Documento de posicionamiento de la AEG,la SEED y la SEAP sobre cribado de cáncer gástrico en poblaciones con baja incidencia

This positioning document, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Endoscopia Digestiva and the Sociedad Española de Anatomía Patológica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H. pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy.     

Técnicas de imagen avanzada en la detección y caracterización de las lesiones precursoras del cáncer gástrico y del cáncer gástrico precoz

Diagnosis of early gastric cancer and its precancerous lesions remains a challenge for great part of western endoscopists. Changes seen in the mucosal pattern are generally subtle and hence difficult to identify. In this article, we will review the usefulness of conventional and virtual chromoendoscopy and magnification endoscopy in the recognition and classification of these lesions.     

Aplicación de la endoscopia sistemática alfanumérica codificada más cromoendoscopia para la detección de lesiones precancerosas gástricas y cáncer gástrico temprano en sujetos con riesgo promedio de cáncer gástrico

Introduction and aims

Gastric cancer is one of the main causes of cancer worldwide, but there is currently no global screening strategy for the disease. Endoscopy is the screening method of choice in some Asian countries, but no standardized technique has been recognized. Systematic alphanumeric-coded endoscopy can increase gastric lesion detection. The aim of the present article was to compare the usefulness of systematic alphanumeric-coded endoscopy with conventional endoscopy for the detection of premalignant lesions and early gastric cancer in subjects at average risk for gastric cancer.

Consenso mexicano sobre detección y tratamiento del cáncer gástrico incipiente

Gastric cancer is one of the most frequent neoplasias in the digestive tract and is the result of premalignant lesion progression in the majority of cases. Opportune detection of those lesions is relevant, given that timely treatment offers the possibility of cure. There is no consensus in Mexico on the early detection of gastric cancer, and therefore, the Asociación Mexicana de Gastroenterología brought together a group of experts and produced the “Mexican consensus on the detection and treatment of early gastric cancer” to establish useful recommendations for the medical community. The Delphi methodology was employed, and 38 recommendations related to early gastric cancer were formulated. The consensus defines early gastric cancer as that which at diagnosis is limited to the mucosa and submucosa, irrespective of lymph node metástasis. In Mexico, as in other parts of the world, factors associated with early gastric cancer include Helicobacter pylori infection, a family history of the disease, smoking, and diet. Chromoendoscopy, magnification endoscopy, and equipment-based image-enhanced endoscopy are recommended for making the diagnosis, and accurate histopathologic diagnosis is invaluable for making therapeutic decisions. The endoscopic treatment of early gastric cancer, whether dissection or resection of the mucosa, should be preferred to surgical management, when similar oncologic cure results can be obtained. Endoscopic surveillance should be individualized.     

Actualizaciones en las lesiones precursoras de cáncer colorrectal

The adenoma-carcinoma sequence is currently well established, and therefore, the potential for adenomas to progress to colorectal cancer (CRC). In the last decade, there has been a change in the paradigm that considered these lesions as the only precursors of CRC and nowadays serrated polyps are also considered to have the potential for malignant transformation.The studies presented this year at the congress of the American Gastroenterological Association provide important information to improve the characterization of CRC precursor lesions, especially as regards their detection, prevalence and treatment and surveillance strategies. Notable among these studies were those focussing on evaluating the epidemiological characteristics of serrated polyps and those attempting to improve the quality of colonoscopy -with the ultimate aim of achieving greater detection of these precursor lesions- by evaluating colon cleansing, the polyp detection rate, withdrawal times, the use of endoscopic caps, narrow band imaging, high-definition endoscopy and, lastly, adequate endoscopic surveillance.     

Documento de información y consenso para la detección y manejo de la enfermedad renal crónica

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific societies, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.     

Tecnologías de endoscopia avanzada para mejorar la detección y caracterización de los pólipos colorrectales

Colorectal cancer is a major health problem. An improvement to its survival has been demonstrated by performing colonoscopy screenings and removing its precursor lesions: polyps. However, colonoscopy is not infallible and multiple strategies have been proposed aimed at improving the quality thereof. This report describes the endoscopic systems available to improve the detection and characterization of polyps, the different classifications for histological prediction and the current indications of advanced endoscopic diagnostic techniques.     

