Revista de Gastroenterología del Perú

From presumed metastasis to infection: coccidioidomycosis mimicking metastatic gastroesophageal adenocarcinoma

Wilfor Diaz Fernandez — 2026-09-15

Early gastroesophageal junction (GEJ) cancer commonly presents without distant disease. The development of locoregional lymphadenopathy and acute pulmonary embolism raises concern for metastatic disease and may lead to inappropriate upstaging if not properly investigated. We present a 51-year-old immunocompetent Hispanic man with newly diagnosed T1a GEJ adenocarcinoma who developed FDG-avid mediastinal lymphadenopathy and an incidental subsegmental pulmonary embolism on staging computed tomography. Histological sampling via endobronchial ultrasound-guided fine needle aspiration revealed granulomatous inflammation without malignancy. Further workup confirmed an acute Coccidioides lymphadenitis. The patient was successfully treated with fluconazole 400 mg daily for three months, with complete radiological and endoscopic resolution. This case underscores the critical importance of histological confirmation of lymphadenopathy before attributing it to metastatic disease in early-stage GEJ cancer. Failure to consider infectious etiologies, particularly coccidioidomycosis in endemic areas or in patients with travel history, may result in unnecessary upstaging, inappropriate treatment escalation, and avoidable harm.

Pancreatic neuroendocrine tumor masquerading as intra-ductal papillary mucinous neoplasm: a case report

Pritesh Kumar N. — 2026-09-25

Pancreatic cysts are being commonly diagnosed owing to the increased utilization of radiological modalities for the evaluation of abdominal complaints. Cysts can represent an underlying benign, pre-malignant or malignant diagnosis, and making an accurate diagnosis is often challenging. Here we report a case of a pancreatic cystic lesion, provisionally diagnosed as intra-ductal papillary mucinous neoplasm (IPMN) based on pre-operative and intra-operative findings, which on final histopathology turned out to be a pancreatic neuroendocrine tumor.

Metástasis ganglionar cervical como presentación inicial de carcinoma esofágico pobremente diferenciado que simula origen mamario: un desafío diagnóstico

Melissa Joyseleni Ayala Antonio — 2026-09-12

El cáncer de esófago es una neoplasia maligna de alta mortalidad, frecuentemente diagnosticada en estadios avanzados debido a su presentación clínica inespecífica. La disfagia progresiva constituye el síntoma cardinal; sin embargo, en ocasiones puede manifestarse inicialmente mediante metástasis ganglionares, lo que dificulta la identificación del tumor primario. Se presenta el caso de una mujer de 49 años con tumoración cervical derecha de crecimiento progresivo asociada a disfagia de tres meses. La tomografía evidenció un nódulo en el espacio carotídeo derecho. La biopsia ganglionar reveló metástasis de carcinoma pobremente diferenciado. La inmunohistoquímica mostró positividad para CK7, GATA3 focal débil y receptores hormonales, sugiriendo inicialmente origen mamario; no obstante, los estudios mamarios fueron negativos. Posteriormente, la tomografía torácica identificó engrosamiento mural esofágico, confirmado mediante endoscopia y biopsia como carcinoma esofágico pobremente diferenciado con estenosis significativa. Se realizó gastrostomía para soporte nutricional y se planificó tratamiento con quimiorradioterapia. La presentación inicial del cáncer de esófago como adenopatía cervical metastásica es infrecuente y puede generar confusión diagnóstica, especialmente cuando el perfil inmunohistoquímico sugiere otro origen tumoral. Reconocer estas formas atípicas es fundamental para orientar la búsqueda del tumor primario y establecer un tratamiento oportuno.

Enterocolitis secundaria a coinfección parasitaria y bacteriana en un paciente pediátrico de Ecuador: reporte de un caso

Joshua Israel Culcay Delgado — 2026-09-12

Casi la mitad de la población mundial, aproximadamente 3 500 millones de personas, está actualmente infectada con al menos un parásito, y alrededor de 1 500 millones de estas infecciones son causadas por helmintos. Estas cifras suelen asociarse con regiones extremadamente empobrecidas como África o el Sudeste Asiático; sin embargo, en el continente americano, una de cada tres personas se ve afectada por infecciones parasitarias, siendo los niños el grupo más vulnerable, con aproximadamente 43 millones de casos. Esta situación representa más que un problema de salud pública, ya que su mitigación depende no solo de programas de profilaxis farmacológica, sino también de acciones sinérgicas que involucren políticas públicas y la asignación de recursos destinados a modificar los determinantes de salud que facilitan estas infecciones. En este estudio, presentamos un caso clínico de coinfección parasitaria por helmintos y protozoos, agravada por la presencia concomitante de tres cepas enteropatógenas de Escherichia coli. Este informe tiene como objetivo describir en detalle los factores de riesgo, presentación clínica, microbiología y patogénesis de los agentes infecciosos involucrados, así como la utilidad de los estudios de laboratorio necesarios para su identificación oportuna.

