Revista de Gastroenterología del Perú

Rescue of a recurrence of rectal adenoma using the endoscopic intermuscular dissection technique

2025-04-26T18:23:01-05:00

Endoscopic intermuscular dissection (EID) emerges as an alternative for the treatment of patients with rectal lesions with suspected deep invasion or with extensive fibrosis which are not candidates for endoscopic submucosal dissection (ESD). In EID the dissection is performed between the inner (circular) and outer (longitudinal) layers of the muscularis propia. We present the case of a patient successfully treated with EID technique. 54-year-old female patient with a history sessile adenomatous lesion of the rectum of approximately 40 mm resected with conventional endoscopic mucosal resection technique. She presented a recurrence of the lesion on the prior resection scar. EID was performed on the scar of prior endoscopic resection, accessing and exposing the intermuscular plane. En bloc resection of the lesion was achieved with negative histological lateral and deep margins, fulfilling criteria for curative resection. Endoscopic resection techniques offer advantages over radical proctectomy, allowing preservation of anorectal function with lower morbidity and mortality. EID has shown effectiveness and safety in prospective studies and case report when ESD is not feasible due to technical limitations. However, further studies are required to evaluate the long-term efficacy and its comparison with other resection techniques.

Endoscopic ultrasound-guided gastro-enteric anastomosis for malignant gastric outlet obstruction: Initial experience in an endoscopic center in Lima-Peru

2024-10-20T18:36:33-05:00

Endoscopic ultrasound-guided gastroenterostomy is a novel, minimally invasive technique used to palliate malignant gastric outlet obstruction (GOO). Utilizing lumen-apposing metal stents (LAMS), the procedure aims to create a communication between the gastric cavity and a jejunal or duodenal loop, offering low morbidity, fewer adverse events, and rapid symptom relief. The causes of GOO include tumors originating in the gastric antrum, duodenum, major papilla, pancreatic head, and distal bile duct. These conditions commonly present symptoms such as postprandial vomiting, abdominal pain, weight loss, early satiety, and abdominal distension. EUS-GE has emerged as an alternative to traditional approaches such as self-expanding metal stent placement and surgical gastrojejunostomy.

Endoscopic findings in microscopic colitis: a diagnostic challenge in clinical practice

2025-06-23T00:45:59-05:00

Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by watery diarrhea and a macroscopically normal-appearing colonic mucosa on colonoscopy. It is classified into lymphocytic colitis (LC) and collagenous colitis (CC). Its incidence has increased in developed countries, but data from Latin America remain limited. We present the case of a 65-year-old woman with fibromyalgia and recent use of duloxetine, who presented with chronic diarrhea. Colonoscopy revealed edematous mucosa with loss of vascular transparency, deep furrows with a cobblestone-like appearance, and an open dot-like surface pattern. Histopathological analysis confirmed a diagnosis of LC. After discontinuing duloxetine, the diarrhea resolved spontaneously without the need for corticosteroids. Although MC has traditionally been described as presenting with a normal-appearing colonic mucosa, studies have reported subtle and nonspecific findings such as edema, erythema, and vascular pattern abnormalities. Detection of these findings can be improved through the use of virtual chromoendoscopy and high-definition equipment. Recognizing these patterns may enhance biopsy targeting and increase the detection of this condition, especially in the evaluation of chronic diarrhea. However, endoscopic findings must be differentiated from other conditions, such as inflammatory bowel disease or ischemic colitis.

Peroral endoscopic myotomy as first-line treatment in pediatric esophageal achalasia: a case report and literature review

2025-06-22T20:45:27-05:00

Esophageal achalasia (EA) is a primary motility disorder characterized by the inability of the lower esophageal sphincter (LES) to relax properly. It is a rare condition in the pediatric population and therefore requires a high index of clinical suspicion. Delayed diagnosis can lead to significant morbidity. Treatment is aimed at reducing LES pressure, which helps relieve symptoms. We present the case of a 10-year-old male patient, with a history of IgE-mediated food allergy to dairy and peanuts, born and raised in the Turks and Caicos Islands, who was referred to our institution with a six-month history of progressive dysphagia for solids, postprandial vomiting, and significant weight loss. A barium esophagram revealed severe dilation of the esophageal body, with a distal esophagus showing the classic “bird’s beak” appearance. High-resolution esophageal manometry confirmed the diagnosis of type I EA. The patient underwent a peroral endoscopic myotomy (POEM), an innovative procedure that has proven to be effective, safe, and durable in the management of pediatric achalasia. This technique is available in experienced centers with specialized equipment and may represent a first-line treatment option in children with esophageal achalasia. To our knowledge, this is the youngest patient reported in Colombia with esophageal achalasia who achieved a successful clinical outcome following POEM.

Gastro-gastric fistula following gastric bypass: a case report

2025-08-10T21:27:35-05:00

A gastro-gastric fistula is an abnormal communication between the excluded gastric pouch and the gastric remnant following Roux-en-Y gastric bypass surgery. This complication typically arises in the late postoperative period and occurs in fewer than 1% of patients. Diagnosing a gastro-gastric fistula can be clinically challenging, as it may present with a spectrum ranging from asymptomatic states to nonspecific symptoms such as epigastric pain, weight regain, gastroesophageal reflux, and emesis. A combination of endoscopic evaluation and contrast imaging studies is essential to establish a diagnosis. There is currently no optimal standardized treatment strategy. Conservative management is generally reserved for asymptomatic patients. Surgical correction remains the standard approach; however, it is technically demanding and associated with higher morbidity compared to primary bariatric procedures. Consequently, novel endoscopic techniques and approaches have emerged, demonstrating promising outcomes and safety profiles in the management of gastro-gastric fistulas.

Abdominal tuberculosis in the era of inflammatory bowel disease: the diagnostic challenge of a forgotten disease

2025-08-10T23:18:05-05:00

Abdominal tuberculosis (ATB) represents a considerable diagnostic challenge due to its nonspecific clinical presentation and resemblance to conditions such as inflammatory bowel disease (IBD) or digestive neoplasms. In endemic regions, timely recognition is crucial to avoid inappropriate immunosuppression and therapeutic delays. Case description: Four immunocompetent adults with ATB were treated at a tertiary-level hospital in southwestern Colombia between January 2023 and May 2025. All presented with chronic diarrhea, abdominal pain, fever, and weight loss. The initial suspicion was Crohn’s disease or infectious colitis. Imaging revealed ileocecal and colonic involvement; endoscopy showed ulcerated lesions, and histology demonstrated granulomatous inflammation with caseous necrosis. Tissue PCR confirmed Mycobacterium tuberculosis infection. In three cases, pulmonary tuberculosis coexisted. All patients received standard antituberculous therapy with favorable outcomes. This series highlights the ability of ATB to mimic IBD and the need to maintain a high index of suspicion in endemic contexts. An integrated approach combining clinical, endoscopic, histological, and molecular evaluation is essential for accurate diagnosis and timely treatment.

Serum infliximab concentrations and body mass index in patients with inflammatory bowel disease

2025-07-31T12:30:53-05:00

Background: Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions associated with healthcare burdens. Advanced therapies, such as infliximab (IFX), have improved disease outcomes. However, the role of body mass index (BMI) in influencing IFX serum concentrations and treatment response remains unclear. Objective: This study aimed to evaluate the association between BMI and IFX serum concentrations during different disease activity phases. Materials and methods: This cross-sectional observational report categorized patients into eutrophic (BMI < 24.9 kg/m²) and overweight/obese (BMI ≥ 25 kg/m²) groups. Serum IFX concentrations were measured, and disease activity was assessed using clinical, laboratory, endoscopic, and/or radiologic criteria. Results: The analysis included 102 patients (80 with CD, 22 with UC). The median serum IFX concentration in eutrophic CD patients was 3.84 µg/mL (1.66–8.82), while in overweight/obese patients was 6.00 µg/mL (1.90–10.34), with no significant difference (p = 0.353). Among the 22 patients with UC, the median serum IFX concentration in eutrophic patients was 6.28 µg/mL (0.860–13.66), compared to 4.23 µg/mL (2.33–12.91) in overweight/ obese patients, with no significant difference (p = 0.920). No differences were found in IFX concentrations between patients in remission or active disease. Conclusions: this study did not confirm that BMI influences IFX concentrations. More studies are needed to explore the impact of BMI on IFX pharmacokinetics and therapeutic efficacy.

