Luis Sabbagh

Recomendaciones para la sedación y la analgesia por médicos no anestesiólogos y odontólogos de pacientes mayores de 12 años

Most of the complications related to sedation are preventable. This document defines some recommendations for non-anesthesiologists so that they can provide sedation level I and II with adequate safety. The most important recommendations are: that the sedation be provided by someone different from the person who performs the surgical procedure; designation of the training and monitoring of thje person who sedates; the use of only one medication for sedation, and the availability of medications and equipment to manage complications; the mandatory need of an assessment prior to the sedation, as well as informed consent and record of events during the procedure; and the recommendation of having a low threshold to request the support of an anesthesiologist.

Sedation and analgesia recommendations for non-anesthesiologist physicians and dentists in patients over 12 years old

ABSTRACT Most of the complications related to sedation are preventable. This document defines some recommendations for non-anesthesiologists so that they can provide sedation level I and II with adequate safety. The most important recommendations are: that the sedation be provided by someone different from the person who performs the surgical procedure; designation of the training and monitoring of thje person who sedates; the use of only one medication for sedation, and the availability of medications and equipment to manage complications; the mandatory need of an assessment prior to the sedation, as well as informed consent and record of events during the procedure; and the recommendation of having a low threshold to request the support of an anesthesiologist.

The gut: esophagus, stomach, and rectum

Before starting the procedure, it is very important to review the patient’s medical records to plan the best technique according to the indication. The procedure should be discussed with the patient and the family to obtain informed consent. EUS is performed after at least 6 hours of fasting. The patient is placed in the left lateral position. An oxygen supply, adequate monitoring of oxygen saturation, heart rate monitoring, and blood pressure monitoring are necessary before placing the patient under conscious sedation.

4542 Endoscopic ultrasonography value in the diagnosis and follow up of the malt gastric lymphoma after helicobacter pylori treatment.

Introduction . Gastric lymphomas represent the 3 to 10% of the gastric neoplasms. Endoscopic Ultrasonography (EUS) is today the gold standard to evaluate the gastric wall, allowing the reliable measurement of the wall thickness, tumor extension and peri gastric node involvement. These characteristics make this tool the first choice to follow up the response of patients with gastric lymphoma under treatment. The main objective of this study was to prospectively evaluate the utility of EUS in the follow up of patients with superficial involvement of low grade MALT gastric lymphoma (mucosa associated lymphoid tissue) under treatement for Helicobacter pylori. Methods .The study was conducted at the Clinica Reina Sofia a tertiary care center. The inclusion criteria were patients with histology and immuno histochemistry diagnosis of low grade MALT gastric lymphoma with superficial involvement (no deeper than submucosa layer and without node involvement). EUS was performed before and on the 3rd, 6th, 9th, 12th, and 18th month after antibiotic treatment with claritromicin, amoxacilin and lansoprazol for Helicobacter pylori eradication. The main outcome variable was defined as the measurement of the tumor involvement of the gastric wall (in millimeters, normal value of 3 mm) by EUS on the specified times. At the same time, biopsy samples were taken. Results.The study period of time was 18 months; during this time, 14 patients were included in the study. The median of the gastric mucosa before treatment was 7 mm (range 3 - 9 mm). Two patients did not respond to the treatment and remained with the same gastric mucosa thickness and positive biopsy for the neoplasm. There was a significant reduction of the gastric mucosa thickness after the sixth month of treatment in 12 patients (85.7%), with a median of 4 mm. The tumor was not evident at the biopsy specimen in this group of patients and the eradication of the Helicobacter pylori was demonstrated. There was a good correlation between the EUS evaluation and the histological findings for tumor evidence and for Helicobacter pylori infection. Conclusions : The results of the present study showed that EUS is a useful tool for the diagnosis and follow up of patients with low grade MALT gastric lymphoma with superficial involvement. There was a good correlation between H pylori eradication, gastric mucosa thickness reduction by EUS and histopathological findings.

7019 A prospective evaluation of endoscopic ultrasonography reliability for choledocholithiasis and pancreatic involvement diagnosis in acute pancreatitis.

