ARGON.COLOMBIA.ppsx

8/10/2019 ARGON.COLOMBIA.ppsx

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IntroduccinIndicacionesResultadosSeguridadConclusiones


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INDICACIONES Ablativas

Esfago de BarrettLesiones planasComplemento a la reseccin

Tratamiento paliativo deneoplasias estenosantesOtras

Diverticulo de ZenkerRecanalizacin de prtesis

Corte de prtesis

Hemostticas

Lesiones vascularesEctasiasProctopatia postradioterapia

Ulceras PpticasErradicacin de vricesesofgicas


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INDICACIONES Ablativas

Esfago de BarrettLesiones planasComplemento a la reseccin

Tratamiento paliativo deneoplasias estenosantesOtras

Diverticulo de ZenkerRecanalizacin de prtesis

Corte de prtesis

Hemostticas

Lesiones vascularesEctasiasProctopatiapostradioterapia

Ulceras PpticasErradicacin de vricesesofgicas


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FICE

NBI


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Vargo J. Clinical applications of the argon plasmacoagulator. Gastrointest Endosc 2004;59:81-87

Diez series: 304 pacientesComplicaciones menores

Dolor torcico y odinofagiaEl porcentaje global de regresin fue del 82.6%Focos sub epiteliales de Barrett hasta en el 50%En displasia y cncer in situ resultados controversiales

No progresin hasta la progresin de displasia a cncerEn la actualidad es un mtodo poco usado

Mejores mtodos endoscpicos de tratamiento


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OBJETIVO. Evaluar elimpacto del AP en el manejo de lesiones vasculares G-Ien las transfusiones, nivel de hemoglobina y la seguridad delprocedimiento

METODOS. Retrospectivo, que incluyo a los enfermos con Angioectasiassangrantes, seguimiento va telefonica o a travs del expediente clnico

RESULTADOS.Cien pacientes, 46 hombres y edad promedio de 74 aos,seguimiento de 16 meses. Las lesiones tratadas fueron malformacionesarteriovenosas (74) y GAVE (26). Los requerimientos transfusionales seabolieron en el 77% y en el resto disminuyeron y la hemoglobina mejoren todos.

CONCLUSIONES: El AP es efectivo y seguro en esta patologa

Kwan. Et al Argon Plasma Coagulation in the Management of Symptomatic

Gastrointestinal Vascular Lesions: Experience in 100 Consecutive Patientswith Long-Term Follow-Up. Am J Gastroenterol 2006;101:58 63


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EXPERIENCIA DE DOS AOS EN EL TRATAMIENTO DE LAS

ECTASIAS VASCULARES CON ARGON PLASMA OBJETIVO.- Evaluar la efectividad del tratamiento con argn plasma (APC) en laslesiones vasculares del tubo digestivo proximal.METODO y METODO .- Se evaluaron de forma retrospectiva a los enfermos condiagnstico de lesin vascular gstrica de junio del 2009 a junio del 2011, que fueron

tratados por APC. ANALISIS.- Se defini xito total cuando hubo correccin de la anemia y no requiritransfusin despus del tratamiento con argn plasma, xito parcial cuando el nmero detransfusiones requeridas era menor o igual al 50% de lo que habitualmente requera elpaciente y no xito cuando no se encontr una disminucin mayor al 50 % de losrequerimientos transfusionales o cuando el paciente continuaba presentando las lesiones vasculares en la endoscopia de control.RESULTADOS .- Se aplicaron 88 tratamientos con APC a 17 pacientes con lesiones vasculares gstricas. Se logr xito total en 13 pacientes, 3 pacientes lograron xito parcial y en 1 paciente no se logr xito.CONCLUSIONES .- El tratamiento con APC demostr ser efectivo en nuestro estudio, sedebe realizar un estudio ms prolongado para tener conclusiones vlidas a cerca de laefectividad de este manejo.


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OBJETIVO. Evaluar la eficacia del AP en el manejo de los diferentes tipos deangiodispolasias con o sin hemorragia activa al momento de la endoscopia

METODOS. 28 pacientes, Diez con angiodisplasia focal, 11 gastropatiahipertensiva portal y 8 GAVE, se analizaron los factores demogrficos,formula roja y requerimientos trasfusionales de cada uno de los subtiposde ectasias vasculares en un seguimiento de 13.6 meses

RESULTADOS. El tratamiento fue exitosos en la mayoria de los enfermos sin

diferencias significativas entre los tres grupos y no se presentaroncomplicaciones

CONCLUSIONES. El AP es til y seguro en las diferentes presentaciones deectasias vasculares gstricas

Bordas. APC in the treatment of the different Types of Gastric Angiodysplasia a series of consecutive Patients diagnosed byacute GI Bleeding Gastrointest Endosc 2006;63:AB183


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La mayora de los estudios son retrospectivosNo son controlados (serie de casos)

Los resultados son buenosPrcticamente sin complicacionesNecesidad de mejores estudios y seguimientos a mslargo plazo.Esto mismo ocurre en las lesiones del Intestinodelgado


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El tratamiento con AP en proctitis postradioterapia esefectivoLos resultados son buenos

Serie de casosLas complicaciones aumentan en frecuencia,

Hasta el 19%Tenesmo, distensin, anismo


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INDICACION AP NIVEL DEEVIDENCIA

PROCTITIS POSRT

40-60 w0.6 A 3.0 L/min

3

ECTASIASGASTRICAS

40-100 w2.0 L/min

3

ANGIOECTASIAS 40-60 w 3

ESFAGO DEBARRETT

30-90 w0.1 A 2.0 L/min

3, 2


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El AP es una herramienta til y segura en endoscopiagastrointestinalEl nivel de evidencia sobre la utilidad en la mayora de lasindicaciones es de 3Es necesario realizar estudios prospectivos, comparativos y alargo plazo para evaluar la utilidad real de este tipo de

tratamientoLos resultados son mejores en ectasias vasculares aisladas que enotras indicaciones