Helicobacter pylori eradication and associated factors: dual therapy versus standard triple therapy in Lima, Peru

2025-05-17T21:52:09-05:00

Objective: Helicobacter pylori (H. pylori) infection is the most important risk factor for gastric cancer development. Dual therapy can achieve higher eradication rates than standard triple therapy, and the factors associated with lower eradication rates have not been fully studied. The objective of our study was to evaluate the H. pylori eradication rate and its associated factors using dual therapy versus standard triple therapy. Materials and methods: This retrospective cohort study included 1,506 patients with H. pylori infection who received dual therapy or standard triple therapy. Eradication was confirmed with urea breath test. Chi-square (χ) test was used to analyze categorical variables, and relative risk (RR) was used to assess associations between eradication rates and clinical variables. Results: Eradication was higher with dual therapy, with 84.58% (384/454) versus 73.86% (777/1052) with standard triple therapy (p<0.001). The overall eradication rate with esomeprazole was 82.13% (648/789), followed by lansoprazole at 73.70% (213/289) and pantoprazole at 70.09% (300/428) (p<0.001). No significant differences were found regarding comorbidities such as diabetes, hypertension, or dyslipidemia. Conclusions: The H. pylori eradication rate with dual therapy was superior to standard triple therapy. The proton pump inhibitor with the highest eradication rate was esomeprazole. There were no significant differences in eradication according to sex, age, or comorbidities.

Prevalence of Helicobacter pylori diagnosed by endoscopy in children with gastrointestinal symptoms treated at a tertiary-level hospital in Lima, Peru

2025-03-02T14:54:45-05:00

Helicobacter pylori - is an infection acquired in childhood, especially in countries with high prevalence such as Peru, however, the number of studies in this population is scarce, so the need to describe its prevalence and the need for treatment is evident. Objectives: To determine, through endoscopy and biopsy, the current prevalence of this infection in Peruvian children with digestive complaints who attend the Hospital Nacional Edgardo Rebagliati Martins. Materials and methods: A retrospective descriptive study was conducted with 242 patients aged 0 to 14 years, using the electronic medical records from the hospital system. Results: The prevalence of Helicobacter pylori was 27.2%. There were no characteristic symptoms in the positive versus negative- group. The most relevant endoscopic findings in the positive group were a high frequency of antral nodular gastritis (72.1% vs. 9.8%, p<0.001) and a lower prevalence of endoscopic esophagitis (13.1% vs. 23.6%, p<0.001). Otherwise, histopathological analysis revealed a higher presence of lymphoid follicles (24.5% vs. 4.5%, p<0.001), while chronic inflammation was lower (54% vs. 87.5%, p<0.001). Conclusions: It is concluded that the histopathological findings associated with positive Helicobacter pylori are characteristic in this group and prevalence of this bacteria in Peruvian children seen in a pediatric gastroenterology unit is apparently lower than similar previous studies. This highlights the need for further research to evaluate its relationship with the possibility of antimicrobial resistance and the rising of immune-mediated diseases.

Endoscopic Ultrasound-Guided Hepatogastrostomy (EUS-HGS) as a Rescue Biliary Drainage Strategy: Experience in a Tertiary Care Hospital in Costa Rica.

2025-06-23T00:14:21-05:00

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for biliary drainage, but it may fail in patients with advanced malignant obstruction. In such cases, endoscopic ultrasound-guided hepatogastrostomy (EUS-HGS) has emerged as an effective therapeutic alternative. This retrospective study describes the experience of Hospital San Juan de Dios, Costa Rica, with EUS-HGS as a rescue drainage strategy after failed ERCP. Objective: To describe the institutional experience with EUS-HGS as a biliary drainage technique in patients with unresectable malignant obstruction and failed ERCP, evaluating its technical feasibility, clinical efficacy, and safety in a high-complexity public center. Materials and Methods: Twenty consecutive patients treated with EUSHGS between April 2023 and March 2024 were included. Clinical success was defined as a ≥50% reduction in total bilirubin at 30 days. Adverse events, procedure time, and technical success were evaluated. Results: Technical success was achieved in 100% of cases (20/20). Nineteen patients (95%) reached clinical success. The mean procedure time was 18 minutes. No major complications or mortality were reported. Three patients (15%) presented mild adverse events (abdominal pain and minimal bleeding). Conclusion: EUS-HGS proved to be a safe, effective, and reproducible technique in patients with failed ERCP. The institutional experience supports its use in public centers with trained personnel, strengthening its role in the management of complex malignant biliary obstruction.

