搜索结果：Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru

The diagnosis and treatment of gastric cancer may have been affected during the COVID-19 pandemic, ultimately influencing mortality from this disease. To evaluate changes in gastric cancer mortality during the COVID-19 pandemic years. An interrupted time series analysis was conducted to assess changes in gastric cancer mortality. Data were obtained from the National Death Information System. Three periods were compared: pre-pandemic (2017-2019), pandemic (2020-2021), and post-pandemic (2022-2023). Segmented regression models were used. Before the pandemic, an average of 2,107 deaths per year was recorded. During 2020 and 2021, mortality increased by 39% and 118%, respectively. The highest peaks occurred between April and July 2020. An additional rise was observed during the early months of 2021. Although mortality progressively declined in 2023, pre-pandemic levels were not restored. The analysis showed that observed deaths consistently exceeded expected projections through late 2022. The COVID-19 pandemic generated a temporary but significant increase in gastric cancer-related mortality in Peru.

Gastric cancer (GC), with nearly 90% being sporadic adenocarcinomas, is preceded by gastric premalignant conditions (GPC). Accurate detection of GPC during esophagogastroduodenoscopy (EGD) can enhance the identification of high-risk patients and improve early GC diagnosis. However, GPC detection rates during EGD vary among endoscopists, potentially leading to differences in GC rates after a negative EGD (GC post-EGD). This study aimed to assess the correlation between the GPC detection rate and the rate of GC post-EGD among endoscopists. We conducted an observational study of EGDs at a community hospital between 2010 and 2019. GPC were defined as glandular atrophy, intestinal metaplasia, and dysplasia. EGDs were categorized into three groups: (i) benign, (ii) GPC, and (iii) malignant findings. GC post-EGD was defined as a diagnosis of gastric adenocarcinoma within three years of an EGD negative for malignancy. GPC detection rates and GC post-EGD were calculated for each endoscopist. A total of 18,635 EGDs were performed by nine endoscopists. Gastric biopsies were obtained in 2,415 (13%) EGDs, identifying 533 GPCs (2.9%). The GC post-EGD rate was 1.26 per 1,000 EGDs. The detection rate of GPC varied between 1.8% and 5.8%, while GC post-EGD rates ranged from 0 to 3.36 per 1,000 EGDs. A negative correlation trend was observed between GC post-EGD and GPC detection rate (rs=-0.65, p=0.057), which was statistically significant for dysplasia (rs=-0.69, p=0.037). The detection rate of GPC-particularly dysplasia-showed a negative correlation with GC post-EGD in a community hospital within a low-risk setting during the period from 2010 to 2019.

Inflammatory bowel disease (IBD) is a chronic condition characterized by periods of activity and remission, with an uncertain and unpredictable course. It mainly affects the economically active population and may compromise physical, psychological, social, and occupational well-being. The aim of this study was to describe health-related quality of life and the presence of anxiety and depression in patients with IBD. An observational, descriptive, cross-sectional study was conducted between April and December 2023. Patients older than 16 years with a confirmed diagnosis of IBD, at least six months of disease duration, and regular pharmacological treatment were included. The Inflammatory Bowel Disease Questionnaire-32 (IBDQ-32), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were administered. Most patients (70%) reported a high quality of life, with no significant differences between ulcerative colitis and Crohn's disease. However, a significant reduction in health-related quality of life was observed in patients with active disease. Symptoms of depression were identified in 62.2% of patients, and anxiety in 58.1%, with both conditions being more frequent in patients younger than 30 years. Although most patients with IBD maintain a good quality of life, more than half experience symptoms of anxiety or depression, even during clinical remission. These findings highlight the importance of integrating mental health assessment and management as an essential component of comprehensive IBD care, in accordance with STRIDE II recommendations.

This article summarizes the clinical practice guideline (CPG) for the evaluation and management of upper gastrointestinal bleeding (UGIB) in the Social Security of Peru (EsSalud). A guideline development group comprising medical specialists and methodologists, formulated clinical questions addressed by CPG. Systematic evidence searches were conducted for each question during 2024. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the certainty of the evidence and formulate the recommendations. The CPG was approved through Resolution No. 000022-IETSI-ESSALUD-2024. This CPG addressed 11 clinical questions, divided into four topics: risk assessment, initial management, variceal UGIB management, and non-variceal UGIB management. Based on these questions, 11 recommendations (7 strong recommendations and 4 weak recommendations), 24 good clinical practices, and 2 flowcharts were formulated. For the 2024 guideline update, no new evidence was found to change the recommendations' direction or strength. This article summarizes the methodology and evidence-based conclusions from the CPG for evaluating and managing UGIB in EsSalud.

