistas por cuartiles (Q1, Q2, Q3 y Q4). Se observó que los endoscopistas con mayor TDP tenían una tasa menor de CCR-PC. Siendo éstas del 8%, 10%, 3% y 4% para Q1, Q2, Q3 y Q4 respectivamente. Conclusiones: La mayoría de los casos de CCR-PC se producen por déficits técnicos del procedimiento. Hay que prestar especial atención a la anemia como indicación en la colonoscopia índice y la TDP se relaciona en nuestro estudio con la aparición de CCR-PC. El análisis histológico muestra una mayor prevalencia de carcinoma MSI-H y adenocarcinoma serrado en el grupo de CCR-PC. Este estudio muestra diferencias histopatológicas y diferencias en la expresión génica entre el CCR-PC y el CCR esporádico, aunque son necesarios más estudios para extrapolar las conclusiones. Objectives: The main targets of the study are to determine interval colorectal cancer prevalence in the Área II of Murcia´s Health System (MHS). To know the sensibility of the colonoscopy in our endoscopy unit by means of post-colonoscopy colorectal cancer (PC-CRC) rate. To describe their histopathological features and compare them with those of a control group of sporadic CRC. To analyse the profiles of gene expression by means of arrays in the PC-CRC and to compare with those of a control group of sporadic CRC. To evaluate the factors associated with the appearance of PC-CRC, as well as its relationship with technical capacity of the endoscopist (Polyp Detection Rate). Materials and methods: It is an observational, descriptive and retrospective study, of cases and controls. People included in this study are the patients older than 18 who have a diagnosis of CRC between January 1, 2012 and December 31, 2014. The histopathological analysis of PC-CRC was realized and was compared with that of a control group of sporadic CRC, paired by histological type, differentiation grade and cancer staging. In addition, there was realized the study of functions and gene profile by means of arrays of PC-CRC and was compared too with that of a control group of sporadic CRC. The rest of the registered variables was the indication of index colonoscopy, quality of preparation, location tumour, patient comorbidities, cecum intubation and Polyp Detection Rate (PDR). Finally, the relationship between PDR of the endoscopists grouped in quartiles, and PC-CRC prevalence was studied. Results: 17 cases of PC-CRC were identified out of 291 cases of CRC diagnosed in the period of the study. PC-CRC rate was 0.0584 and colonoscopy sensibility 94.16% in the Area II of MHS. Serrated adenocarcinoma and MSI-H carcinoma prevalence were higher in PC-CRC group than sporadic CRC group, but statistical differences were not found. Among histopathological characteristics it highlights the presence of inflammatory Infiltration in all the cases of PC-CRC and absence of this one in 41.17 % of the cases of the control group of sporadic CRC (p = 0.011). 47% of PC-CRC had Lymphoid infiltration Crohn like opposite to 5% in sporadic CRC control group (p = 0.007). Synchronic PC-CRC increased significantly (11% in PC-CRC opposite to 0.37% in sporadic CRC). Index colonoscopy indication also showed some differences. Anaemia is the most frequent indication in PC-CRC group and rectal bleeding in sporadic CRC. PDR was calculated to check if the PC-CRC prevalence was influenced by technical quality of the endoscopist. The endoscopists were grouped in quartiles (Q1, Q2, Q3, Q4). It was observed that endoscopists with major TDP had a less PC-CRC rate. Being these 8 %, 10 %, 3 % and 4 % for Q1, Q2, Q3 and Q4 respectively. Conclusions: Most of the cases of PC-CRC take place because of technical deficits in procedure of colonoscopy. It is necessary to pay special attention to anaemia as indication in the index colonoscopy. PDR is related in our study to the PC-CRC appearance. Histological analysis shows a major prevalence of MSI-H carcinoma and serrated adenocarcinoma in the PC-CRC group. This study shows differences in histopathology and genic expression between PC-CRC and sporadic CRC group, although more studies are necessary to extrapolate the conclusions

Gastric varicella: two cases in cancer patients

Gastric involvement with the varicella-zoster virus is an uncommon clinical condition where early suspicion and diagnosis are important to prevent the consequences deriving from its high morbidity and mortality, which in immunocompromised patients oscillate between 9% and 41% according to the various series. Two cases of gastric involvement with the varicella-zoster virus (VZV) in two patients with blood cancer are reported below. Gastric lesions are usually preceded by typical papulovesicular skin lesions. When gastric involvement is the first symptom of the disease its diagnosis and management may be delayed, which may entail severe consequences for immunocompromised patients. It is therefore that we suggest its inclusion in the algorithm for immunocompromised patients with abdominal pain and ulcer-like endoscopic lesions

Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project).

Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity