J. Cantero

Accuracy of computed tomographic colonography for the detection of polyps and colorectal tumors: a systematic review and meta-analysis

Background: The real accuracy of computed tomographic colonography (CTC) is still unknown. Objective: To perform a meta-analysis of the diagnostic accuracy of CTC for the detection of polyps and colorectal tumors. Methods: Selection of studies:Studiesassessing the accuracy of CTC for the detection of colorectal polyps and tumors were selected. Data synthesis:Meta-analyses combining sensitivities, specificities and likelihood ratios (LRs) for the diagnosis of polyps and colorectal tumors were carried out. Results: Forty-seven studies, providing data of 10,546 patients, were included. Overall per-polyp sensitivity of CTC was 66% (64–68%), for polyps 6–9 mm in size it was 59% (56–61%), and 76% (73–79%) for polyps larger than 9 mm. Overall per-patient sensitivity was 69% (66–72%), for polyps 6–9 mm 60% (56–65%), and 83% (70–85%) for lesions larger than 9 mm. Overall CTC specificity was 83% (81–84%). Positive and negative LRs were 2.9 (1.8–4) and 0.38 (0.27–0.53), respectively; for polyps 6–9 mm in size, they were 3.8 (2.5–5.7) and 0.4 (0.27–0.59), and 12.3 (7.7–19.4) and 0.19 (0.12–0.3) for polyps larger than 9 mm. Conclusion: CTC is highly specific for the detection of colorectal polyps and tumors. Some studies reported high sensitivities, but the results of the studies were highly heterogeneous, while the studied variables explained only part of this discrepancy.

The colorectal carcinoma prognosis factors. Significance of diagnosis delay

INTRODUCTION detection of early-stage colorectal carcinoma (CRC)--( Dukes A or B)--provides better survival rates in these patients. Thus, the effectiveness of screening programs in asymptomatic patients or of early diagnosis in symptomatic individuals has been postulated. The aim of this study was to establish whether a delay in diagnosis or other factors are related to CRC stage. PATIENTS AND METHODS a retrospective study was performed on 96 patients with CRC. Age at diagnosis, gender distribution, intestinal disorders, diagnosis delay, primary sign and -regarding CRC- localization, stage (Dukes) and grade of differentiation (well differentiated; non-well differentiated; poorly differentiated) were recorded. RESULTS diagnosis delay was 185 +/- 190 days. Patients delay in obtaining a diagnosis was 119 +/- 158 days. In 40% of patients CRC was diagnosed at an early stage (Dukes A or B), and in 13% CRC was poorly differentiated. The only factor with an independent effect on Dukes stage was tumor differentiation (p: 0.0012). Distal location was associated with less advanced tumors without statistical significance (p: 0.156). CONCLUSION based on the presented data, a greater effort regarding screening programs for healthy people seems warranted, as improved survival has been demonstrated when diagnosis delay is reduced, particularly in patients with the highest mean delay.

Estudio de los factores pronósticos clínicos y endoscópicos en los pacientes con hemorragia digestiva de origen gastroduodenal

Fundamento La ulcera peptica representa la causa mas frecuente de hemorragia digestiva alta(HDA). Puesto que en la mayoria de los casos su evolucion es favorable y el episodio hemorragicocede espontaneamente, se ha planteado la posibilidad de reducir el numero de los ingresoshospitalarios en estos pacientes. Nuestro objetivo fue revisar las variables clinicas y endoscopicasde los pacientes con HDA secundaria a lesiones pepticas gastroduodenales evaluadosen nuestro hospital durante un ano, asi como identificar las caracteristicas que se asocian auna evolucion desfavorable de la HDA. Pacientes y metodo Analisis retrospectivo de todos los episodios de HDA de pacientes que acudierona nuestro hospital durante un ano. Se incluyo a aquellos pacientes en los que se identificomediante gastroscopia una ulcera gastroduodenal o una gastritis/duodenitis erosiva comocausa de la HDA. Se evaluo el papel pronostico de diversas variables clinicas, analiticas y endoscopicas.Como variables «resultado» de mala evolucion se incluyeron la persistencia o recidivahemorragica, la cirugia y la mortalidad (la variable «evolucion» se categorizo como «desfavorable» cuando se observaba alguna de las variables mencionadas). Resultados Se identifico a 156 pacientes, con una edad media (DE) de 61 (17) anos. La presentacionmas frecuente fue en forma de melena (79%). El 46% tenia enfermedades asociadas y el50% recibia gastroerosivos. La causa mas frecuente de HDA fue la ulcera duodenal (52%), seguidade la ulcera gastrica (30%). La HDA evoluciono desfavorablemente en el 7% de los casos. Enel analisis multivariante las variables que se asociaron a una evolucion desfavorable fueron laedad, la presentacion como hematemesis de sangre roja, una presion arterial sistolica . 100mmHg, una frecuencia cardiaca . 100 lat/min y una clasificacion endoscopica de Forrest masgrave. El 11% de los pacientes fue dado de alta inmediatamente, sin complicaciones posteriores.Si aplicaran las variables predictivas obtenidas en el modelo multivariante, podria evitarse el ingresoen 59 pacientes (38%) sin complicaciones posteriores. Conclusiones Hemos identificado una serie de variables clinicas y endoscopicas faciles de obtenery de aplicar en la practica clinica, que permiten estimar con relativa seguridad la evolucionde la HDA. De este modo puede identificarse con fiabilidad un subgrupo relativamente numerosode pacientes con HDA susceptible de recibir tratamiento ambulatorio.