Advanced age is associated with a greater prevalence of oesophageal motor disorders due to increased lower oesophageal sphincter (LES) pressure and decreased peristaltic vigour. Secondary peristalsis is particularly affected by age, which may be related to increased oesophageal dysmotility in older adults. To describe the most common oesophageal disorders in older adults undergoing high-resolution oesophageal manometry (HREM) according to the Chicago Classification V4.0. An observational, descriptive, retrospective, cross-sectional study was conducted at San Ignacio University Hospital. Patients over 65 years of age who underwent HREM for various reasons between 2020 and 2025 were included. Total number of patients included, age and age range. A total of 177 patients aged 65 years or older, with an age range of 68-76 years, were included. The main indication for HREM was dysphagia, present in 49.7% of patients, followed by reflux symptoms in 39%. The most frequent pathological manometric diagnosis was inconclusive outlet obstruction (14.1%), followed by ineffective oesophageal motility (9.6%) and achalasia (5.1%). A manometric diagnosis of ineffective oesophageal motility was made in 17.1% of patients with erosive gastro-oesophageal reflux disease (GERD). Older adults are more likely to have esophageal dysmotility, and outflow tract obstruction disorders are the most frequently identified in this population.

Colorectal cancer (CRC) is one of the leading causes of cancer-related death in Peru. Endoscopic resection of colorectal polyps has been shown to reduce the incidence and mortality of CRC. Underwater endoscopic mucosal resection (UEMR) has emerged as a safe and effective technique for the management of non-pedunculated polyps. To evaluate the efficacy and safety of UEMR for non-pedunculated colorectal polyps larger than 10 mm in a high-complexity hospital in Lima, Peru. Observational, retrospective, and descriptive study of patients aged ≥18 years who underwent UEMR between January and December 2023. En bloc resection, R0 resection, recurrence, and complication rates were analyzed. Clinical, endoscopic, and histopathological data were collected. A total of 119 UEMRs were performed in 91 patients, with a median age of 72 years. 60.5% of lesions were located in the right colon, and most measured between 10-19 mm. The en bloc resection rate was 80%, and the R0 resection rate was 78%. The complication rate was 15%, including one perforation and two delayed bleeding events. Most complications occurred in the right colon. Recurrence was 3.1%, observed only in piecemeal resections. Histopathological findings included low-grade (47.9%) and high-grade (28.6%) adenomas, as well as 7 carcinomas (5.8%). UEMR is an effective and safe technique for the treatment of non-pedunculated colorectal polyps larger than 10 mm, particularly for lesions ≤20 mm. Its advantages include a high en bloc resection rate, low complication risk, and low cost.

The weakest part of the duodenal wall is the ampulla of Vater, since here the circular arrangement of the duodenal musculature is destructured to integrate the sphincter of Oddi. This characteristic could be the reason why most duodenal diverticula appear in the juxtapapillary region, even including the papilla inside. The objective of the research was to determine the patients diagnosed with juxtapapillary diverticulum (JD) after endoscopic retrograde cholangiopancreatography (ERCP), who were confused with different previous diagnoses. Retrospective study with intentional sample, where ERCP was performed on a universe of 12,686 patients who were referred with different previous gastrointestinal pathologies, therefore, they required diagnosis or treatment with this procedure. Of the 12,686 patients who underwent ERCP, between 01/07/2014 and 28/06/2024, a total of 872 (6.9%) presented a confirmatory diagnosis of juxtapapillary diverticulum, a diagnosis that differed partially or totally from the one presented before the procedure. The prevalence detected was one of the highest reported for Latin America. DY is generally asymptomatic, affecting mostly elderly patients, but when it is symptomatic, they present different signs and symptoms, which simulate a wide variety of diagnoses, where the clinical and previous imaging studies do not provide sufficient clues for a correct analysis, therefore, ERCP is the perfect tool for the timely diagnosis and treatment of DY, clearing previous diagnostic doubts.