Real-world experience with upadacitinib induction for inflammatory bowel disease in Colombia: uparecol-induction

2025-03-15T15:02:55-05:00

ntroduction: There are no studies on the efficacy and safety of upadacitinib for Inflammatory Bowel Disease (IBD) in Latin America. This study aims to describe its efficacy and safety during the induction phase in patients with moderate-to-severe IBD. Materials and methods: A multicenter observational descriptive study in IBD patients who received upadacitinib during the induction phase between July 2024 and January 2025. Results: A total of 26 patients were included, 53.8% female, with a mean age of 41.5 years (range 18.1-70.4; SD 17.5). Ulcerative colitis (UC) was present in 61.5% and Crohn’s disease (CD) in 38.5%, with a mean disease duration of 6.4 years. In UC, 62.5% achieved clinical response, 37.5% clinical remission, and 56.3% biochemical remission. In CD, 70% achieved clinical response, 20% clinical remission, and 50% biochemical remission. Nine of 16 UC patients (56.3%) and 3 of 10 CD patients (30%) achieved clinical remission of stool frequency and abdominal pain. In UC, there was a trend towards greater efficacy in urgency (OR 2.87; 95% CI: 0.53-18.25; p=0.19). Among 12 patients with extraintestinal manifestations (EIMs), 75% achieved remission. Adverse events were reported in 5 patients (19.3%): three cases of acne, one mild infection, and one severe infection. Conclusions: This first Latin American study on upadacitinib in IBD demonstrates its efficacy and safety in patients with moderate-to-severe disease activity.

Safety and efficacy of underwater endoscopic mucosal resection for non-pedunculated colorectal polyps larger than 10 mm

2025-05-08T18:25:56-05:00

Introduction: Colorectal cancer (CRC) is one of the leading causes of cancer-related death in Peru. Endoscopic resection of colorectal polyps has been shown to reduce the incidence and mortality of CRC. Underwater endoscopic mucosal resection (UEMR) has emerged as a safe and effective technique for the management of non-pedunculated polyps. Objectives: To evaluate the efficacy and safety of UEMR for non-pedunculated colorectal polyps larger than 10 mm in a high-complexity hospital in Lima, Peru. Materials and methods: Observational, retrospective, and descriptive study of patients aged ≥18 years who underwent UEMR between January and December 2023. En bloc resection, R0 resection, recurrence, and complication rates were analyzed. Clinical, endoscopic, and histopathological data were collected. Results: A total of 119 UEMRs were performed in 91 patients, with a median age of 72 years. 60.5% of lesions were located in the right colon, and most measured between 10–19 mm. The en bloc resection rate was 80%, and the R0 resection rate was 78%. The complication rate was 15%, including one perforation and two delayed bleeding events. Most complications occurred in the right colon. Recurrence was 3.1%, observed only in piecemeal resections. Histopathological findings included low-grade (47.9%) and high-grade (28.6%) adenomas, as well as 7 carcinomas (5.8%). Conclusions: UEMR is an effective and safe technique for the treatment of non-pedunculated colorectal polyps larger than 10 mm, particularly for lesions ≤20 mm. Its advantages include a high en bloc resection rate, low complication risk, and low cost.

Variceal gastrointestinal bleeding: epidemiology, pathogenesis, management and prophylaxis

2025-08-05T14:00:05-05:00

Variceal gastrointestinal bleeding is one of the main complications of portal hypertension in patients with cirrhosis. It affects those with decompensated cirrhosis, and its occurrence marks a turning point in the progression of liver disease. Despite therapeutic advances, challenges remain in comprehensive management, particularly in resource-limited settings. Treatment aims to control active bleeding, prevent early rebleeding, and reduce mortality. This review summarizes recent evidence on the pathophysiology, diagnosis, and updated management of variceal gastrointestinal bleeding, including emerging strategies such as early vasoactive therapy, rational use of transfusions, antibiotic prophylaxis, and the key role of timely endoscopy. It also highlights the importance of identifying clinically significant portal hypertension to prevent complications and improve clinical outcomes.

Gastric remnant cancer: a comprehensive narrative review from carcinogenesis to treatment

2025-05-17T18:23:55-05:00

Gastric remnant cancer is cancer secondary to partial gastrectomy after five years. Peculiarities due to the gastrectomy status may influence this type of GC. Modifications in the gastric microbiome, luminal pH, dietary habits, increased bile reflux, and Epstein-Barr virus infection, together with the traditional GC risk factors, cooperate to increase the risk of cancer in the remnant stomach. H. pylori infection has been widely associated with GC, and its role in the pathogenesis of the remnant stomach, as well as the preventive effect of its eradication after gastrectomy, are issues of great scientific interest. Bariatric surgery is another condition potentially related to increased GC risk and challenges to its diagnosis. In this scenario, this article aims to review the current evidence of the fundamental aspects involved in developing the gastric remnant cancer

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2025-10-03T03:06:07-05:00