Brunner’s gland hamartoma causing gastric outlet obstruction: case report

César Vivian Lopes — 2026-09-25

Proliferative lesions of Brunner’s glands > 5 mm in size are called hamartomas. Brunner’s gland hamartomas are located mainly in the first and second portions of the duodenum and are mostly asymptomatic. However, large hamartomas can lead to serious complications, such as gastric outlet obstruction. Herein, we describe the case of a patient with a large duodenal Brunner’s gland hamartoma admitted with gastric outlet obstruction, which was resected successfully endoscopically. A 59-year-old female was admitted with a history of recurrent episodes of postprandial vomiting and upper abdominal pain. Esophagogastroduodenoscopy revealed a pedunculated polyp on the duodenal bulb, causing intermittent pyloric obstruction. Endoscopic biopsies were inconclusive. Linear endosonography showed a solid lesion arising from the submucosal layer, and samples obtained by EUS-guided tissue acquisition confirmed a Brunner’s gland hamartoma. The lesion was endoscopically resected with a hot snare, and the specimen was transorally retrieved. After polyp removal, the patient’s symptoms were completely resolved. A patient with recurrent episodes of postprandial vomiting and upper abdominal pain, in the presence of a subepithelial duodenal lesion, either pedunculated or sessile, should have ruled out a Brunner’s gland hamartoma. EUS-guided tissue acquisition can confirm the diagnosis, and endoscopic resection is feasible for most cases.

Hemorragia digestiva alta secundaria a várices downhill en un paciente con enfermedad renal crónica: reporte de un caso

Gonzalo David Layza-Reyes — 2026-09-25

Las várices downhill son un subtipo infrecuente de varices esofágicas, generalmente asociadas a obstrucción del retorno venoso superior. A diferencia de las várices por hipertensión portal, no existen guías clínicas específicas que lo describan, por lo que la información disponible se basa principalmente en reportes de casos aislados y series limitadas. Presentamos el caso de una mujer de 31 años con ERC, en hemodiálisis desde hace 17 años y con antecedente de múltiples accesos venosos centrales. La paciente ingresó por emergencia con un cuadro de hematemesis y melena, el estudio endoscópico identificó las varices downhill. Tras su manejo con endoligadura y polidocanol, estudios posteriores evidenciaron una obstrucción venosa central causante de esta patología. Este caso resalta la importancia de considerar esta entidad en pacientes con factores de riesgo similares, así como la necesidad de generar mayor evidencia que contribuya al desarrollo de recomendaciones específicas para su diagnóstico y manejo adecuado.

Risk factors for thiopurine-related toxicity in Latin American inflammatory bowel disease patients

Belén Giacaman — 2026-09-12

Objectives: Thiopurines continue to play a role in inflammatory bowel disease (IBD) treatment, particularly in resource-limited countries. However, there are scarce data from Latin America regarding thiopurines-associated AE. We aim to describe the thiopurine-associated AE and determine risk factors for its occurrence. Materials and methods: Clinical data from IBD patients treated with thiopurines in a Chilean tertiary centre were retrospectively collected including AE that required thiopurine withdrawal and weight-based thiopurine dose. A multivariable model was fitted to determine independent risk factors of thiopurine-related AE. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: A total 163 out of 587 (27.7%) patients discontinued thiopurine treatment due to AE including myelosuppression, hepatitis, pancreatitis, and gastrointestinal intolerance. Multivariate analysis showed that older age (OR: 1.02; 95% CI: 1.01-1.04; p=0.01) and lower body weight (OR: 0.97; 95% CI: 0.95-0.99; p=0.01) were independent risk factors for thiopurine-associated AE. Conclusions: Discontinuation of thiopurines due to AE is frequent in Latin IBD patients. Particular caution should be exerted in older and low-weight IBD patients starting thiopurine treatment.