Adenoma detection rate (ADR) and sessile serrated lesion (SSL) detection rate (SDR) are crucial quality indicators for colonoscopy, as their improvement contributes to effective prevention of colorectal cancer. Artificial intelligence (AI) has been shown to significantly increase ADR. This study compared white light imaging (WLI) versus AI-assisted WLI for neoplasia detection. This was a prospective, randomised trial of screening, surveillance, and symptomatic patients. Our primary objective was to evaluate ADR. Secondary objectives included SDR, mean number of adenomas per patient (MAP), neoplasia detection rate (NDR), advanced ADR (AADR), and colonoscope withdrawal time. A total of 621 adenomas were diagnosed in 711 patients, with 310 adenomas in the WLI group and 311 adenomas in the WLI+AI group (p=0.65). Eighty-three SSLs and two intramucosal carcinomas were also detected, totalling 706 neoplasms. ADR was 45.9% in the WLI group and 50.8% in the WLI+AI group (p=0.20). ADR was 54.4% for screening, 49.0% for surveillance, and 40.0% for symptomatic patients (p=0.01). Marginal significance was observed in the WLI+AI group for screening patients (61.5% vs. 49.2%, p=0.06). SDR was 9.0% for both groups. MAP (0.9 vs. 0.9, p=0.34), NDR (51.0% vs. 56.8%, p=0.13), and AADR (8.4% vs. 7.6%, p=0.78) did not differ significantly between the groups. Withdrawal time was similar for the WLI (12.4 ± 5.1 min) and WLI+AI (12.2 ± 4.1 min) groups (p=0.32). AI-assisted colonoscopy demonstrated high ADR and NDR. While without statistical relevance overall, marginal significance was observed for screening patients.

Extraintestinal manifestations (EIMs) are a key component of the clinical burden of inflammatory bowel disease (IBD), with articular involvement being the most common and one of the main contributors to functional impairment and reduced quality of life. Despite its clinical relevance, its pathogenesis remains incompletely understood. Current evidence supports the existence of a gut-joint axis, involving immune dysregulation, genetic susceptibility, and alterations in the intestinal microbiota. Articular involvement in IBD encompasses a broad spectrum of manifestations, including both peripheral and axial forms, with heterogeneous clinical presentations that may precede, accompany, or occur independently of intestinal activity. This variability contributes to diagnostic delays and under-recognition in clinical practice. In this context, early identification of clinical features and a deeper understanding of the underlying mechanisms are essential to improve diagnostic accuracy and therapeutic strategies. This article aims to provide an updated review of the literature on articular involvement in IBD, integrating recent advances in pathophysiology and highlighting key clinical aspects for its suspicion, diagnosis, and management.

The objective of this study is to analyze the main clinical and epidemiological factors related to the risk of malignancy in intraductal papillary mucinous neoplasia of the pancreas in a cohort of patients seen at a referral clinic in Lima, Peru, based on the criteria of the IAP/Fukuoka guidelines. This is a retrospective cohort study, which evaluated patients diagnosed with pancreatic IPMN from December 2015 to August 2023. They were classified according to involvement of the main branch, side branch, and mixed pancreatic ducts, considering aspects such as high-risk stigmata, concerning factors, age, sex, medical history, and others. A total of 253 patients with pancreatic IPMN were included, 71.2% had side branch IPMNs, 9% had main branch IPMNs, and 19.8% were mixed. 49 patients (19.4%) underwent surgery at the time of diagnosis due to high-risk stigmata or factors concerning for malignancy. The remaining 204 patients were enrolled in a follow-up program for a mean of 31 months (6-100 months). During follow-up, a decision was made to operate on 38 of them. Of the 87 patients operated on, 36.7% presented invasive cancer and 11.4% high-grade dysplasia. The presence of a mural nodule greater than 5 mm increased the probability of malignancy 11.21 times; jaundice increased the risk of malignancy by more than 5 times. Wirsung duct dilation between 5 and 9.9 mm had a prevalence ratio (PR) of 2.12, and for dilation greater than 10 mm, a PR of 4.69 (p<0.05). The presence of three or more risk factors showed a PR of 6.77 in the bivariate analysis, and an adjusted prevalence ratio (aPR) of 17.11 in the multivariate analysis. Diagnosis and periodic monitoring of IPMNs allow for early detection of potentially malignant lesions, allowing for timely, often curative, surgery. However, there is currently no reliable way to diagnose and identify which cystic lesions already present or are likely to present malignant characteristics, thus providing clear indications for surgical intervention in these patients.

