RESUMO
Background: Barrett's esophagus (BE) is the replacement of the usual esophageal mucosa by a simple columnar epithelium with the presence of goblet cells (GC) of intestinal type. It has been related to different risk factors such as gastroesophageal reflux disease (GERD), inappropriate consumption of irritating foods, smoking and overweight. There are CC mimic cells, known as blue cells (BC), which make the diagnosis of BE difficult, due to the lack of a precise definition of the nature and location of the gastroesophageal junction and the microscopic variations in this area. Objective: To identify morphologically and with histochemical techniques Alcian blue (AA) and periodic acid-Schiff (PAS) between GC and BC. Material and methods: Retrolective cross-sectional analytical study where 45 samples of patients diagnosed with BE were included. Results: The morphological characteristics are similar in both cell varieties. PAS staining was 100%, unlike AA staining, with only 16 cases with staining, corresponding to 35.55%. Conclusions: PAS staining has a high sensitivity and specificity for the identification of GC, this being a fundamental pillar for the correct diagnosis of BE. The presence of BC detected by AA does not exclude the diagnosis of BE, since both cell types can coexist.
Introducción: el esófago de Barrett (EB) es el recambio de la mucosa habitual esofágica por un epitelio cilíndrico simple con presencia de células caliciformes (CC) de tipo intestinal. Se ha relacionado con factores de riesgo como la enfermedad por reflujo gastroesofágico (ERGE), consumo inapropiado de alimentos irritantes, tabaquismo o sobrepeso. Hay células imitadoras de las CC, las células azules (CA), que dificultan el diagnóstico del EB y es debido a falta de una definición precisa sobre la naturaleza y ubicación de la unión gastroesofágica y las variaciones microscópicas en esta zona. Objetivo: identificar morfológicamente y con las técnicas de histoquímica azul alciano (AA) y ácido peryódico de Schiff (PAS) las CC y las CA. Material y métodos: estudio transversal retrolectivo analítico; se incluyeron 45 muestras de pacientes diagnosticados con EB. Resultados: las características morfológicas son similares en ambas variedades celulares. La tinción de PAS fue del 100%, a diferencia de la tinción de AA, con solo 16 casos con tinción, correspondiente al 35.55%. Conclusiones: la tinción de PAS tiene una alta sensibilidad y especificidad para la identificación de CC, lo cual es fundamental para el correcto diagnóstico de la EB. La presencia de CA detectadas mediante AA no excluye el diagnóstico de EB, ya que ambos tipos celulares pueden coexistir.
Assuntos
Esôfago de Barrett , Humanos , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/complicações , Esôfago de Barrett/metabolismo , Células Caliciformes/metabolismo , Estudos Transversais , Azul Alciano/metabolismoRESUMO
El esófago de Barrett (EB) se define como la condición en la cual una mucosa columnar metaplásica predispuesta a neoplasia reemplaza la mucosa escamosa del esófago distal. La guías actuales recomiendan que el diagnóstico requiere el hallazgo de metaplasia intestinal (MI) con células caliciformes de al menos 1 cm de longitud. El EB afecta aproximadamente al 1% de la población general y hasta en 14% de los pacientes con enfermedad por reflujo gastroesofágico (ERGE). El EB es precursor del adenocarcinoma esofágico (ACE), neoplasia en aumento en países occidentales. Los principales factores de riesgo descritos para ACE asociado a EB son: sexo masculino, edad > 50 años, obesidad central y tabaquismo. El riesgo anual de ACE en EB sin displasia, displasia de bajo (DBG) y alto grado es 0,1-0,3%, 0,5% y 5-8%, respectivamente. El tratamiento del EB no displásico consiste en un cambio de estilo de vida saludable, quimioprevención mediante inhibidores de la bomba de protones y vigilancia endoscópica cada 3 a 5 años. Se recomienda que a partir de la presencia de DBG los pacientes sean referidos a un centro experto para la confirmación del diagnóstico, estadio y así definir su manejo. En pacientes con EB y displasia o cáncer incipiente, el tratamiento endoscópico consiste en la resección y ablación, con un éxito cercano al 90%. El principal evento adverso es la estenosis esofágica que es manejada endoscópicamente.
Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). BE is a precursor of esophageal adenocarcinoma (EAC), which has increased in western countries. The main risk factors described for EAC associated with BE are male sex, age > 50 years, central obesity and tobacco use. Annual risk of EAC in patients with BE without dysplasia, low grade (LGD) and high-grade dysplasia is 0,1-0,3%, 0,5% y 5-8%, respectively. Treatment of non-dysplastic BE consists mainly of a healthy lifestyle change, chemoprevention with proton pump inhibitors and surveillance endoscopy every 3 to 5 years. It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.
Assuntos
Humanos , Masculino , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/etiologia , Esôfago de Barrett/terapia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Adenocarcinoma/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/terapia , Fatores de Risco , EsofagoscopiaRESUMO
Barrett's esophagus (BE) is the condition in which a metaplastic columnar mucosa predisposed to neoplasia replaces the squamous mucosa of the distal esophagus. The current guidelines recommends that diagnosis requires the finding of intestinal metaplasia (IM) with goblet cells of at least 1 cm in length. BE affects approximately 1% of the general population and up to 14% of patients with gastroesophageal reflux disease (GERD). BE is a precursor of esophageal adenocarcinoma (EAC), which has increased in western countries. The main risk factors described for EAC associated with BE are male sex, age > 50 years, central obesity and tobacco use. Annual risk of EAC in patients with BE without dysplasia, low grade (LGD) and high-grade dysplasia is 0,1-0,3%, 0,5% y 5-8%, respectively. Treatment of non-dysplastic BE consists mainly of a healthy lifestyle change, chemoprevention with proton pump inhibitors and surveillance endoscopy every 3 to 5 years. It is recommended that from the presence of LGD patients are referred to an expert center for confirmation of the diagnosis, stage and thus define their management. In patients with BE and dysplasia or early-stage cancer, endoscopic therapy with resection and ablation is successful in about 90% of the patients. The main adverse event is esophageal stricture, which is managed endoscopically.
Assuntos
Adenocarcinoma , Esôfago de Barrett , Neoplasias Esofágicas , Humanos , Esôfago de Barrett/terapia , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/etiologia , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Fatores de Risco , Adenocarcinoma/etiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Lesões Pré-Cancerosas/terapia , Lesões Pré-Cancerosas/diagnóstico , Masculino , EsofagoscopiaRESUMO
BACKGROUND & AIMS: Despite the significant advances made in the diagnosis and treatment of Barrett's esophagus (BE), there is still a need for standardized definitions, appropriate recognition of endoscopic landmarks, and consistent use of classification systems. Current controversies in basic definitions of BE and the relative lack of anatomic knowledge are significant barriers to uniform documentation. We aimed to provide consensus-driven recommendations for uniform reporting and global application. METHODS: The World Endoscopy Organization Barrett's Esophagus Committee appointed leaders to develop an evidence-based Delphi study. A working group of 6 members identified and formulated 23 statements, and 30 internationally recognized experts from 18 countries participated in 3 rounds of voting. We defined consensus as agreement by ≥80% of experts for each statement and used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the quality of evidence and the strength of recommendations. RESULTS: After 3 rounds of voting, experts achieved consensus on 6 endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesion location, extraluminal compressions, and quadrant orientation), 13 definitions (BE, hiatus hernia, squamous islands, columnar islands, Barrett's endoscopic therapy, endoscopic resection, endoscopic ablation, systematic inspection, complete eradication of intestinal metaplasia, complete eradication of dysplasia, residual disease, recurrent disease, and failure of endoscopic therapy), and 4 classification systems (Prague, Los Angeles, Paris, and Barrett's International NBI Group). In round 1, 18 statements (78%) reached consensus, with 12 (67%) receiving strong agreement from more than half of the experts. In round 2, 4 of the remaining statements (80%) reached consensus, with 1 statement receiving strong agreement from 50% of the experts. In the third round, a consensus was reached on the remaining statement. CONCLUSIONS: We developed evidence-based, consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.