Trends in the clinical presentation of celiac disease over time: a study from a national university hospital in Uruguay

Carolina Olano — 2026-09-12

The clinical presentation of celiac disease (CD) has evolved over recent decades. Understanding these shifts is essential to strengthen diagnostic suspicion and improve detection. Objectives: To evaluate temporal trends in the clinical presentation of CD at a university hospital in Uruguay. Materials and methods: A retrospective cross-sectional study, approved by the institutional ethics committee, was conducted. It included patients diagnosed with CD between 1970 and 2023 who presented positive IgA anti-tissue transglutaminase antibodies and compatible duodenal histology (Marsh III). Patients were categorized by diagnostic period: before 1986, 1986-1995, 1996-2005, 2006-2015, and 2016-2023. Clinical presentation was classified according to the Oslo criteria as classical, non-classical, or asymptomatic. Results: A total of 331 patients were included; 84% were female. The mean age at diagnosis was 32 years (range 0-77), showing a progressive shift toward adulthood diagnosis. Overall, 61% presented with classical CD, 27% with non-classical CD, and 12% were asymptomatic. Linear trend analysis demonstrated a significant decrease in classical CD (slope -15.7, p=0.0003), accompanied by an increase in non-classical (slope 12.5, p=0.00267) and asymptomatic presentations (slope 3.15, p=0.042). Conclusions: Over the past four decades, CD presentation has shifted toward later diagnosis and away from classical phenotypes, with an increasing recognition of non-classical and asymptomatic forms. These findings underscore the importance of maintaining clinical suspicion beyond traditional malabsorptive presentations.

Estimación de la demanda de colonoscopía para un tamizaje de cáncer colorrectal basado en un test de sangre oculta en deposiciones en Chile

Oscar Corsi — 2026-09-26

El tamizaje de cáncer colorrectal (CCR) basado en test de sangre oculta en deposiciones (TSOD) ha demostrado su eficacia en múltiples estudios. Objetivo: El objetivo de este trabajo es estimar la demanda potencial de colonoscopia a partir de TSOD inmunológica cualitativa de muestra única en la población general de 50-75 años del sistema público de salud (FONASA) según datos de la Encuesta Nacional de Salud (ENS) 2016-2017 en Chile para evaluar su factibilidad de implementación. Materiales y métodos: Estudio de prevalencia en una sub-muestra representativa de participantes entre 50-75 años beneficiarios de FONASA. Se aplicó una TSOD inmunológica cualitativa de muestra única. Se compararon las prevalencias TSOD positivo entre distintos grupos y se construyeron modelos multivariados ajustados por sexo, edad, zona urbano - rural, previsión de salud, IMC, consumo de alcohol, tabaco y antecedente familiar de CCR. Resultados: Se incluyeron un total de 892 personas (97,8% retorno), edad promedio de 60,52 (DE 0,40) años, 53,71% mujeres y 3,22% refirió antecedente familiar de CCR. La prevalencia de sangrado digestivo bajo en los últimos 3 meses alcanzó 10,22% y de cambio en el hábito intestinal, 36,86%. La positividad de la PSOD fue de 17,46% (IC95% 14,07-21,29), sin diferencias según sexo, antecedente familiar de CCR o reporte de síntomas, estimando una demanda de colonoscopía para 440,443 personas. Conclusiones: La implementación de una estrategia basada en una TSOD exige un aumento significativo de la oferta de colonoscopía en Chile para responder a la demanda incremental del grupo etario distribuida de forma heterogénea entre regiones.

Comparison between the different suction techniques for eus-guided tissue acquisition in pancreatic diseases and other gastrointestinal lesions: a systematic review and meta-analysis of randomized controlled trials

Edson Guzmán-Calderón — 2026-09-12

Objectives: Endoscopic ultrasound–guided fine-needle aspiration/biopsy (EUS-FNA/B) is pivotal for diagnosing solid pancreatic lesions and other gastrointestinal (GI) masses. Multiple suction strategies are used to optimize tissue acquisition. Currently, their comparative performance remains uncertain. Materials and methods: We searched PubMed, Medline, Cochrane, and Ovid through July 2025 for English-language. RCTs comparing four suction methods during EUS-FNA/B of solid pancreatic or other GI lesions. Primary outcomes were specimen tissue adequacy and diagnostic accuracy. Results: Twenty-two RCTs encompassing 2,922 patients were included; pancreas was the sampled organ in 81% of cases, with the remainder primarily lymph nodes. Across 20 RCTs reporting adequacy, WS was associated with lower specimen adequacy than no suction (RR 0.88, 95% CI 0.77-0.99). WS likewise yielded lower diagnostic accuracy than no suction (RR 0.89, 95% CI 0.82-0.97). In head-tohead comparisons versus DS, differences among DS, SSP/capillarity, no suction, and WS were generally nonsignificant. Ranking analyses favoured no suction as the top performer and consistently placed WS lowest for both adequacy (p=0.92 vs 0.06, respectively) and accuracy (p=0.96 vs 0.04, respectively). In the needle-stratified analysis, results were concordant: with 22-G devices, WS showed lower adequacy (RR 0.86, 95% CI 0.74-0.99) and lower accuracy (RR 0.86, 95% CI 0.77-0.95) than with no suction. Conclusions: This meta-analysis suggests that wet suction may be associated with lower diagnostic yield and reduced tissue adequacy compared to no suction, especially with 22G needles. However, outside of these comparisons, no consistent differences were observed among the other techniques. Future comparative studies with standardized methodology and stricter control of confounding factors are needed.