To evaluate colonoscopy quality indicators in Peruvian national public hospitals and to estimate the polyp detection rate (PDR) corresponding to adenoma detection rate (ADR) benchmarks of 25% and 35%. A multicenter retrospective study was conducted using colonoscopy reports from July 2023 to June 2024. Rates of adequate bowel preparation and cecal intubation, as well as withdrawal time, polypectomy technique, PDR, and ADR were evaluated. A total of 3,758 colonoscopies performed by 63 endoscopists were analyzed. The rate of adequate bowel preparation was 91.1%, and the cecal intubation rate was 95.6%. The withdrawal time was not reported in 75% of procedures without polyp detection. Only 30.2% of polyps measuring 4-9 mm were removed using cold snare polypectomy. The overall PDR was 41.3%, and the overall ADR was 22.8%. The adenoma-to-polyp detection rate quotient was 0.56; a PDR of 62.5% corresponded to an ADR of 35%, and a PDR of 44.7% to an ADR of 25%. Colonoscopy quality in Peruvian national public hospitals showed adequate rates of bowel preparation and cecal intubation but suboptimal ADR values and deficient documentation practices, underscoring the need to implement targeted strategies to improve colonoscopy quality.

To report a case series of patients with inflammatory bowel diseases and a history of malignancy and to analyze how this condition influenced therapeutic decision-making presents a challenging scenario. This was a retrospective observational study analyzing 11 patients with inflammatory bowel disease and malignant neoplasms followed at an inflammatory bowel disease outpatient clinic of a university hospital. Clinical, therapeutic, and oncologic findings are reported descriptively based on medical record review. Seven patients (64%) had ulcerative colitis, and six (55%) were female, with a mean age of 47 years. Extra-intestinal neoplasms predominated. Six patients (55%) received advanced therapy near the time of cancer diagnosis; reintroduction was possible in four cases. Judicial action was required for two patients. Clinical decision-making in patients with inflammatory bowel disease and a history of malignancy is an individualized process, based on multidisciplinary discussion, bioethical considerations, and the most reliable available evidence, even in the face of state-imposed logistical obstacles. Continuous updating of Clinical Protocols and Therapeutic Guidelines is essential to ensure equitable access to the most appropriate and non-harmful treatment for this patient group.

Worldwide, women represent a significant part, and even the majority, of medical personnel, evidencing a global trend towards the feminization of the profession. However, challenges persist in gender equality in leadership and academic roles. Understanding how women endoscopists manage the delicate balance between their demanding careers and personal lives is crucial to ensuring equitable professional environments. This research thoroughly explored these dynamics, seeking to understand the unique challenges, coping strategies and factors that influence the successful integration of personal and professional life for these specialists. a survey was designed that addressed aspects of personal life, academic training, incorporating the Maslach Burnout Inventory (MBI) and the adapted MacDonald and MacIntyre job satisfaction scale. The non-probabilistic sample included 202 female endoscopists aged between 29 and 73 years. It was found that those with children perceived difficulties in career advancement and a lack of workplace support during child-rearing. Nevertheless, there were no significant differences between women with and without children in the perception of workplace discrimination, professional advancement opportunities, or specialized training capabilities. A negative relationship was found between age and the perception of burnout. Job satisfaction, in turn, showed no correlation with any personal variables. These results suggest that, while motherhood imposes work-life balance challenges, professional experience may mitigate burnout, regardless of job satisfaction. Support and mentorship policies are required to achieve an inclusive environment.

Peru has a high incidence and mortality rate of stomach and colorectal cancers. While chromoendoscopy (CE) with indigo carmine dye is the gold standard for gastrointestinal tumor early detection, its accessibility is limited in Peru due to cost and infrastructure restrictions. This study explores the potential of a natural alternative: anthocyanin dye extracted from purple corn (PC), a widely consumed and accessible food source in Peru. A PC decoction was prepared by boiling the PC and adjusting the pH to 8. A 38-year-old male patient underwent colonoscopy, finding a rectal polyp followed by CE with both IC and PC solution (PCS). The PCS effectively stained the colonic mucosa, allowing for visualization of the lesion. In this report, PCS is presented as a potential cost-effective and readily available natural contrast agent for CE, particularly relevant for low-resource environments in Peru. Further research and collaboration are needed to address standardization and staining duration for more reliable and accurate results.

