Introduction:Colorectal cancer in adults under 50 years of age, known as early-onset colorectal cancer, has shown a progressive increase in incidence worldwide. This age group is usually excluded from screening programs. Objectives:To describe the epidemiological and clinical characteristics and survival outcomes of patients with early-onset colorectal cancer treated at a referral center. Materials and methods:A retrospective cohort study that included patients up to 49 years of age with a histological diagnosis of colorectal adenocarcinoma treated between 2015 and 2024. Clinical variables, tumor location, TNM stage, and survival were analyzed. Results:A total of 56 patients were included, with a median age of 42 years (IQR 13.3). The most frequent tumor location was the right colon (32.1%). Fifty-seven percent had advanced-stage disease and 33.9% had metastases at diagnosis. The median overall survival was 78 months, with a 5-year survival rate of 59.3%. The presence of metastases at diagnosis was independently associated with poorer survival (HR 2.38; 95% CI 1.08 - 5.26; p = 0.031), and age under 40 years showed a trend toward poorer prognosis (HR 2.17; 95% CI 0.95-5.00; p = 0.065). Conclusion:Although the right colon was the most common individual site, no clear predominance of any tumor site was observed. The cohort was characterized by a high proportion of advanced disease at diagnosis and an overall survival rate lower than that reported in other series. Metastatic disease was the main determinant of survival, and patients younger than 40 years of age tended to have a poorer prognosis.
Pancreatic teratoma is an extremely rare benign congenital neoplasm. We present the case of a 61-year-old female patient who consulted for a 3 month history of abdominal pain. An abdominal ultrasound was performed, which revealed a hypoechoic nodular formation in duodenopancreatic topography, with a focal echogenic internal area with defined contours. A CT scan was requested, which reported a hypodense nodular formation at the level of the uncinate process with areas of fatty density and focal calcification measuring 34 mm x 42 mm in close contact with the mesenteric vein. It was decided to complement diagnostic studies with magnetic resonance and endoscopic ultrasound with a puncture biopsy, without findings of malignancy. The laboratory tests showed normal tumor markers. A converted laparoscopic cephalic pancreaticoduodenectomy was performed, with the pathology anatomy reporting morphological findings consistent with mature cystic teratoma.
Introduction:Ingestion of caustic substances in children can cause esophagogastric injuries with significant sequelae, particularly esophageal stenosis. Early upper gastrointestinal endoscopy allows for grading the injury according to the Zargar endoscopic classification and guiding follow-up. Objective:To describe the endoscopic and therapeutic profile of pediatric patients who ingested caustic substances and were treated between 2018 and 2024 at a referral pediatric hospital. Materials and Methods:Observational, retrospective, and descriptive study. Patients under 14 years of age who underwent emergency upper gastrointestinal videoendoscopy due to suspected or clinically confirmed ingestion of caustic substances (January 2018 - December 2024) were included. Lesions were classified according to the Zargar endoscopic classification (0, I, IIa, IIb, III). Gastric involvement and the need for treatment (dilations, intralesional triamcinolone injection, or surgery) were recorded. Results:A total of 161 patients were analyzed (mean age 3 years; 65.8% male). At the initial endoscopy, no lesions were detected in 60 patients (37.3%); Zargar I was observed in 39 (24.2%), Zargar II in 53 (32.9%), and Zargar III in 9 (5.6%). Gastritis was noted in 25 cases (15.5%), mainly in Zargar II-III lesions. Esophageal dilations were required in 32 patients (19.8%): 25/53 (47.2%) with Zargar II lesions and 7/9 (77.8%) with Zargar III lesions. Five patients (3.1%) were identified with refractory stenosis (intervals ≤ 21 days). Fifteen patients received intralesional triamcinolone, although no conclusive benefit was observed in reducing the number of dilations. Two patients (1.2%) required surgical treatment (gastric ascension). Conclusions:In this series, Zargar II lesions were the most common among significant lesions and were associated with a significant proportion of dilations. Early endoscopic stratification allows for the anticipation of the need for intervention and follow-up. In our experience, intralesional triamcinolone did not show a conclusive benefit.