Scientific productivity of gastroenterologists in Peru: a nationwide cross-sectional study

Diego A. Leon-Quispe — 2026-09-12

Objectives: To describe the characteristics of scientific publications by Peruvian gastroenterologists. Materials and methods: A descriptive cross-sectional study was conducted in a random sample of 357 gastroenterologists registered with the Colegio Médico del Perú as of July 2025. The literature search was performed in PubMed/MEDLINE, Scopus, and Google Scholar between August and October 2025, including articles published up to 2024. Results: Most gastroenterologists were male (64.2%), with a median age of 49 years (IQR: 39-63). Overall, 42.9% had published at least one scientific article, mostly 1-2 publications; only 5.9% had more than 10 articles. The median h-index was 1 (IQR: 1-2). A total of 559 articles were identified, of which 61.5% were published in Peruvian journals and 67.3% in Spanish. Original articles accounted for 56.7%, predominantly with analytical designs, and 53.9% were published in Q3-Q4 journals. The median number of citations per article was 2 (IQR: 0-6). Among articles with more than 10 citations, only 10.2% had a Peruvian gastroenterologist as first author. The main research topics were Helicobacter pylori and gastric diseases, hepatology, and diagnostic and therapeutic endoscopy. Conclusions: Fewer than half of Peruvian gastroenterologists have published at least one scientific article, and among those who did, both productivity and academic impact were low. Publications were mainly concentrated in local, lower-quartile journals, with few citations.

Patient preferences and perceptions of inflammatory bowel disease monitoring tools: a cross-sectional survey from a specialized gastroenterology clinic in Panama

Carlos Rettally — 2026-09-25

Objectives: The aim of this study was to evaluate patient preferences and perceptions regarding commonly used tools for monitoring inflammatory bowel disease (IBD), including colonoscopy, intestinal ultrasound (IUS), computed tomography or magnetic resonance imaging (CT/MRI), and fecal calprotectin (FC). Materials and methods: A cross-sectional anonymous electronic survey was administered to adult patients with a confirmed diagnosis of IBD attending a specialized private gastroenterology clinic in Panama. Eighty-two patients were invited to participate, and fifty-one completed the survey. Intestinal ultrasound was associated with the highest levels of satisfaction and acceptability. Results: Colonoscopy was most frequently perceived as providing physicians with the most useful clinical information and as the test that best helped patients understand their disease status. When asked which single test they would prefer to repeat for ongoing disease monitoring, most participants selected IUS. These findings suggest that patients favor non-invasive monitoring strategies, although colonoscopy continues to be perceived as the diagnostic reference standard. Conclusions: Improving patient education regarding the clinical value of IUS may facilitate broader adoption of patient-centered monitoring approaches in routine practice.

Guía informada por la evidencia para el manejo de la enfermedad de Crohn en población adulta: recomendaciones de la Pan American Crohn's and Colitis Organisation (PANCCO)