Duodeno-caval fistula (DCF) is an extremely rare entity that can have potentially lethal consequences. It is associated with infectious, neoplastic, traumatic processes, or foreign bodies. We report a case of DCF secondary to the migration of a metallic wire from the duodenum to the inferior vena cava (IVC), accompanied by extensive venous thrombosis. A 48-year-old male with no relevant medical history presented with fever and nonspecific abdominal pain. He was admitted with an initial diagnosis of acute dengue in the context of an ongoing epidemic. Computed tomography revealed a linear metallic foreign body crossing the second portion of the duodenum, penetrating the visceral wall, and lodging within the lumen of the IVC, with air inside and extensive venous thrombosis. Upper digestive video endoscopy (EGD) was performed, with successful extraction of the foreign body. The patient received intravenous antibiotic therapy for 10 days and oral anticoagulation for 6 months. Clinical evolution was favorable, and the patient recovered without complications. DCF due to a foreign body is extremely rare. Endoscopic management can be successful in selected cases, avoiding invasive surgical procedures.

We describe the case of a pediatric patient with eosinophilic gastroduodenitis secondary to visceral toxocariasis, presenting with clinical, endoscopic, and histological features suggestive of gastric lymphoma. The patient, from a rural area, exhibited severe gastrointestinal symptoms, persistent hypereosinophilia, deep ulcerative lesions in the stomach and duodenum, as well as systemic involvement. After an extensive immunological, hematological, and infectious disease evaluation, the diagnosis was confirmed by positive serology for Toxocara canis. The patient showed favorable clinical evolution with antiparasitic therapy, immunomodulation, and intensive nutritional support. This case highlights the importance of considering infectious etiologies in the differential diagnosis of eosinophilic gastroduodenal disorders, particularly in pediatric patients with systemic involvement and a presentation mimicking malignant disease.

The management of early rectal cancer is shifting toward organ-preserving strategies. Endoscopic submucosal dissection (ESD) achieves en bloc resections for low-risk T1 lesions, while surgery remains the gold standard for deep submucosal invasion due to the risk of nodal metastasis. Endoscopic intermuscular dissection (EID) has emerged as an alternative in selected high-risk patients. We report the case of a 71-year-old man with chronic kidney disease and ischemic heart disease, in whom a 15 mm sessile rectal lesion with features of deep invasion was detected. EID achieved complete resection without complications, and MRI confirmed cT1-2N0 disease. Histopathology revealed moderately differentiated adenocarcinoma with deep invasion, lymphovascular invasion, and grade 2 tumor budding. Given surgical contraindications, active surveillance was chosen after multidisciplinary discussion. At six months, the patient remains recurrence-free. Unlike conventional ESD, EID allows dissection between the inner circular and outer longitudinal muscle layers, improving deep margins in sm2-sm3 lesions. Evidence suggests that lymphovascular invasion, tumor budding, and poor differentiation are the strongest predictors of nodal metastasis. In selected patients, EID may provide curative resection while avoiding major surgery. Careful risk stratification and multidisciplinary evaluation are essential to balance oncologic safety and organ preservation.

Endoscopic ultrasound-guided gastroenterostomy is a novel, minimally invasive technique used to palliate malignant gastric outlet obstruction (GOO). Utilizing lumen-apposing metal stents (LAMS), the procedure aims to create a communication between the gastric cavity and a jejunal or duodenal loop, offering low morbidity, fewer adverse events, and rapid symptom relief. The causes of GOO include tumors originating in the gastric antrum, duodenum, major papilla, pancreatic head, and distal bile duct. These conditions commonly present symptoms such as postprandial vomiting, abdominal pain, weight loss, early satiety, and abdominal distension. EUS-GE has emerged as an alternative to traditional approaches such as self-expanding metal stent placement and surgical gastrojejunostomy.

At the conclusion of an endoscopic procedure, we must prepare a report of the observed findings. However, the generated report is not only intended to describe and list what was detected during the endoscopy. The endoscopy report should serve as a relevant tool that not only improves communication among medical staff, but also supports subsequent clinical decision-making through a clear diagnosis. This objective can be achieved by systematizing our reports through the routine use of validated classifications and scales. Nevertheless, their use is often complex and not regularly applied, particularly among endoscopists in training. For this reason, we present the following narrative review, aimed at providing gastroenterologists in training with the most important classifications, explained in a simple manner and accompanied by updated references.