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Therapeutic Double Balloon Enteroscopy Reduces Transfusion


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Therapeutic Double Balloon Enteroscopy Reduces TransfusionRequirements in the Management of Occult or ObscureGastrointestinal BleedingMark E. Benson, Courtney Barancin, Roberto M. Gamarra, NaliniM. Guda, Sigurdur Einarsson, Anurag Soni, Deepak V. GopalIntroduction: Patients with occult or obscure gastrointestinal (GI) bleeding can bechallenging to manage. Double Balloon Enteroscopy (DBE) is a novel procedureenabling therapeutic interventions within most of the small bowel. Further researchregarding the clinical impact of these interventions is needed. Aim: To evaluate the

impact of therapeutic DBE on packed red blood cell transfusion requirements inpatients with occult or obscure GI bleeding. Methods: This is a retrospective review ofpatients who underwent DBE at two tertiary care centers from 5/07 to 10/08 witha focus on patients who had therapeutic endoscopic interventions for occult orobscure GI bleeding. A Students T -test and Chi square analysis were used forcomparison of samples with significance considered if the P value was less than 0.05.Results: There were 77 patients, mean age 64 years (14-89), who underwent DBE inthe 18 month period. Of the 77 patients, 70 had occult or obscure GI bleeding. Fortyseven(67%) of the 70 patients had endoscopic findings potentially accounting for theblood loss. These small bowel lesions varied in location from the mid-Jejunum toproximal-mid Ileum and were out of reach via standard small bowel enteroscopy orcolonoscopy with Ileoscopy. Forty patients had arterio-venous malformations(AVMs),4 patients had small bowel ulcerations, 1 patient had celiac disease, 1 patient hada bleeding small bowel (mid-Ileum)polyp and 1 patient had bleeding jejunaldiverticula. Forty-two (60%) of the 70 patients had therapeutic DBE interventionsincluding argon plasma coagulation (NZ41), hemoclip placement (NZ3) and snarepolypectomy (NZ1). Among the patients with therapeutic interventions, there wasa statistically significant per patient decrease in the amount of blood units transfusedduring the preceding 6 months, [mean 1.8 units (rangeZ0-20)] compared to the 6

months after the DBE exam, [mean 0.3 units (rangeZ0-5)]; (PZ0.04). There were 3patients who had post procedure GI bleeding within 30 days after therapeutic DBE; allwere managed conservatively. This was not significantly higher compared to thegroup of patients who did not have a therapeutic intervention (PZ 0.17).Conclusions: 1) Therapeutic DBE results in a long-term and clinically significantbeneficial outcomes among patients with occult or obscure GI bleeding as noted bya decrease need for red blood cell transfusion requirements. 2) AVMs are the mostcommonly treated lesion in patients with occult or obscure GI bleeding. 3)Therapeutic DBE is a safe procedure. 4) Gastroenterologists who performDBE needto be aware of the its potential therapeutic benefits.

Gastrointestinal Endoscopy Vol. 69, Issue5, Page AB194

W1436


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W1436Diagnostic Yield and Therapeutic Utility of Double-BalloonEnteroscopy (DBE) in Patients with Obscure GastrointestinalBleeding (OGIB): A Systematic ReviewShabana F. Pasha, Jonathan A. Leighton, Ananya Das,M Edwyn Harrison, G Anton Decker, David E. Fleischer, VirenderK. Sharma

Background: DBE is a relatively new endoscopic modality that allows for a moreextensive evaluation of the small bowel and treatment of lesions previouslyinaccessible by conventional enteroscopy. Complete enteroscopy is possible,usually with a combination of an antegrade and retrograde approach. Aim: Asystematic review of the literature on DBE was undertaken to determine itsdiagnostic and therapeutic yield in patients with OGIB. Methods: A recursiveliterature search of studies evaluating the role of DBE in the diagnosis andtreatment of patients with OGIB was performed. Data on DBE findings, treatmentand patient outcomes were extracted, pooled and analyzed. Results: Thirteenstudies evaluated the role of DBE in patients with OGIB (8 manuscripts and 5abstracts). The studies included 906 patients with 28.5% males (140/490); mean age56.5 years (range 8-94 years). The number of DBEs performed per patient was 1.3(range 1-2). DBE detected a potential bleeding source in 66% of patients (596/906;95% CI 63-69). The findings included arteriovenous malformations in 25.6%patients (206/804; 95% CI 22.6-28.7); inflammatory lesions (ulcers, erosions or

strictures) in 16.1% (130/804; 95% CI 13.6-18.9) and small bowel neoplasms(polyps/tumors) in 13.9% (112/804; 95% CI 11.6-16.5). Subsequent management(medical, surgical or endoscopic) was influenced by DBE findings in 44% patients(355/818; 95% CI 40-47). Endoscopic treatment was performed in 26.6% patients(189/709; 95% CI 23.4-30), and included argon plasma coagulation (62%; 117/189),electrocoagulation (21.6%; 41/189) and polypectomy (3%; 6/189). Eight-fourpercent of patients (169/200; 95% CI 78.7-89.2) remained transfusion free overa mean follow-up period of 229 days (range 30-480). Conclusion: DBE is an excitingnew technology that plays an important role in the diagnosis and treatment of

Gastrointestinal Endoscopy Vol. 65, Issue5, Page AB366

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