Assuntos
Esôfago de Barrett , Neoplasias Esofágicas , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/patologia , Esôfago de Barrett/terapia , Brasil , Consenso , Técnica Delphi , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Esofagoscopia , HumanosRESUMO
Barrett's esophagus (BE) is a known precursor of dysplasia and adenocarcinoma. Endoscopic resection and surgery are the techniques used to treat these kinds of lesions. However, endoscopic resection is considered the first choice for the management of superficial lesions. Dysplasia in BE most commonly appears like a flat lesion but here we describe an unusual case of dysplasia and superficial adenocarcinoma looking like an extensive polypoid lesion.
Assuntos
Adenocarcinoma , Esôfago de Barrett , Neoplasias Esofágicas , Pólipos , Humanos , Esôfago de Barrett/complicações , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/patologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/cirurgia , Esofagoscopia/métodos , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Adenocarcinoma/patologia , Hiperplasia , Pólipos/patologiaRESUMO
BACKGROUND: Barrett's esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols. OBJECTIVE: This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE. METHODS: A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms "Barrett" and "diagnosis or treatment or therapy or surveillance". We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old. RESULTS: A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE. CONCLUSION: Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.
Assuntos
Esôfago de Barrett , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/terapia , Endoscopia do Sistema Digestório , Esofagoscopia , Seguimentos , HumanosRESUMO
Objetivo: Demonstrar fatores envolvidos nos distúrbios do sono em profissionais que fazem plantões. Métodos: Trata-se de estudo transversal, cuja amostra foi composta de 244 voluntários, plantonistas da área da saúde, sendo 191 do sexo feminino, que responderam a um questionário socioeconômico, associado à aplicação da Escala de Sonolência de Epworth e ao Índice de Qualidade do Sono de Pittsburgh. Os dados foram analisados pelos coeficientes de Spearman e de Kendall Tau, com distribuição de probabilidade gama. Resultados: Houve significância (p<0,05) com o Índice de Qualidade do Sono de Pittsburgh e a atividade física (+0,216), ergonomia (+0,148), filhos (-0,146), valor da remuneração (+0,112) e disfunção durante o dia (+0,352). Também houve significância com a Escala de Sonolência de Epworth e atividade física (+0,138), renda familiar (-0,118), trabalho semanal (-0,151), latência do sono (-0,106), duração do sono (-0,107), eficiência do sono (-0,139) e disfunção durante o dia (+0,170). Por fim, a eficiência do sono teve significiância com profissão (-0,209), tabagismo (+0,402), Escala de Sonolência de Epworth (-0,139) e dissonias com a obesidade (índice de massa corporal >30; razão de chance de 1,40; intervalo de confiança de 95% de 1,02-1,94). Conclusão: As medidas autorrelatadas são prontamente obtidas com questionários validados, como a Escala de Sonolência de Epworth e o Índice de Qualidade do Sono de Pittsburgh, encontrando-se correlações com renda familiar, ter ou não filhos, índice de massa corporal, atividade física, ergonomia, condições de trabalho, tabagismo e componentes biopsicossociais. Em virtude do caráter transversal deste estudo é indispensável mais estudos com maior follow-up
Objective: To demonstrate factors involved in sleep disorders in professionals who take shifts. Methods: This is a cross-sectional study whose sample consists of 244 volunteers, on-duty health workers, 191 females, who answered a socioeconomic questionnaire, associated with application of the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. Data were analyzed with Spearman's and Kendall Tau coefficients, and gamma probability distribution. Results: There was significance (p<0,05) with the Pittsburgh Sleep Quality Index and physical activity (+0,216), ergonomics (+0,148), children (-0,146), the wage (+0,112), dysfunction during the day (+0,352). Also there was significance with the Epworth Sleepiness Scale and physical activity (+0,138), family income (-0,118), weekly workload (-0,151), sleep latency (-0,106), sleep duration (-0,107), sleep efficiency (-0,139), and dysfunction during the day (+0,170). Finally, sleep efficiency was significant with occupation (-0,209), smoking habits (+0,402), Epworth Sleepiness Scale (-0,139), dyssomnia with obesity (body index mass >30; OR of 1,40; CI 95% 1,02-1,94). Conclusion: Self-reported measures are readily obtained with validated questionnaires such as Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, with correlations with family income, having children or not, body mass index, physical activity, ergonomics, working conditions, smoking habits, and biopsychosocial components. Due to the cross-sectional nature of this study, further research with longer follow-up is indispensable
