Invaginación yeyuno-yeyunal como presentación de un carcinoma primario pulmonar: Reporte de un caso

Las metástasis intestinales por cáncer de pulmón son muy infrecuentes y lo es más aún que se manifiesten antes que el tumor primario. La presentación clínica puede requerir una resección quirúrgica intestinal motivada por perforación, hemorragia u obstrucciónsuboclusión intestinal, como en el caso que motiva este reporte. La sobrevida, en los pocos casos reportados, es escasa y generalmente no supera las 20 semanas, independientemente del tratamiento que se realice. Presentamos el caso de una invaginación yeyuno-yeyunal que se manifestó por síndrome suboclusivo y hemorragia digestiva, causada por la metástasis de un carcinoma adeno-escamoso de pulmón

Recovery of endoscopy services in the era of COVID-19: recommendations from an international Delphi consensus

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.status: publishe