Introduction:Gastrointestinal fistulas are uncommon but potentially severe conditions associated with infectious collections, bleeding, sepsis, malnutrition, and increased morbidity and mortality. Advances in therapeutic endoscopy have expanded the options for minimally invasive treatment. Endoscopic treatment has become a first-line therapeutic strategy for colorectal anastomotic leaks and fistulas. For esophageal and gastric fistulas, esophageal stents remain a widely used alternative; however, their tolerability may be limited by the location of the defect. The X-Tack™ endoscopic suturing system (Boston Scientific), introduced in 2020, allows for the clousure of anatomical defects through the working channel of the endoscope without requiring scope withdrawal, facilitating access to complex anatomical locations and larger defects. Patients and Methods:We present a case series of nine gastrointestinal fistula defects in eight patients treated in Colombia. The locations included the proximal esophagus, stomach, duodenum, colon, and rectum. In all cases, the X-Tack™ endoscopic suturing system was used as part of the therapeutic strategy employed to manage the defects. Results:The mean age of the patients was 56.5 years, and 62.5% were male. The most common location was the esophagus (50%). The predominant suture pattern was "Z" (87.5%). In all cases, endoscopic closure of the treated defect was achieved, with no procedure-related adverse events and clinical resolution during the reported follow-up period. Conclusions:In this case series, the X-Tack™ system was used as part of a multimodal therapeutic strategy for the management of complex gastrointestinal fistulas at different anatomical locations. Its use allowed for the closure of the treated defects without procedure-related complications and with clinical resolution, suggesting that it may represent a feasible and safe treatment option in selected patients. Prospective studies with a larger number of patients are needed to more precisely define its role within the therapeutic algorithm for gastrointestinal fistulas.
Periampullary tumors are characterized by their low incidence and are often incidental findings during endoscopic procedures performed for other reasons. Among these, ampullary adenomas carry a potential for malignant transformation, making early detection and timely treatment essential. The choice of resection method primarily depends on the size of the lesion and the degree of deep-layer infiltration, factors that may hinder endoscopic resection and lead to the need for surgical management. Endoscopic resection is usually performed via endoscopic retrograde cholangiopancreatography, and the placement of a pancreatic stent is an effective preventive measure to reduce the risk of post-procedural pancreatitis, one of the most common complications. We present the first documented case in Argentina of endoscopic resection of an ampullary adenoma with placement of a biodegradable pancreatic stent.
Refractory functional constipation is a persistent challenge inpediatrics. Beyond polyethylene glycol and traditional laxatives, newpharmacological and non-pharmacological therapies are emerging. Amongthe innovative medications, prosecretory agents like linaclotide(already approved for children over 6 years old), lubiprostone andplecanatide, wich increase intestinal secretion, stand out. Other drugs,such as prucalopride (5HT-4 agonist) and pyridostigmine, aim to improvemotility. Rectal and interventional therapies include transanalirrigation, -which has shown good results-; antegrade enemas andbotulinum toxin A injections, which are useful for specificdysfunctions. Biofeedback remains an effective tool. Neuromodulation isemerging as a promising option. Implanted sacral nerve stimulation andnon-invasive techniques such as percutaneous/transcutaneous tibial nervestimulation and transcutaneous sacral neuromodulation demonstrateimprovements in symptoms and quality of life. There are therapies thathave been little explored but show promise for the future, such asvibrating capsules, magnetic neurostimulation, and mind-body approacheslike hypnosis. Specific pediatric research and an individualizedtreatment approach are crucial to optimize adherence and outcomes inthese complex patients.
Introduction:. Anti-HCV seropositivity is a public-health concern in Argentina, with potential disparities by gender. We estimated anti-HCV seropositivity in a multicenter public laboratory network, described gender-based differences, and examined the association with all-cause mortality. Methods:Retrospective observational study with centralized chemiluminescent immunoassay testing at Hospital El Cruce, using samples from 64 public centers from January 1, 2013 to December 31, 2023. The analyses were performed at the patient level (the first test per person) and the positivity rate was calculated for each testing site. Vital status information was obtained from hospital records and RENAPER (with a cut-off date of December 2024). Mortality by anti-HCV serostatus was assessed using logistic regression with a prespecified 2:1 matching on age, gender, and testing site. Results:Of the 74,503 adults tested, 1,101 (1.48%) were anti-HCV-positive. Of those tested, 83.0% were women (61,837/74,503) and 17.0% were men (12,666/74,503). Within gender seropositivity was 0.73% in women (451/61,837) and 5.05% in men (639/12,666). The per-test positivity rate was 0.5% in peripheral centers (451/90,194) and 5.1% in the hospital (922/18,082). Of the individuals who tested positive for anti-HCV, 25.0% (275/1,101) were deceased at the cut-off date. In a matched cohort of 2:1 by age, gender, and site, anti-HCV positivity was associated with a higher risk of death (adjusted OR 4.75; 95% CI 3.82 - 5.94; p < 0.001). Conclusions:Men were tested much less frequently than women (17.0% versus 83.0% of those tested), yet they were far more likely to test positive for anti-HCV (5.05% versus 0.73% within gender), accounting for the majority of positive results (58%). Therefore, screening policies should prioritize increasing testing among men, especially in high-yield hospital settings, and ensure rapid linkage to care. The association between anti-HCV seropositivity and higher mortality reinforces the urgency of these actions.
Introduction:. Malnutrition and sarcopenia increase morbidity and mortality in patients with liver cirrhosis. Exocrine pancreatic insufficiency may further worsen nutritional deficits. Aim:. To evaluate exocrine pancreatic function using fecal elastase in patients with liver cirrhosis due to alcohol and other causes. Materials and methods:. Cross-sectional descriptive study including patients with cirrhosis who underwent fecal elastase testing at the Hospital Clínico Universidad de Chile between February 2016 and July 2023. Demographic, clinical, nutritional, and survival variables were evaluated. Results:. Eighty-five patients were included, with a median age of 60 years. The most frequent etiologies were alcohol consumption in 40 patients (47%) and metabolic dysfunction-associated steatotic liver disease in 21 (25%). Of the 85 patients, 88% had fecal elastase > 200 µg/g, 5% had values between 100 - 199 µg/g, and 7% had values < 100 µg/g. Fecal elastase levels were significantly lower in patients with alcohol-related cirrhosis compared with those with other etiologies (p = 0.003). Among patients with alcohol-related cirrhosis, 20% had fecal elastase < 200 µg/g (15% < 100 µg/g). Patients consuming > 20 g/day of alcohol had significantly lower fecal elastase levels (p = 0.013) than those with lower consumption. Conclusion:. In patients with alcohol-related cirrhosis, we found a 20% prevalence of reduced fecal elastase. Alcohol consumption > 20 g/day was associated with lower fecal elastase levels. Considering that malnutrition and sarcopenia influence prognosis and that exocrine pancreatic insufficiency may be clinically silent, measurement of fecal elastase could be justified in patients with alcohol-related cirrhosis, particularly when nutritional deficits are present.
Pediatric Crohn's disease localized exclusively to the ileum is a rare condition in our setting. Due to its overlapping clinical presentation, a high index of suspicion is required, and differential diagnoses must be considered with respect to infectious, infiltrative, and other less frequent conditions. We present the case of an 11-year-old patient with a history of anemia, pain in the right iliac fossa, weight loss, and fever. Imaging studies revealed thickening of the terminal ileum and intestinal stenosis near the ileocecal valve, with prestenotic dilation. Video colonoscopy showed that the colonic mucosa was normal and revealed cicatricial stenosis of the ileocecal valve. The pathological anatomy was inconclusive, reporting moderate nonspecific colitis. Due to symptoms of subintestinal obstruction, a laparoscopic resection of the distal ileum, appendix, ileocecal valve, and cecum was performed, with creation of a double-barrel ostomy. Histology of the surgical specimen confirmed the diagnosis of Crohn's disease.
Introduction:Metabolic dysfunction-associated fatty liver disease (MAFLD) and metabolic dysfunction-associated steatohepatitis (MASH) are highly prevalent conditions and represent a major public health problem. Objective:To conduct an updated systematic review of randomized controlled trials evaluating the impact of semaglutide on hepatic outcomes in patients with MAFLD/MASH. Materials and methods:A systematic literature search was performed in accordance with PRISMA guidelines. Randomized, placebo-controlled clinical trials assessing the effect of semaglutide on hepatic outcomes in patients with MAFLD/MASH were included, using histological parameters and/or imaging methods. Results:The analyzed studies suggest a benefit of semaglutide compared with placebo in hepatic outcomes. Regarding the outcome of MASH resolution without worsening of fibrosis, consistent results were observed among studies that included liver biopsy. However, when evaluating fibrosis improvement without worsening of MASH, the results were heterogeneous. Imaging studies demonstrated a consistent benefit of semaglutide on hepatic steatosis. Nevertheless, no significant changes in liver stiffness were demonstrated. Differences in sample size, follow-up duration, and analyzed populations may explain these discrepancies. Conclusion:The use of semaglutide in patients with MAFLD/MASH was associated with improvements in variables related to hepatic steatosis and, to a lesser extent, with changes in fibrosis markers. These findings should be confirmed in larger studies with longer follow-up periods.
Background:Endoscopic ultrasound is a minimally invasive diagnostic technique that combines endoscopic and ultrasonographic imaging to evaluate gastrointestinal and adjacent tissue lesions. This report describes its use in the diagnosis of mesorectal metastases from renal clear cell carcinoma. Case Presentation:. A 54-year-old woman with a history of renal clear cell carcinoma treated with right nephrectomy. Follow-up computed tomography revealed rectal wall thickening and mesorectal nodules. Endoscopic ultrasound identified a subepithelial rectal lesion and mesorectal nodules, and guided biopsy confirmed metastases from renal clear cell carcinoma (PAX8 and CD10-positive). Conclusion:. Endoscopic ultrasound is an effective method for diagnosing mesorectal metastases, and is particularly useful in rare renal clear cell carcinoma cases.