Fabian Juliao-Baños — 2026-08-24

Introducción. La enfermedad de Crohn (EC) es una enfermedad inflamatoria intestinal crónica, recidivante y progresiva cuya incidencia y prevalencia han aumentado de forma sostenida en América Latina, asociadas a la urbanización y la occidentalización de los estilos de vida. Su curso heterogéneo, el daño estructural acumulativo y el impacto en la calidad de vida justifican recomendaciones regionales que orienten el tratamiento médico, endoscópico y quirúrgico de los adultos afectados. Objetivo. Presentar las recomendaciones informadas por la evidencia de la guía de la Pan American Crohn's and Colitis Organisation (PANCCO) para el manejo de la EC en adultos latinoamericanos. Metodología. La guía se desarrolló mediante adaptación y actualización de la guía de la Asociación Colombiana de Gastroenterología (2020), siguiendo las orientaciones de la OPS/OMS. Un grupo desarrollador interdisciplinario formuló siete preguntas clínicas en formato PICO; cuatro fueron actualizadas mediante búsquedas sistemáticas (enero 2020–febrero 2026) en MEDLINE, Embase, Cochrane y Epistemonikos, con evaluación de calidad mediante AMSTAR-2, ROBIS, RoB 2.0 y ROBINS-I, y calificación de la certeza y formulación de recomendaciones mediante el sistema GRADE. Resultados. Se formularon 52 recomendaciones organizadas en siete preguntas clínicas sobre predicción de recaída, inducción y mantenimiento de la remisión con terapia convencional, terapia avanzada en enfermedad moderada a grave, enfermedad perianal fistulizante, abordaje quirúrgico-endoscópico y prevención de la recurrencia posquirúrgica, complementadas con puntos de buena práctica clínica. Conclusiones. Esta guía reúne la evidencia más reciente disponible para el tratamiento de la EC en adultos, incorporando el uso de terapias avanzadas, el manejo multidisciplinario de la enfermedad perianal fistulizante, y el papel de la cirugía y la endoscopia terapéutica, ofreciendo un marco práctico para la toma de decisiones clínicas en el contexto de recursos y necesidades propio de América Latina.

Calidad en endoscopía: más allá de completar el procedimiento

Hugo Cedrón Cheng — 2026-09-26

Estado actual y evolución de la procura de órganos y tejidos en EsSalud: gestión funcional versus gestión por procesos

Yazcitk Miguel Sandoval-Guevara — 2026-09-26

El trasplante de órganos y tejidos constituye la mejor alternativa terapéutica para la insuficiencia orgánica terminal, pero su desarrollo depende de la disponibilidad de donantes. Esta revisión narrativa institucional, de carácter histórico y crítico, analiza la evolución de la procura de órganos y tejidos en el Seguro Social de Salud del Perú (EsSalud) desde la creación de la Gerencia de Procura y Trasplante en 2011 hasta el primer semestre de 2026. La revisión describe cinco etapas de desarrollo institucional: la organización inicial, la expansión de unidades y coordinadores, el fortalecimiento operativo, la gestión basada en información y la transición hacia una gestión por procesos. Esta transformación se expresa en la cadena de procura de cinco eslabones, la ampliación de la red de once a veinticinco Unidades de Procura, la implementación del Centro de Operaciones de Procura y la formulación de la estrategia Hospital Amigo de la Donación. Se presenta la producción histórica de los procesos de procura en EsSalud desde el 2011-2026 y se incluyen los indicadores del primer semestre de 2026, manteniendo una negativa familiar que se mantiene como principal barrera de 85% en el DNI. Los beneficios de las intervenciones descritas mostrarán resultados en los próximos meses y será necesario una evaluación posterior para valorar el impacto en la mejora de la donación de órganos y tejidos en nuestro país.

Standardization of quality in bariatric endoscopy: the BEQI framework and a simplified assessment tool (BEQI-S)

Rodrigo Dorelo — 2026-09-14

Upper gastrointestinal endoscopy plays a central role in the preoperative assessment and postoperative follow-up of patients undergoing bariatric surgery. However, despite the increasing procedural volume and the complexity associated with surgically altered gastrointestinal anatomy, no specific validated quality indicators currently exist for this setting. This gap contributes to substantial variability in clinical practice and may impact diagnostic performance and patient safety. The aim of this study was to critically analyze the available evidence on quality in upper gastrointestinal endoscopy in bariatric surgery and to propose a structured framework of specific quality indicators. A structured narrative review was conducted based on a literature search in PubMed, LILACS, Embase, and the Cochrane Library (2015–2025), prioritizing clinical guidelines, position statements, and studies with methodological relevance and clinical applicability. Based on this synthesis, the Bariatric Endoscopy Quality Indicators (BEQI) framework was developed, organizing quality indicators across the pre-procedural, intra-procedural, and post-procedural phases, and integrating established endoscopic quality domains with bariatric-specific variables. In addition, a simplified tool (BEQI-S) was designed as a 13-item binary checklist, enabling a structured assessment of procedural quality and incorporating the concept of critical failures. The implementation of these indicators may contribute to standardizing clinical practice, improving diagnostic quality, enhancing patient safety, and facilitating audit and quality improvement processes. Prospective multicenter validation represents the next essential step to establish this model as a quality standard in bariatric endoscopy.