Nueva inmunoterapia y cáncer de pulmón

Recent research on the relationship between the immune system and cancer has revealed the molecular mechanisms by which cancer cells co-opt certain T cell receptors which block the cytotoxic response to defend themselves from the antitumor immune attack. These findings have helped identify specific targets (T cell receptors or their corresponding ligands) for the design of monoclonal antibodies that can unlock the immune response.These drugs, known as immune checkpoint inhibitors, have shown efficacy in metastatic melanoma and kidney cancer, and have been successfully tested in non-small cell lung cancer in recent trials. Immune checkpoint inhibitors were included in clinical practice as a second-line option after an initial chemotherapy (CT) regimen, and in the last year positive results have been reported from randomized trials in which they were compared in first line with standard CT. Responses have been surprising and durable, but less than 20%-25% in unselected patients, so it is essential that factors predicting efficacy be identified. One such biomarker is PD-L1, but the different methods used to detect it have produced mixed results.This non-systematic review discusses the results of the latest trials, the possibilities of incorporating these drugs in first-line regimens, the criteria for patient selection, adverse effects, and the prospects of combinations with conventional treatment modalities, such as CT, radiation therapy, and antiangiogenic agents.     

Técnicas de tipificación molecular para la vigilancia y control de la infección

Molecular typing methods are useful in the surveillance and control of nosocomial outbreaks because they can provide information on the clonal relatedness among isolates, identify reservoirs, and determine routes of transmission. The gold standard assay for molecular typing is pulsed-field gel electrophoresis (PFGE) due to its high discriminatory power. Some major disadvantages of PFGE include the high cost of the equipment, its labor intensiveness (the technique is not automated) and the time required to analyze the profiles of DNA bands (pulsotypes). Although there are many molecular typing methods based on polymerase-chain reaction (PCR), the most widely used is repetitive sequence-based PCR (REP-PCR). Most of the PCR techniques used for molecular typing have none of the limitations of PFGE as they are less expensive and labor intensive (some, such as bioMérieux's Diversilab system, are commercially available) and generate DNA profiles that are easier to interpret, depending on the microorganism. The discriminatory power of PCR is generally lower than or similar to that of PFGE. Both PFGE and PCR require optimal laboratory standardization to guarantee good reproducibility. PCR methods are preferable in the study of small, timelimited outbreaks. In more complex outbreaks of longer duration, in which clonal evolution and dynamics are studied, the use of PFGE is preferable. Molecular typing methods based on DNA sequencing, such as multilocus sequence typing, are applicable in global epidemiological studies or in analyses of the population structure of microorganisms.     

Actualizaciones sobre colonoscopia en el cribado,seguimiento y tratamiento del cáncer colorrectal y sus lesiones precursoras

Colonoscopy is the gold standard for the diagnosis and treatment of diseases of the colon and, in particular, for the screening and surveillance of colorectal cancer. In Digestive Disease Week 2010 in New Orleans, the results of highly interesting studies on diagnostic and therapeutic colonoscopy were presented. As key points, the utility of quality indicators in colonoscopy and the need for constant surveillance were stressed and new quality indicators such as the polyp detection rate were proposed. In addition, new therapeutic regimens for anterograde preparation were evaluated, showing once again that the split dose and administration shortly before the examination are determining factors. There is increasing evidence on the advantages of propofol over other products in sedation and administration by gastroenterologists or specially trained nurses is becoming widespread. Several ingenious methods concerning the endoscopic technique were presented. These methods aim to improve the performance of colonoscopy and include the new colon capsule, the water method or cap technique, as well as narrowband imaging and confocal endomicroscopy. Lastly, the results presented reinforce the use of advanced digestive endoscopic techniques for the treatment of large colorectal lesions, whether benign or early malignant lesions.     

Valor predictivo pretratamiento del cociente neutrófilos/linfocitos circulantes sobre la posibilidad de resección R0 en el cáncer gástrico

Introduction

New parameters complementary to clinical TNM classification are needed, to orient preoperative on the possibility of a R0 gastric cancer resection. We analysed the possible predictive value of blood neutrophil/lymphocytic ratio (N/L) in relation to resectability.

