RESUMO
BACKGROUND: Screening colonoscopy requires quality parameters to determine its efficacy to detect cancerous or precancerous lesions. Limitations of the procedure are the patient's rejection, difficulty for its preparation or lack of preparation. OBJECTIVE: To assess whether patient satisfaction correlates with the quality of the procedure. METHOD: 100 consecutive patients for a screening colonoscopy were included, they were randomized to use a preparation with polyethylene glycol (PEG) or sodium picosulfate (P). In addition, a second parameter evaluated was related to a follow-up phone call performed to half of the patients prior to the study, during the preparation time. RESULTS: P was better tolerated and qualified, however, there was no difference with the quality of preparation, adenomatous polyps detection rate, cecum insertion rate and patient satisfaction. A difference was found in whom had a follow-up phone call. DISCUSSION: A good colon preparation is a key factor to have a quality colonoscopy, and it has been shown important that a good relationship for explain the doubts and follow the preparation. CONCLUSION: It was found that the type of preparation and patient follow-up during the study correlate with the quality of the study and patient satisfaction.
ANTECEDENTES: La colonoscopia de escrutinio requiere parámetros de calificación para determinar su eficiencia en la detección de lesiones cancerosas o precancerosas. Sus limitantes son su rechazo, la dificultad durante su preparación o la falta de preparación. OBJETIVO: Evaluar la satisfacción del paciente y los criterios de calidad del estudio. MÉTODO: Se incluyeron 100 pacientes enviados para colonoscopia de escrutinio asignados aleatoriamente a uno de dos grupos de preparación colónica: polietilenglicol (PEG) o picosulfato de sodio (P), para evaluar la satisfacción y la limpieza colónica. Otra evaluación fue por medio de llamada de refuerzo al momento de la preparación. RESULTADOS: Con P se tuvieron mejores tolerabilidad y calificaciones de satisfacción, en comparación con PEG. No hubo diferencia para la calidad de la limpieza, la tasa de detección de pólipos adenomatosos ni la intubación cecal. La llamada telefónica de reforzamiento incrementó la satisfacción, la limpieza colónica y la tasa de detección de adenomas. DISCUSIÓN: Una relación estrecha con el paciente durante su proceso de limpieza y explicación del procedimiento se ha visto como uno de los factores más importantes para lograr una colonoscopia de alta calidad. CONCLUSIÓN: El tipo de preparación colónica y la intervención durante la preparación se relacionaron con una mejor calidad del estudio y una mayor satisfacción del paciente.
Assuntos
Pólipos Adenomatosos/diagnóstico por imagem , Catárticos , Citratos , Colonoscopia/psicologia , Compostos Organometálicos , Satisfação do Paciente , Picolinas , Polietilenoglicóis , Idoso , Colonoscopia/normas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. OBJECTIVE: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. MATERIALS AND METHOD: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). RESULTS: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. CONCLUSION: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.
Assuntos
Adenocarcinoma/cirurgia , Pólipos Adenomatosos/cirurgia , Colonoscopia , Neoplasias Colorretais/cirurgia , Pólipos Intestinais/cirurgia , Lesões Pré-Cancerosas/cirurgia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Pólipos Adenomatosos/diagnóstico por imagem , Pólipos Adenomatosos/epidemiologia , Pólipos Adenomatosos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Colo/diagnóstico por imagem , Colo/patologia , Colo/cirurgia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/epidemiologia , Pólipos Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Estudos Retrospectivos , Adulto JovemRESUMO
Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. Materials and method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.
Introducción: Los pólipos colorrectales son estructuras que se proyectan en la superficie de la capa mucosa del intestino grueso. Son clasificados en neoplásicos y no neoplásicos. La detección precoz de lesiones preneoplásicas es relevante en la prevención del cáncer colorrectal. Pueden ser resecados y reducir los índices de morbimortalidad. La colonoscopia es el patrón de oro para el diagnóstico y resección de lesiones precursoras. Objetivo: Evaluar aspectos epidemiológicos, endoscópicos e histológicos relacionados a las resecciones endoscópicas de lesiones de colon y recto en un centro de entrenamiento. Matariales y métodos: Fue realizada una búsqueda en la base de datos de nuestra institución durante el período de enero de 2011 a julio de 2014. Se seleccionaron aquellos sometidos a las resecciones endoscópicas de pólipos y/o lesiones colorrectales. Las siguientes variables fueron definidas: datos generales de los pacientes (edad género e indicación del examen) y datos de la lesión polipoidea (número, tipo histológico, distribución topográfica). Resultados: Fueron identificadas 678 lesiones en 456 exámenes. Con relación al sexo, 242 (53,1 %) eran del género femenino y 214 (46,9 %) masculino. El promedio de edad fue de 64,54 años, con extremos de 5 y 94 años. La ubicación más frecuente fue en el recto (21 %) y sigmoide (20 %). Histológicamente, 34,7% eran pólipos hiperplásicos y 58,9% adenomatosos, siendo 74,1% tubulares, 10,6% tubulovellosos, 2% vellosos y 13% indeterminados y, 1,7% correspondieron a adenocarcinomas. En el 65,4% de los casos existía solamente un pólipo al hacer el examen, 34,6% presentaban dos o más lesiones. Conclusión: En nuestro trabajo, con un promedio de 250 exámenes/mes, los parámetros evaluados fueron compatibles a los resultados encontrados en la literatura.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Lesões Pré-Cancerosas/cirurgia , Neoplasias Colorretais/cirurgia , Adenocarcinoma/cirurgia , Pólipos Intestinais/cirurgia , Colonoscopia , Pólipos Adenomatosos/cirurgia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Reto/cirurgia , Reto/patologia , Reto/diagnóstico por imagem , Brasil/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/diagnóstico por imagem , Pólipos Intestinais/patologia , Pólipos Intestinais/epidemiologia , Pólipos Intestinais/diagnóstico por imagem , Estudos Retrospectivos , Colo/cirurgia , Colo/patologia , Colo/diagnóstico por imagem , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/epidemiologia , Pólipos Adenomatosos/diagnóstico por imagemAssuntos
Neoplasias Colorretais/diagnóstico por imagem , Sigmoidoscopia , Pólipos Adenomatosos/diagnóstico por imagem , Pólipos Adenomatosos/etiologia , Pólipos Adenomatosos/patologia , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/patologia , Humanos , Estadiamento de Neoplasias , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: This study aimed to assess the diagnostic accuracy of double contrast barium enema (DCBE) compared to colonoscopy among Hispanic patients with positive fecal occult blood testing (FOBT). Secondary objectives were to determine: the diagnostic accuracy according to adenoma location, size, and pathologic characteristics; and patient satisfaction with each procedure METHODS: Cross-sectional study comparing the ac curacy of DCBE and colonoscopy in detecting adenomatous polyps and/or colorectal cancer in patients with positive FOBT. DCBE and a colonoscopy were performed in all patients. Polyps identified during colonoscopy were removed and classified by histology. Tolerability and patient's satisfaction with study procedures was assessed. RESULTS: Fifty patients were enrolled, mainly men with a mean age of 63 years old. Polyps were fou in 40/50 (80%) patients in colonoscopy, compared to 19/50 (38%) in DCBE. Eighty-four percent of polyps were missed by DCBE. Sensitivity of DCBE was 45% and specificity 90% for all adenomas. Diagnostic accuracy of DCBE was 54% for any size adenomas, and 72% for >10 mm adenomas. Sensitivity increased from right to left colon while specificity decreased. Patients preferred colonoscopy over DCBE. CONCLUSIONS: This study supports the use of colo noscopy as the gold standard test for the evaluation of positive FOBT and was preferred over DCBE b the patients. Diagnostic accuracy of DCBE was inferior to colonoscopy, for all size polyps and larg adenomas. Compared to colonoscopy, DCBE is a substandard test for colorectal cancer screening and may result in ineffective outcomes.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Pólipos Adenomatosos/diagnóstico por imagem , Sulfato de Bário , Pólipos do Colo/diagnóstico por imagem , Neoplasias Colorretais/diagnóstico por imagem , Meios de Contraste , Enema , Hemorragia Gastrointestinal/diagnóstico por imagem , Sangue Oculto , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Pólipos Adenomatosos/complicações , Pólipos Adenomatosos/diagnóstico , Idoso , Sulfato de Bário/administração & dosagem , Pólipos do Colo/complicações , Pólipos do Colo/diagnóstico , Colonoscopia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico , Meios de Contraste/administração & dosagem , Estudos Transversais , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Computed tomographic colonography has been proposed for detection of colorectal polyps instead of colonoscopy in colorectal cancer screening programs. AIM: To evaluate the performance of computed tomographic colonography in the detection of colorectal polyps with colonoscopy used as the gold standard. METHODS: We prospectively studied 20 patients at high risk for colorectal neoplasia (14 men and 6 women; mean age, 55 years and 59 years). Computed tomographic colonography was performed immediately before colonoscopy. We inserted a rectal balloon catheter and insufflated the colon with room air to the level that a good distension was observed. Twenty milligrams of hioscin was given immediately before computed tomographic imaging of the abdomen and pelvis in order to minimize the degree of smooth-muscle spasm and peristalsis and to reduce the patient's discomfort. RESULTS: Computed tomographic colonography images were considered satisfactory in all cases. Colonoscopy detected 85 polyps in 19 of 20 patients (95%). All the observed polyps were successfully removed and examined histologically. The radiological examination correctly identified 8 of 10 polyps 10 mm or more in diameter, 2 of 19 (18,2%) with 5-9 mm, and just 1 of 53 <5mm (9,1%). Seventeen of the 43 adenomatous polyps were > or =5 mm. Eight (47%) were correctly identified on computed tomographic colonography. None of the neoplasias <5 mm were identified on colonography. Nineteen patients preferred colonoscopy in the event of having to repeat on of the two examinations. CONCLUSION: For the detection of colorectal polyps, computed tomographic colonography seems to be useful only when the result is positive, as the negative results of this examination cannot eliminate the presence of these lesions.
Assuntos
Neoplasias do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/normas , Colonoscopia/normas , Neoplasias Retais/diagnóstico por imagem , Pólipos Adenomatosos/diagnóstico por imagem , Adulto , Idoso , Pólipos do Colo/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Retais/patologia , Sensibilidade e EspecificidadeRESUMO
The detection of osteomas in the maxillofacial region may be the initial clinical finding in Gardner's syndrome (GS). The most common location of osteomas is in the skull, but the lesion can also occur in the jaws. We present a case of a 47 year old male patient with GS who was referred for radiological evaluation. Extraoral examination revealed an epidermoid cyst and the patient had a history of intestinal polyps. A panoramic radiograph demonstrated numerous osteomas and diffuse sclerosis of the mandible, and compound odontomas with impacted teeth. CT scan allowed the localization and extension of the osteomas, and showed other sites in the maxillofacial region as well. CT images also revealed a different behaviour of osteoma, invading the mandibular canal.
Assuntos
Síndrome de Gardner/diagnóstico por imagem , Neoplasias Mandibulares/diagnóstico por imagem , Pólipos Adenomatosos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Odontoma/diagnóstico por imagem , Osteoma/diagnóstico por imagem , Osteosclerose/diagnóstico por imagem , Radiografia Panorâmica , Tomografia Computadorizada por Raios X , Dente Impactado/diagnóstico por imagemRESUMO
INTRODUCTION: Squamous and adenosquamous carcinomas of the gallbladder have poor prognosis. Because these tumors are silent in the initial stage, they are generally diagnosed in advanced stages. MATERIAL AND METHOD: We performed a retrospective observational study of five patients with squamous or adenosquamous carcinoma of the gallbladder. There were two women and three men with a mean age of 71 years (range, 68-75). All patients showed abdominal pain, nausea, vomiting, and weight lost (4-8 kg). One patient presented with acute cholecystitis. None of the patients had jaundice and all had gallstone disease. RESULTS: Surgery was performed in all patients. Extended cholecystectomy was performed in three patients, cholecystectomy and bile drainage in one patient, and colonic bypass and cholecystectomy in the remaining patient. Pathologic analysis revealed epidermoid carcinoma in two patients and adenosquamous carcinoma in three patients. Two patients were treated with adjuvant chemotherapy. All died within 6 months of surgery. CONCLUSIONS: In both histological types of gallbladder carcinoma, treatment depends on the grade of local and regional invasion and tumor spread at diagnosis.