Background. Acute pancreatitis, a common severe disease, remains as an important cause of high morbidity, mortality and costs. Gallstones are by far the main etiologic agents for the disease in our country. The gold standard to identify common bile duct stones in biliary pancreatitis currently is made by endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure without a 100% of accuracy and with known morbidity and mortality. The main objective of this study was to prospectively evaluate the ability of endosonography (EUS) to identify choledocholithiasis and to assess severity of pancreatic involvement. Methods. The study was conducted at the Clinica Reina Sofia a tertiary care center. The inclusion criteria were patients older than 18 years of age with acute pancreatitis having EUS, abdominal C-T Scan and ERCP when indicated. EUS was performed independently or before the ERCP to every patient included in the study and within 72 hours of admission by the same examiner. The outcome variable was defined as the presence of choledocholithiasis assessed by EUS or by ERCP. Pancreatic involvement findings were correlated with length of hospital stay and compared with the dynamic C-T Scan. Results. Seventy-four patients were prospectively studied during three years. 51 patients had both EUS and ERCP; Normal in 4 (7.8%) vs.12 (23.5%); microlithiasis in 21 (41.2%) vs. 8 (15.7%); biliar sludge in 8 (15.7%) vs. 15 (29.4%); and choledocholithiasis in 18 (35.3%) vs. 16 (31.4%), chi square 12.08, p

Prevalencia de síntomas del reflujo gastroesofágico y factores asociados: una encuesta poblacional en las principales ciudades de Colombia

Problema: el reflujo gastroesofagico es un proceso fisiologico que en algunas personas puede tornarse pato- logico y que produce molestias y lesiones esofagicas y extraesofagicas que afectan la calidad de vida de los individuos que lo presentan. Actualmente no se cuenta con estadisticas sobre la frecuencia de esta condicion en Colombia. Objetivo: cuantificar la prevalencia de sintomas de enfermedad por reflujo gastroesofagico (ERGE) en los adultos de cuatro ciudades principales de Colombia utilizando el cuestionario GERDQ, y explorar la asociacion de variables sociodemograficas y antropometricas con esta enfermedad. Metodologia: estudio de corte transversal de base poblacional. Se incluyeron 6842 personas, mayores de 18 anos y menores de 80 anos de edad, residentes en Bogota, Cali, Medellin y Barranquilla. La muestra fue seleccionada por muestreo aleatorio estratificado. Se aplico una encuesta telefonica que incluia el cues- tionario GERDQ para la identificacion de sintomas de reflujo en la ultima semana. Se calculo la prevalencia de reflujo por estratos teniendo en cuenta el punto de corte de la encuesta (8 o mas puntos) y se realizaron comparaciones entre ellos utilizando la prueba de x2. Se exploro la asociacion de variables sociodemografi- cas y antropometricas mediante analisis bivariados y modelos de regresion logistica. Resultados: se obtuvieron 6842 encuestas. La prevalencia estimada de sintomas de reflujo en general fue del 11,98% (IC 95%: 11,05-12,97). En el analisis por ciudades, Barranquilla presento la frecuencia mas alta (16,22%; IC 95%: 14,58-18,01) y Bogota, la mas baja (10,75; IC 95%: 9,30-12,38). Para los sintomas evaluados con el cuestionario GERDQ, la prevalencia estimada fue: pirosis, 13,6% (IC 95%: 12,50-14,60); regurgitacion, 16,9% (IC 95%: 15,74-17,99); epigastralgia, 16,67% (IC 95%: 15,54-17,80): nauseas, 11,4% (IC 95%: 10,46-12,35); dificultad para dormir por presentar pirosis o regurgitacion, 8,17% (IC 95%: 7,36-8,97); y consumo de medicamentos adicionales a los formulados por el medico, 6,68% (IC 95%: 6,01-7,35). El sexo femenino, el vivir en Barranquilla o Medellin y el presentar una comorbilidad se asociaron estadisticamente con la presencia de reflujo. Conclusion: la prevalencia de sintomas de reflujo en cuatro ciudades capitales de Colombia, medida con el cuestionario GERDQ, de 11,98% (IC 95%: 11,05-12,97), es similar a la reportada en otros paises de Latinoamerica, siendo las comorbilidades (particularmente hipertension arterial [HTA]) el factor que mas se asocio con esta condicion en todos los estratos del estudio.