Assuntos
Humanos , Esôfago de Barrett/diagnóstico , Neoplasias Esofágicas/diagnóstico , Adenocarcinoma/diagnóstico , Esôfago de Barrett/cirurgia , Esôfago de Barrett/complicações , Esôfago de Barrett/etiologia , Esôfago de Barrett/fisiopatologia , Esôfago de Barrett/patologia , Esôfago de Barrett/sangue , Esôfago de Barrett/epidemiologia , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/fisiopatologia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/epidemiologia , Adenocarcinoma/cirurgia , Adenocarcinoma/etiologia , Adenocarcinoma/fisiopatologia , Adenocarcinoma/patologia , Adenocarcinoma/sangue , Adenocarcinoma/epidemiologia , Refluxo Gastroesofágico/complicaçõesRESUMO
ABSTRACT BACKGROUND: Barrett's esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols. OBJECTIVE: This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE. METHODS: A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms "Barrett" and "diagnosis or treatment or therapy or surveillance". We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old. RESULTS: A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE. CONCLUSION: Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.
RESUMO CONTEXTO: O esôfago de Barrett (EB) é uma condição que aumenta o risco de ocorrência de displasias e câncer no esôfago, a qual apresenta inúmeras controvérsias entre médicos generalistas e até especialistas, em especial no que tange o seu diagnóstico, tratamento e seguimento. OBJETIVO: Tentar esclarecer as controvérsias relacionadas ao estabelecimento do diagnóstico, tratamento, seguimento e vigilância do EB. MÉTODOS: Foi realizado revisão sistemática da literatura fundamentada apenas em ensaios clínicos randomizados e controlados (completos ou em fase IV), em indivíduos maiores que 18 anos, publicados nos últimos 10 anos, por meio de busca, nas bases de dados: PubMed, Cochrane e SciELO (utilizando os termos MeSH e não-MeSH: "Barrett" no título AND diagnosis or treatment or therapy or surveillance" em todos os campos). RESULTADOS: Um total de 42 ensaios clínicos controlados e randomizados foram identificados e selecionados após aplicação dos critérios de inclusão e exclusão. Evidenciou-se, principalmente, o surgimento de técnicas seguras, alternativas à endoscopia digestiva alta (EDA) tradicional para aprimorar a detecção do esôfago de Barrett, associadas a boa aceitação por parte dos pacientes, quando realizadas por meio de acesso nasal. Ainda, o uso de protocolo de biópsias guiadas por cromoendoscopia eletrônica favoreceu reduzir significativamente o número de biópsias necessárias para alcançar as melhores taxas de identificação histológica do EB. Ademais, foi evidenciado que o uso de esomeprazol 40 mg 2x/dia associado ao ácido acetil salicílico 300 mg/dia pode ter efeito protetivo em relação ao desenvolvimento de câncer no EB, além de ser identificado protocolos de seguimento e vigilância endoscópica dos pacientes com EB >1 cm fundamentados, especialmente, no grau de displasia e comprimento do EB (EB sem displasia com 1 a 3 cm = EDA a cada 5 anos; EB sem displasia com >3 a 10 cm = EDA a cada 3 anos; EB com displasia de baixo grau = EDA a cada 6 a 12 meses; EB com displasia de alto grau = realização de terapia endoscópica ablativa e EDA a cada 3 meses). CONCLUSÃO: Foi verificado a necessidade do desenvolvimento de mais ensaios clínicos randomizados e controlados relacionados ao tema, especialmente no que tange o estabelecimento do seguimento e vigilância do EB, entretanto, na luz das melhores evidências apresentadas na última década, o diagnóstico de EB deve seguir, idealmente, protocolos de biópsias guiadas por cromoendoscopia eletrônica. Ademais, o tratamento deve ser fundamentado primeiramente em