Helicobacter pylori "test-and-scope" strategy for dyspeptic patients. Is it useful and safe?

AIM To evaluate outcome of test-and-scope strategy using 13C-urea breath test, Helicobacter pylori IgG serology, and CagA serology. PATIENTS AND METHODS A series of 100 dyspeptic patients were studied. Biopsies were obtained for histology and rapid urease test (gold standard). Serum samples were obtained for Helicobacter pylori IgG and CagA serology, and 13C-urea breath test was carried out. RESULTS If endoscopy had not been performed in Helicobacter pylori patients based on 13C-urea breath test, <45 years, without alarm symptoms, and without non-steroidal anti-inflammatory drug use, 15% of endoscopies would have been saved, and one gastric ulcer and two oesophagitis would have been missed. Based on Helicobacter pylori IgG serology, 21% of endoscopies would have been saved. Finally, if endoscopy had been performed only in CagA+ patients, 31% of endoscopies would have been saved, missing one gastric ulcer and two cases of oesophagitis. CONCLUSIONS In our geographical area, the test-and-scope strategy based on 13C-urea breath test or Helicobacter pylori IgG serology would have saved only 15-20% of endoscopies. Although some relevant pathology would have been missed, it is not of a malignant type. 13C-urea breath test is the preferred non-invasive method to be used in this strategy, while Helicobacter pylori IgG serology is of limited value due to its low accuracy. With the use of CagA serology a larger number of unnecessary endoscopic examinations can be avoided.

Bile acid malabsorption in patients with chronic diarrhea and Crohns disease

INTRODUCTION AND AIM Crohns disease (CD) is a form of inflammatory bowel disease and is mainly characterized by diarrhea and abdominal pain. The aim of our study was to analyze the usefulness of performing a 75SeHCAT scan in CD patients with chronic diarrhea and suspected bile acid malabsorption (BAM). In addition, we aimed to determine whether there was a relationship with the clinical features of the disease and a previous bowel resection. PATIENTS AND METHODS this was an observational cross-sectional study of 39 patients with a diagnosis of CD and chronic diarrhea. All cases underwent a 75SeHCAT scan for BAM diagnosis, after discarding disease activity. RESULTS the study cohort included 19 females and 20 males. The median age was 44 years and the majority of patients were A2 L1 B1 according to the Montreal classification; 84.6% of patients had undergone a previous bowel resection. BAM was present in 97.4% of patients (100% and 83.3% of patients with and without previous surgery, respectively), which was severe in 92.1% of cases. Treatment with bile acid sequestrants was initiated and a favorable response was obtained in 72.2% of patients. The relationship between BAM degree (moderate or severe), bowel surgery and the response to bile acid sequestrant treatment was also analyzed but not statistically significant. CONCLUSION BAM is a frequent cause of diarrhea in CD patients in endoscopic or radiological remission. This condition was present in all patients with a history of a bowel resection. A response to bile acid sequestrants treatment was observed in 73% of patients.

Valoración precoz de la anemia en el paciente con hemorragia digestiva aguda: concordancia entre gasometría venosa y laboratorio convencional

BACKGROUND AND OBJECTIVE Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB). PATIENTS AND METHODS Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis. RESULTS One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB. CONCLUSIONS Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results.