Experience in the use of argon plasma in gastrointestinal tract lesions in two institutions in Bogotá

La terapia de coagulación con argón plasma (APC) ha tomado importancia en la última década en la endoscopia gastrointestinal, y está posicionada como una técnica efectiva en el tratamiento de lesiones del tracto digestivo. Su efectividad fue inicialmente reportada en el tratamiento paliativo de neoplasias gastrointestinales y, posteriormente, su uso se ha extendido para múltiples indicaciones, entre ellas el tratamiento de sangrado debido a angiodisplasias, proctitis por radioterapia y hoy en día es utilizada para control de hemorragia gastrointestinal en lesiones vasculares como Dieulafoy. En la actualidad su uso se ha extendido, con el advenimiento de la enteroscopia, a lesiones del intestino delgado en especial las angioectasias. En este estudio se describe la experiencia de dos instituciones con el uso endoscópico del APC, y se exponen las indicaciones y efectividad del tratamiento. Métodos: Entre noviembre del 2007 y abril del 2009, la terapia con argón plasma se utilizó para el tratamiento de 65 pacientes con patologías del tracto digestivo con fi n terapéutico, ya fuera curativo o paliativo con un total de 134 sesiones. El tratamiento se efectuó en dos centros de cuarto nivel de atención, el Hospital Universitario San Ignacio y la Clínica de Marly en Bogotá - Colombia. Resultados: El tratamiento con APC se realizó en 65 pacientes, utilizando en total 134 sesiones de argón. Las indicaciones para su uso son similares a las reportadas en la literatura: proctitis actínica, angiodisplasias, ectasia vascular antral y control de sangrado por lesiones tumorales. Se utilizó además en control de sangrado por lesión vascular de Dieulafoy y en el control de hemorragia por úlcera péptica sangrante con vaso expuesto. No se presentaron complicaciones mayores, lo que respalda lo expuesto en la literatura en relación a que es una técnica efectiva y segura para el manejo de diversas patologías del tracto digestivo. Conclusiones: La experiencia recogida en este estudio descriptivo demuestra el posicionamiento de la técnica del APC en nuestro medio, con una amplia gama de indicaciones sobre patologías del tracto digestivo y un excelente margen de efectividad y seguridad. Si se tienen presentes las indicaciones y recomendaciones para su aplicación, el uso del argón es una técnica sencilla, útil y efectiva.Q4In the last decade Argon Plasma Coagulation therapy (APC) has become important in gastrointestinal endoscopy. It is regarded as an effective technique in the treatment of lesions in the gastrointestinal tract. Its effectiveness was initially reported in the palliative treatment of gastrointestinal neoplasm, but its use has subsequently been extended to multiple indications such as treatment of bleeding angiodysplastic lesions, proctitis via radiotherapy and for gastrointestinal hemorrhage control of lesions such as Dieulafoy’s lesion. With the advent of enteroscopy its use has been extended to small intestinal lesions, especially to Angioectasias. This study describes indications and effectiveness of treatment in the experience of two institutions that make endoscopic use of APC. Methods: Between November, 2007 and April, 2009 Argon Plasma therapy was used in a total of 134 sessions for either curative or palliative treatment of 65 patients with digestive tract pathologies. Treatments were performed in two level four attention centers, the San Ignacio University Hospital and the Marly Clinic, both located in Bogotá, Colombia. Results: 65 patients received APC treatment in a total of 134 sessions. Indications for its use were similar to those reported in the literature: actinic proctitis, angiodysplasia, antral vascular ectasia and control of bleeding due to tumoral lesions. It was also used to control bleeding from vascular lesions such as Dieulafoy’s lesion and for hemorrhage control for bleeding peptic ulcers with exposed vessels. The absence of greater higher complications validates reports in the literature that this is a safe and effective technique for management of several digestive tract pathologies. Conclusions: The experience collected in this descriptive study shows that the addition of the APC technique in our environment provides a high range of indications about digestive tract pathologies with good effectiveness and safety margin. Reasonable use of Argon Plasma Coagulation therapy (APC), keeping in mind indications and recommendations for its application, is a simple, useful and effective technique.Revista Nacional - Indexad

Tumor of small bowel

Se presenta el caso de una mujer joven, que tuvo varios episodios de sangrado digestivo oscuro manifiesto por lo que requirió soporte transfusional, realización de dos esofagogastroduodenoscopias y dos colonoscopias, en las que no se identificó causa del sangrado. Se realizó enteroscopia de doble balón encontrando una lesión subepitelial, ulcerada, de aspecto neoplásico en el íleon, la cual se marcó con tinta china y se tomaron biopsias que no fueron diagnósticas. Después de realizar estudios de extensión que fueron negativos, se llevó a laparotomía diagnóstica y terapéutica resecando el segmento de ileon comprometido por la lesión y cuyo diagnóstico histopatológico y por inmunohistoquímica fue conclusivo de carcinoma neuroendocrino mal diferenciado de alto grado de célula grande. Al final presentamos además, una revisión de sangrado oscuro manifiesto y tumor neuroendocrino de intestino delgado.Q4Young woman who is having episodes of overt obscure gastrointestinal bleeding that requires transfusions. The endoscopic study consists of 2 endoscopies of the upper digestive system and two colonoscopies. The tests do not find the cause of the digestive hemorrhage. A double-balloon enteroscopy is performed and it is found that the Ileum has an ulcerate subepitelial lesion with neoplasic appearance which is marked with Chinese ink and biopsies are taken from the tissue which are not diagnosed. Studies of staging are performed ant the result is negative. A laparatomy is performed for diagnosis and treatment which includes the intestinal resection of ileum where the tumor is placed. The result of the test shows to be a neuroendocrine carcinoma of high degree of large cells undifferentiated. One appears in addition a revision to overt obscure gastrointestinal bleeding and neuroendocrine tumor of small bowel.Revista Nacional - Indexad

Empagliflozin and Dapagliflozin Improve Endothelial Function in Mexican Patients with Type 2 Diabetes Mellitus: A Double-Blind Clinical Trial

Aim: To assess the acute effect of empagliflozin versus dapagliflozin administration on flow-mediated vasodilation in patients with type 2 diabetes mellitus. Design: A double-blind clinical trial, at the Experimental and Clinical Therapeutics Institute, University Health Sciences Center, at the Universidad de Guadalajara, in inpatients with T2D according to the 2023 ADA criteria. Methods: Thirty patients (15 males and 15 females), aged between 35 and 65 years, were included in this study, according to the 2023 ADA criteria. The eligible patients were randomly assigned to three groups: empagliflozin 25 mg once daily, dapagliflozin 10 mg once daily, or placebo once daily. Anthropometric parameters were taken using validated techniques. FMD was measured using a high-resolution semiautomatic ultrasound UNEX-EF 38G (UNEX Co., Ltd., Nagoya, Japan). Arterial tension was determined with the OMRON electronic digital sphygmomanometer (HEM 907 XL, Kyoto, Japan). Results: The group of patients who received empagliflozin had a significantly lower baseline flow-mediated dilation (FMD) compared to the group receiving dapagliflozin (p = 0.017); at the end of this study, the empagliflozin group achieved a comparable FMD to the dapagliflozin group (p = 0.88). Conclusion: After the treatment period, the empagliflozin and dapagliflozin groups achieved similar FMD, suggesting a class effect