Rosario Albis

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.

4625 Endoscopic ultrasound and intraductal ultrasonography are complementary for the management of ampullary tumors.

Whipples resection is the gold standard treatment of the ampullary tumors. Nevertheless endoscopic snare resection (ESR), which is less invasive, can be applied in a curative intent when some criteria are respected : -1- no risk of metastatic lymph node e.g. benign ampullomas or early carcinomas respecting the submucosae -2- no tumoral extension inside the pancreatic and the bile ducts. While endoscopic ultrasound (EUS) stages, with a good accuracy, an ampullary tumor as respecting the muscularis propria (uT1), intraductal ultrasonography (IDUS) is very promising to appreciate the involvement of the submucosae and the existence of an intraductal extension. The combination of the two methods could then allow optimizing the therapeutic choice. AIM: to estimate the clinical impact of EUS +/- IDUS in the management of ampullary tumors PATIENTS AND METHODS: between Jan 99 and Nov 99, 10 patients with ampullary tumors had a pretherapeutic staging. A radial EUS (GFUM20, Olympus Co) was systematically performed. When the staging was uT1 an IDUS (UM-G20-29R, Olympus Co) was done. A Whipples resection was proposed when final staging was -1- lesion infiltrating the submucosae or more ; -2- tumor extension inside the biliary or pancreatic ducts. An ESR was proposed in the other cases. RESULTS: EUS concluded to a tumor >uT1 in 4 cases. Pathology (Whipples resection) confirmed the staging (3 pT3; 1 pT2). EUS conclude to a tumor uT1 in 6 cases and IDUS was performed. - In 4 cases tumors were considered without intraductal involvement and respecting the submucosae. ESR was always curative (severe dysplasia; resection margins free of tumor). – In 2 cases IDUS evidenced involvement of the submucosae. 1 with a tumor extension inside the ducts was operated on and diagnosed as pT2. 1 refused surgery and an ESR was performed confirming the involvement of the submucosae (positive resection margins). A moderate pancreatitis was the only ESR complication. CONCLUSION: EUS and IDUS togheter allow an accurate T staging of ampullary tumors. The clinical impact is major: endoscopic snare resection can be applied in a curative intent in early tumors, Whipples resection in other cases or when ESR is not complete.

3490 Technical evaluation of two new biliary miniprobes for intraductal ultrasonography.

BACKGROUND: Intraductal ultrasonography (IDUS) using thin ultrasonic probes could be useful in some biliopancreatic indications. Initial prototypes were limited by the size of the probes and their fragility. Insertion was then mainly performed via a transhepatic route. Two new thinner Olympus miniprobes could allow performing IDUS routinely via ERCP. AIM: To evaluate the technical features of these miniprobes. METHODS: UM-S20-20R (SP) with a tip of 1.7 mm and UM G20-29R (SG) with a channel for a 0.035 inches guidewire (tip=2.0 mm) have a 20 MHz frequency. Insertion can be done transpapillary (via ERCP) or percutaneously (via transhepatic route). Limiting factors for the probe insertion and the image quality were studied. RESULTS: 30 intraductal biliary EUS were performed in 25 patients (staging and/or follow-up of ampulla or bile duct tumors: 18; indeterminate biliary stenosis: 8; mucinous producing pancreatic tumor (MPPT): 4). - In 3 cases (Klatskins tumors) SP was inserted after a percutaneous drainage inside a 12 F catheter, without technical problems; the image quality was not affected by the drain, and the interface was excellent. - In 27 cases a transpapillary insertion was intended. SP was used in 7 cases. Insertion succeeded in 3 sphincterotomized patients but only in 1/4 non sphincterotomized patients. The insertion through a biliary stenosis failed 2/3. SG was used in 20 cases. It was inserted in biliary ducts in 16/16 patients. A precut was once necessary. The insertion inside the wirsung until the tail was performed 4/4 without problem. SG passed through biliary stenosis 13/15. In two Klatskins tumors one hepatic duct was not catheterized by the guidewire. Two factors hampered the interpretation: - air artifacts (after sphincterotomy and in MPPT) – large tumors (limited penetration depth). No probe rupture was observed. CONCLUSION: 1. The slim probe is a good option for transhepatic route due to its size allowing a smaller diameter for the drainage catheter 2. The miniprobe with guidewire is better for the transpapillary route avoiding sphincterotomy and overcoming stenotic areas. It could now be used routinely during ERCP.