Infantile hemangioendothelioma is the most common benign mesenchymal tumor of the liver and usually occurs within the first six months of life. Although serum alpha-fetoprotein is a significant tumor marker in cases of hepatoblastoma, hepatocellular carcinoma and germ cell tumors, elevated levels are rarely observed in patients with infantile hepatic hemangioendothelioma. In such cases, given that the differential diagnoses have different prognoses, accessible diagnostic options should be sought in order to to guide clinical management. The exact cause of alpha-fetoprotein elevation in hemangioendothelioma has not yet been clarified, although some studies have shown that hepatocytes trapped near the tumor are responsible for the increased serum levels. In this paper, we describe a clinical case of solitary infantile hepatic hemangioendothelioma as a rare clinical presentation with elevation of this tumor marker.
Mujer de 63 años, asintomática desde el punto de vista digestivo, con antecedente de trastorno ansioso-depresivo en tratamiento con polifarmacia psiquiátrica. Es derivada para cribado de cáncer gástrico por antecedentes familiares. Du· Mario rante la videoendoscopía digestiva alta se observa la mucosa esofágica con desprendimiento laminar, exudado blanquecino, y aspecto traquealizado en toda su extensión (Figura 1). El estómago y el duodeno no presentan alteraciones. Se toman biopsias aleatorizadas de la mucosa esofágica.
Introducción. Las fístulas gastrointestinales son una condición poco frecuente pero potencialmente grave, asociada con colecciones infecciosas, hemorragia, sepsis, malnutrición y aumento de la morbimortalidad. Los avances en la endoscopia terapéutica han ampliado las opciones de tratamientos mínimamente invasivos. El tratamiento endoscópico se ha consolidado como una estrategia de primera línea en las fugas y fístulas anastomóticas colorrectales. En las fístulas esofágicas y gástricas, las prótesis esofágicas continúan siendo una alternativa ampliamente utilizada, aunque su tolerancia puede verse limitada por la localización del defecto. El sistema de sutura endoscópica X-Tack™ (Boston Scientific), introducido en 2020, permite el cierre de defectos anatómicos a través del canal de trabajo del endoscopio, sin necesidad de retirarlo, facilitando el acceso a localizaciones anatómicas complejas y a defectos de mayor tamaño. Pacientes y métodos. Se presenta una serie de nueve defectos fistulosos gastrointestinales en ocho pacientes tratados en Colombia. Las localizaciones incluyeron esófago proximal, estómago, duodeno, colon y recto. En todos los casos se utilizó el sistema de sutura endoscópica X-Tack™ como parte de la estrategia terapéutica empleada para el manejo del defecto. Resultados. La media de edad de los pacientes fue de 56,5 años; el 62,5% correspondió a hombres. La localización más frecuente fue el esófago (50%). El patrón de sutura predominante fue en “Z” (87,5%). En todos los casos se logró el cierre endoscópico del defecto anatómico tratado, sin eventos adversos relacionados con el procedimiento y con resolución clínica durante el seguimiento reportado. Conclusiones. En esta serie de casos, el sistema X-Tack™ fue utilizado como parte de una estrategia terapéutica multimodal para el manejo de fístulas gastrointestinales complejas en diferentes localizaciones anatómicas. Su uso permitió el cierre de los defectos anatómicos tratados sin complicaciones relacionadas con el procedimiento y con resolución clínica, lo que sugiere que puede constituir una alternativa factible y segura en pacientes seleccionados. Son necesarios estudios prospectivos con un mayor número de pacientes para definir con mayor precisión su papel dentro del algoritmo terapéutico de las fístulas gastrointestinales.
Los tumores de la región periampular se caracterizan por su baja frecuencia y por ser hallazgos incidentales en estudios endoscópicos realizados por otras causas. Entre ellos, los ampulomas presentan un potencial de transformación maligna, lo que hace fundamental su detección y tratamiento oportunos. La elección del método de resección depende principalmente del tamaño de la lesión y del grado de infiltración de capas profundas, factores que pueden dificultar la resección endoscópica y condicionar la necesidad de un abordaje quirúrgico. La resección endoscópica se realiza habitualmente mediante colangiopancreatografía retrógrada endoscópica, y la colocación de un stent pancreático constituye una medida preventiva eficaz para reducir el riesgo de pancreatitis posprocedimiento, una de las complicaciones más frecuentes. Se presenta el primer caso documentado en la Argentina de resección endoscópica de un ampuloma, con colocación de un stent pancreático biodegradable.