Tratamiento de las várices gástricas con cianoacrilato, experiencia institucional

La principal causa de hemorragia de vias digestivas altas es la enfermedad ulcerosa del estomago y/o duo- deno (Enfermedad ulceropeptica). Cada vez y con mayor frecuencia se presentan pacientes con sangrado originado en varices gastricas, quizas debido al numero creciente de pacientes que las presentan como una secuela de la hipertension portal causada a su vez por problemas hepaticos, especialmente por la cirrosis. Las opciones actuales de tratamiento de las varices gastricas incluyen desde metodos preventivos o profilac- ticos, hasta los propiamente terapeuticos mediante el uso de medicamentos (vasopresina, somatostatina y sus analogos), las derivaciones portosistemicas transyugulares (TIPS, por sus siglas en ingles) los metodos endoscopicos y la cirugia. Los metodos endoscopicos incluyen el uso de bandas y de inyeccion de sustancias esclerosantes, o de sustancias obturativas como el N-Butyl-2-cianoacrilato (Histoacryl®). Desde hace poco tiempo, y basados en la literatura cada vez con mejores niveles de evidencia y grados de recomendacion, he- mos empezado a usar el cianoacrilato en la Clinica Universitaria Colombia. Presentamos nuestra casuistica y realizamos una revision del tema.

Hepatotoxicidad por isoniazida en un paciente con enfermedad de Crohn. Reporte de caso y revisión de la literatura

La isoniazida se utiliza para el tratamiento o profilaxis de la tuberculosis; sin embargo, su uso puede aso- ciarse con reacciones hepaticas adversas. La hepatitis clinicamente manifiesta sucede en 0,5%-1% de los pacientes que reciben isoniazida como monoterapia. En este articulo se describe el caso de un paciente con enfermedad de Crohn que curso con hepatotoxicidad grave por isoniazida, y se hace una revision de la literatura al respecto.

Low-cost technique for resection of a large duodenal lipoma with the aid of a modified polypectomy snare

A 63-year-old man presented to our hospital with chronic abdominal pain associated with intermittent periods of postprandial vomiting. Esophagogastroduodenoscopy and endoscopic ultrasound confirmed the diagnosis of a lipoma in the second portion of the duodenum. Owing to the unavailability of a therapeutic gastroscope, a conventional polypectomy snare was modified (▶Fig. 1) in order to be used as a third hand that holds the lipoma, and works as an additional tool in parallel with the scope (▶Video1). The modification consisted of removing the handle of the manual control device, such that the endoscope could be extracted from the stomach cavity, leaving the snare body inside of it in the same way that a guidewire would be used. The modified polypectomy snare was placed around the pylorus to act as a “trap.” Then, the endoscope tip was advanced through the snare into the duodenum where the lesion was grasped and pulled into the antrum. The modified snare was closed around the pseudopedicle, holding the lipoma in the antrum. The lipoma was resected using a second polypectomy snare, and the mucosal defect was closed with a hemoclip. The patient was discharged home without complications. A modified polypectomy snare can be a useful accessory tool when a therapeutic endoscope is not available. Endoscopy_UCTN_Code_TTT_1AO_2AG

Presentación atípica de esofagitis herpética

La infeccion esofagica por virus del herpes es una entidad rara que se ha reportado con mayor frecuencia en pacientes inmunocomprometidos. Esta infeccion afecta principalmente a pacientes con virus de la inmuno- deficiencia humana (VIH) y a pacientes que reciben terapia inmunosupresora o quimioterapia. La severidad de los sintomas esta relacionada con el grado de afectacion esofagica, siendo la odinofagia la presentacion clinica mas frecuente. Por otro lado, el hallazgo endoscopico mas comun es la presencia de ulceras multiples bien circunscritas que se presentan tipicamente en el tercio distal del esofago. El tratamiento estandar des - crito es el aciclovir oral por 1 a 2 semanas.