Importancia de los controles de calidad para la detección de la resistencia a antibióticos β-lactámicos en enterobacterias

β-lactam antimicrobial agents are frequently used to treat infections caused by Enterobacteriaceae. The main mechanism of resistance to these antibiotics is the production of certain enzymes, collectively named β-lactamases. Due to their substrate profile and their epidemiological implications, the most clinically important β-lactamases are extended-spectrum β-lactamases, class C β-lactamases and carbapenemases. Phenotypic detection of these enzymes may be complicated and is based on the use of specific inhibitors of each β-lactamase and on the loss of activity on some β-lactam indicators. Various international committees postulate that it is no longer necessary to interpret the susceptibility results or determine the mechanism of resistance. Several critics disagree, however, and consider that susceptibility results should be interpreted until more data are available on the clinical efficacy of treatment with β-lactams.Given these methodological difficulties and constant changes in the interpretation criteria, we consider that training and external quality controls are essential to keep updated in this field. For learning purposes, these external quality controls should always be accompanied by a review of the results and methodology used, and the analysis of errors. In this paper we review and contextualize all the aspects related to the detection and interpretation of these β-lactamases.     

Impacto de la colonoscopia intraoperatoria en la detección y prevención de la fuga de la anastomosis colorrectal por cáncer de recto

Introduction and aimThe value of leakage testing during colorectal resections to identify anastomotic leaks or bleeding has not been established. Our aim was to compare the impact of intraoperative colonoscopy (IOC) versus insufflation with a syringe, as leakage testing in lower anterior resection for rectal cancer, with respect to the incidence of postoperative leakage (PL).Materials and methodsA retrospective study utilizing a prospective database of 426 patients with rectal cancer that underwent elective lower anterior resection, within the time frame of January 2015 and December 2019, was conducted. The anastomotic leak test was chosen by the surgeon. The incidence of PL was compared between patients that underwent IOC and those that had the syringe leak test, utilizing the logistic regression analysis. Propensity score matching was included.ResultsThere were no significant differences in the clinical characteristics or morbidity and mortality rates between the 2 groups. Four patients were excluded, leaving a patient total of 422. Seventy patients with IOC were compared with 352 that had the syringe leak test. The incidence of PL was 5.7% in the IOC group and 12.2% in the control group (P = .001). After propensity score matching (n = 221), balancing the characteristics between the groups, the incidence of PL was 5.7% in the IOC group and 13.9% in the syringe leak test group (P = .001).ConclusionIOC was shown to be a safe method for evaluating the integrity of colorectal anastomosis and was associated with a higher percentage of protective stoma use, appearing to reduce the risk for PL.     

Genotipos de Helicobacter pylori asociados con cáncer gástrico y displasia en pacientes de Colombia

Introduction and aimsColombia has high incidence levels of gastric cancer that can be explained by the genetic variability of Helicobacter pylori (H. pylori). Our aim was to establish the relation of the H. pylori CagA and VacA genotypes to dysplasia and gastric cancer, in a high-risk population.Material and methodsA case-control study was conducted on 202 patients from a high-risk cancer zone. Patients with dysplasia and gastric cancer (cases) and patients with nonatrophic gastritis (controls) were included. Endoscopic sampling and histologic classification were carried out according to the Sydney system and the Lauren classification. Genetic information was obtained through polymerase chain reaction on paraffin blocks. The measures of association of the variables of interest were evaluated in bivariate and multivariate models. A P<0.05 was considered statistically significant and the SPSS version 25 program was employed.ResultsAge above 50 years (OR: 23.76; CI: 8.40-67.17; P=0.000) and the VacA s1m1 genotype (OR: 6.18; CI: 1.25-30.51; P=0.025) were associated with higher risk for developing dysplasia and gastric cancer. The CagA+ genotype was not found to be a risk factor for developing those pathologies (OR: 1.02; CI: 0.39-2.62; P=0.965).ConclusionsThe H. pylori VacA genotypes are markers for the development of gastric cancer. That information could be used to create a risk index in a predictive model to optimize the healthcare of higher-risk patients.     

Análisis de la satisfacción de los participantes en el Programa de detección precoz de cáncer colorrectal de Barcelona: valoración positiva de la farmacia comunitaria

Background and objective

Population-based bowel screening programmes with faecal occult blood (FOB) tests need to achieve high uptake rates and offer quality services. We invited participants in the Barcelona Programme to complete a satisfaction survey, in order to explore factors influencing uptake and respondents’ opinion and satisfaction with each step of the screening process.