técnicas endoscópicas, especialmente aquelas terapias com radiofrequência, e quando associado a displasia de alto grau, deverá ser ponderado quanto aos riscos de se insistir em métodos endoscópicos ablativos ou considerar um tratamento cirúrgico ressectivo. Por fim, reforça-se a necessidade de todo paciente com EB >1 cm permanecer em seguimento endoscópico por toda a sua vida, conforme protocolos pré-estabelecidos, exceto se apresentar comorbidades limitantes que impediriam a realização de alguma conduta mais intervencionista. Infelizmente, não há ensaios clínicos randomizados que avaliaram qual é a melhor recomendação de protocolo para o seguimento endoscópico de EB (>1cm), porém, baseado nas atuais Guidelines Internacionais, é recomendado esofagogastroduodenoscopia (EGD) a cada 5 anos em EB sem displasia com 1 a 3 cm de extensão; a cada 3 anos em EB com displasia com 3 a 10 cm de extensão, a cada 6 a 12 meses em EB com displasia de baixo grau e, finalmente, EGD a cada 3 meses após terapia ablativa endoscópica nos casos de EB com displasia de alto grau.
Assuntos
Humanos , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/terapia , Seguimentos , Endoscopia do Sistema Digestório , EsofagoscopiaRESUMO
OBJECTIVE: Perform a prospective study based on sequential clinical, endoscopic, and histologic evaluations of the foregut late after laparoscopic sleeve gastrectomy (LSG) in obese patients. After LSG, several studies have suggested an increase in the incidence of clinical gastroesophageal reflux (GERD) while others have reported an improvement but based mainly on clinical questionnaires. METHODS: Prospective study of 104 consecutive patients submitted to LSG. Several postoperative endoscopic and histologic evaluations of the esophagogastric junction (EGJ) and the gastric tube (GT) were performed and correlated with symptomatic findings. RESULTS: According to clinical preoperative findings, patients were divided into non-refluxers (Group I) and refluxers (Group II). Seven patients were unreachable, leaving 97 (93%) for late evaluation. Among Group I, 58.5% developed de novo GERD, while in Group II just 13.6% showed the disappearance of them. Endoscopic evaluations showed progressive deterioration of the EGJ in Group I, with the development of erosive esophagitis (EE), hiatal hernia (HH), and dilated cardia in a large proportion of them. In the GT, the presence of bile was seen in 40%, and an open immobile pylorus was detected in 82%. Short-segment Barrett's esophagus (BE) appeared in 4%. CONCLUSIONS: Patients submitted to LSG showed a significant and progressive increase in the presence of "de novo" GERD. Also, an increased duodenogastric reflux was seen through an open and immobile pylorus. Therefore, based on these results, it seems like LSG is a "pro-reflux" surgical procedure, which should be continuously evaluated late after surgery.
Assuntos
Endoscopia Gastrointestinal , Doenças do Esôfago/epidemiologia , Gastrectomia , Técnicas Histológicas , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Gastropatias/epidemiologia , Adolescente , Adulto , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/epidemiologia , Esôfago de Barrett/etiologia , Esôfago de Barrett/cirurgia , Comorbidade , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/estatística & dados numéricos , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/etiologia , Doenças do Esôfago/cirurgia , Esofagite/diagnóstico , Esofagite/epidemiologia , Esofagite/etiologia , Esofagite/cirurgia , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/epidemiologia , Hérnia Hiatal/etiologia , Hérnia Hiatal/cirurgia , Técnicas Histológicas/métodos , Técnicas Histológicas/estatística & dados numéricos , Humanos , Incidência , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Úlcera Péptica/diagnóstico , Úlcera Péptica/epidemiologia , Úlcera Péptica/etiologia , Úlcera Péptica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Período Pré-Operatório , Estudos Prospectivos , Gastropatias/etiologiaRESUMO
INTRODUCTION: The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. AIM: To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. MATERIAL AND METHODS: The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. RESULTS: Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. CONCLUSIONS: The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer.