Instituto de Gastroenterología y Endoscopía de Avanzada (IGEA), Argentina; Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Ecuador; Universidad del Salvador (USAL), Argentina; Instituto de investigaciones médicas Alfredo Lanari, Argentina; Instituto Modelo de Cardiología de Córdoba, Argentina; Grupo MIT, Argentina; Sanatorio Allende, Argentina; Instituto Modelo de Gastroenterología de Formosa., Argentina; Instituto Norpatagónico de Gastroenterología y Endoscopía Digestiva (INGED), Argentina; Clínica San Miguel, Argentina; Hospital Nacional Profesor Alejandro Posadas, Argentina; Clínica de Cuyo (CDC), Argentina; Centro de Estudios Digestivos (CED), Argentina; Hospital Italiano de Mendoza (HIM), Argentina; Instituto Otorrinolaringológico Tandil, Argentina; Hospital Regional Río Grande (HRRG), Argentina; Hospital Regional Ramón Carrillo (HRRC), Argentina.

Endoscopic retrograde cholangiopancreatography is the method of choice for draining both benign and malignant biliary obstruction. Given the failure or impossibility of this procedure, the options for draining the biliary tree are limited to percutaneous drainage, surgical biliary diversion, or endoscopic ultrasound-guided bile duct drainage. Echo-endoscopic biliary drainage is an effective alternative to endoscopic retrograde cholangiopancreatography failure and in recent years, it has been taking an increasingly important place because it is less invasive and has a lower rate of complications. Our aim is to report a series of cases of patients with proximal malignant biliary strictures, treated by means of an endoscopic ultrasound-guided liver-gastrostomy, as palliative treatment.

Gastric outlet obstruction is an uncommon condition in children. Traditionally, surgery has been the standard mode of treatment, but it is associated with higher morbidity and mortality. Endoscopic treatment has emerged as an alternative to conventional treatment. We present the case of a 4-year-old patient with refractory prepyloric stenosis secondary to peptic ulcer disease. The picture begins with vomiting and abdominal pain of 2 months of evolution. Pre-pyloric stenosis was confirmed. Faced with the lack of response to medical treatment and balloon dilation, radiated incisions were made with electrocautery and steroid injections. When medical treatment is not sufficient, endoscopic balloon therapy should be the first therapeutic gesture in this type of stenosis; given its refractoriness, we believe it is important to highlight the usefulness of endoscopic treatment, which could prevent surgery and associated morbidity and mortality.

Background: Endoscopic self-expanding metallic colonic stent / prosthesis placement emerges as a therapeutic option for neoplastic colonic obstruction in two situations: palliative treatment and bridge to surgery. This procedure makes it possible to avoid two-stage surgeries and reduce the probability of a definitive colostomy with the consequent deterioration in quality of life and associated complications. Aim: To report our experience in the placement of colonic prostheses in neoplastic obstruction as palliative treatment in our environment, after 10 years of experience. Design: Prospective, longitudinal, descriptive and observational. Method: From August 2008 to December 2019, all patients who received self-expanding metallic colonic stent with palliative intention due to advanced CRC were analyzed by the same group of endoscopists. Demographic and clinical variables, technical success, clinical success, survival, early and late complications, as well as their resolution were analyzed. Results: A total of 54 self-expanding prostheses were placed. The mean age was 71 years. 85% of the lesions were located in the left colon. 58% of the cases (31 patients) were performed on an outpatient basis. Technical and clinical success was 92% and 98% respectively. With an average survival of 209 days. Conclusion: These 10 years of experience allow us to conclude that the placement of self-expanding metal prostheses as a palliative treatment for neoplastic colonic obstruction is effective, safe, and can be performed in both an outpatient setting and with a short hospital stay, allowing early oral discharge and feeding. improving the conditions to face a possible palliative chemotherapeutic treatment. Keywords: Colorectal cancer, colonic prosthesis, colorectal obstruction, quality of life.

Tratamiento endoscópico de la obstrucción del tracto de salida gástrico de origen pépticocicatricial en un niño de 4 añosEndoscopic treatment of cicatricial pyloric stenosis of peptic origin in a 4-year-old boy

Resumen: Introducción: La colocación de stent/prótesis colónicas metálicas autoexpansibles por vía endoscópica surge como opción terapéutica para la obstrucción colónica neoplásica en dos situaciones: tratamiento paliativo y puente a la cirugía. Este procedimiento permite evitar cirugías en dos tiempos y disminuir la probabilidad de colostomía definitiva con el consecuente deterioro de la calidad de vida y complicaciones asociadas la misma. Objetivos: Comunicar nuestra experiencia en la colocación de prótesis colónicas en la obstrucción neoplásica como tratamiento paliativo en nuestro medio, tras 10 años de experiencia. Diseño: Prospectivo, longitudinal, descriptivo y observacional. Material y métodos: Desde agosto de 2008 a diciembre de 2019, se analizaron todos los pacientes a quienes el mismo grupo de endoscopistas colocaron PAE con intención paliativa por CCR avanzado. Fueron analizadas las variables demográficas, clínicas, el éxito técnico, el éxito clínico, la sobrevida, las complicaciones tempranas y tardías, así como su resolución. Resultados: Se colocaron un total de 54 prótesis autoexpansibles. La media de edad fue 71 años. El 85% de las lesiones se localizaron en colon izquierdo. El 58% de los casos (31 pacientes) se realizaron en forma ambulatoria. El éxito técnico y clínico fue del 92% y 98% respectivamente. Con una sobrevida promedio de 209 días. Conclusiones: Estos 10 años de experiencia nos permiten concluir que la colocación de prótesis metálicas autoexpansibles como tratamiento paliativo de la obstrucción neoplásica colónica es eficaz, segura, se puede realizar tanto en forma ambulatoria como con internación breve, permitiendo la externación y alimentación oral temprana, mejorando las condiciones para afrontar un eventual tratamiento quimioterapéutico paliativo.

Introduction. Barrett Esophagus is an acquired condition secondary to gastroesophageal reflux disease, and it´s the main risk factor for Esophageal Adenocarcinoma. Although there is controversy about tissue sampling at endoscopy when segments are lesser than 10 mm, the prevalence of ultrashort Barrett´s esophagus is up to 20%. Objective. To estimate ultrashort Barrett Esophagus prevalence in a poblational cohort of Argentina and to assess the presence of dysplasia. Methods. A cross-sectional study of the endoscopic and pathological reports of ultrashort Barrett suspicion in an outpatient endoscopy center was performed during 2016-2017. 894 patients were enrolled. Results. 52% of the cohort were male, whose mean age was 56 years (± 12 years). Average Body Mass Index was 26 ± 4 kg/m2. Endoscopically, 50% had hiatal hernia and mean length was 2.32 ± 0.59 cm. Virtual chromoendoscopy was applied in 60% of patients. Ultrashort Barrett´s Esophagus prevalence was 25% (IC 95%), 224/894 patients. Median length was 0.74 ± 0.24 cm. Male sex and presence of hiatal hernia showed a statistically significant association with ultrashort BE presence in multivariate analysis. Conclusion. Ultrashort BE was identified in 25% of the patients, being more frequent in male sex and in patients with hiatal hernia; two variables that are independently related to intestinal metaplasia. Dysplasia was not observed.

The American Society for Gastrointestinal Endoscopy has proposed two policies for handling diminutive rectosigmoid polyps known as "predict, resect and discard" and "predict and leave in". These strategies were proposed as cost-effective supported on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended.

Antecedentes. El sangrad o rectal es un signo precoz de cán - cer colorrectal (CCR), cuyo diagnóstico temprano disminuye la morbi-mortalidad. En individuos jóvenes sin factores de riesgo la enfermedad es poco prevalente. Asimismo, los des - órdenes anorrectales benignos son la causa más frecuente de sangrado y la patología periorificial identificada es asumida como el origen del signo. Por estas razones, el sangrado rectal con frecuencia es subevaluado en adultos jóvenes. Objeti - vo. Estimar la prevalencia de adenomas y adenocarcinomas de recto-sigma en pacientes menores de 50 años con procto - rragia. Métodos. El estudio tiene un diseño: observacional, retrospectivo y transversal. Los procedimientos se realizaron bajo sedación con equipos Olympus CF 160 y CF 180. Se consideró proctorragia al sangrado rectal registrado como indicación de videocolonoscopía (VCC). La confirmación histológica fue establecida según la clasificación de Viena. Los pacientes firmaron el consentimiento informado previo al procedimiento. Se revisaron las VCC realizadas en adul - tos de ambos sexos menores de 50 años que consultaron por sangrado rectal a un centro ambulatorio de Gastroenterolo - gía entre octubre de 2010 y octubre de 2011. Se excluyeron los pacientes de alto riesgo para CCR. Resultados. Se revi - saron 1.257 VCC y se incluyeron 1.203 pacientes, 49% fueron mujeres y la edad media fue 38 años (rango: 18-49 años). La prevalencia de adenomas fue 6,7% [intervalo de confianza del 95% (IC 95%) 5,4–8,3], y la de adenocar - cinoma 1,6% (IC 95% 1–2,5). Conclusiones. El adeno - carcinoma y las lesiones adenomatosas son poco frecuentes en individuos jóvenes. Aunque la proctorragia es un signo hallado más frecuentemente en patologías anorrectales benignas, subestimar este signo podría tener un serio impacto en casi 10 de cada 10 0 individuos.

Colorectal cancer (CRC) is a major cause of death from cancer in western world and rectal bleeding is a clinical presentation. In the young population with no risk factors for CRC, its prevalence is lower and the etiology of rectal bleeding is often benign. For these reasons, the investigation of young patients who have rectal bleeding is frequently underestimated.

BACKGROUND:Rectal bleeding is a sign of colorectal cancer (CRC). Its early diagnosis decreases mortality and improves survival. In young population with no risk factors for the disease, CRC is infrequent. Moreover, benign anorectal disorders are most frequent causes of bleeding and generally, when anal pathology is identified, it is assumed as the origin of the sign. For all these reasons, rectal bleeding sometimes is sub-assessed in young patients.OBJECTIVE:Estimate the prevalence of adenomas and adenocarcinomas in sigmoid and rectum in patients younger than 50 years old referred for proctorrhagia.METHODS:The study design was descriptive, retrospective and cross-sectional. Procedures were performed under sedation and Olympus CF 160 y CF 180 scopes were used. Proctorrhagia was considered as rectal bleeding registered as indication of the procedure. Histology was established according to Vienna classification. Informed consent was signed before the procedures. Colonoscopy reports were reviewed. The study took place in an outpatient clinic in Buenos Aires city, between October 2010 and October 2011. High risk patients for CRC were excludedRESULTS:We included 1,203 from 1,257 reviewed VCC, 49% were female and the median age was 38 years old (range: 18-49 years old). The prevalence of adenomas and adenocarcinomas in sigmoid and rectum was 67% [95% confidence interval (95% CI): 5.4-8.3] and 1.6% (95% CI 1-2.5), respectively.CONCLUSIONS:Adenocarcinomas and adenomas are infrequent in a young population without risk factors for CRC. However, even when benign anal disorders are the most frequent cause for rectal bleeding, miss evaluation of this sign could have a serious impact in almost 10 of 100 individuals.

Colorectal cancer (CRC) has a high mortality rate, is preventable and curable if it is early diagnosed. Adenomas, preneoplastic lesions, have different morphology, being flat lesions generally more aggressive in the adenoma-carcinoma sequence. Accuracy in flat adenomas detection during white light endoscopic examination is suboptimal and high definition diagnostic techniques are not available worldwide. For these reasons the true prevalence of these polyps is controversial.