Background and Objectives:EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed.Methods:This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD.Results:Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the First choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended.Conclusion:This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.

Objectives:The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN).Methods:Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence.Results:Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one.Conclusions:EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.

Background and Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers. Results: ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50–200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended. Conclusion: This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.

Background and Objectives:Currently, pancreatic cystic lesions (PCLs) are recognized with increasing frequency and have become a more common finding in clinical practice. EUS is challenging in the diagnosis of PCLs and evidence-based decisions are lacking in its application. This study aimed to develop strong recommendations for the use of EUS in the diagnosis of PCLs, based on the experience of experts in the field.Methods:A survey regarding the practice of EUS in the evaluation of PCLs was drafted by the committee member of the International Society of EUS Task Force (ISEUS-TF). It was disseminated to experts of EUS who were also members of the ISEUS-TF. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized.Results:Fifteen questions were extracted and disseminated among 60 experts for the survey. Fifty-three experts completed the survey within the specified time frame. The average volume of EUS cases at the experts' institutions is 988.5 cases per year.Conclusion:Despite the limitations of EUS alone in the morphologic diagnosis of PCLs, the results of the survey indicate that EUS-guided fine-needle aspiration is widely expected to become a more valuable method.

El cáncer Colorrectal (CCR) ocupa la cuarta causa de muerte por cáncer en Estados Unidos de América y la quinta causa de muerte por cáncer en Colombia y de esta forma se convierte en un problema de salud pública. El 98 % de los cánceres Colorrectales son adenocarcinomas y el otro 2% corresponden a linfomas, carcinoides y tumores estromales gastrointestinales. Las manifestaciones clínicas se relacionan con el tamaño y la localización de la lesión, el 80% de los casos reportados de CCR no presentan un componente hereditario convirtiéndolos en CCR esporádicos. El CCR está asociado con la acumulación de mutaciones en genes supresores de tumores (p53, APC, SMAD, SCC, NM23), oncogenes (MYC y RAS) y genes reparadores del ADN (MSH1, MSH6 y MLH2) estas alteraciones genéticas hacen de este tipo de cáncer un desorden poligenético, convirtiéndolo en un modelo clásico para estudiar las bases genéticas del cáncer. Colorectal cancer took the fourth leading cause of cancer death in the United Statesof America and the fifth leading cause of cancer death in Colombia and thus becomesa public health problem. 98% of colorectal cancers are adenocarcinomas and theother 2% are lymphomas, carcinoids, and gastrointestinal stromal tumors, the clinicalmanifestations are related to the size and location of the lesion, 80% of reported casesof CRC not present a hereditary component making them sporadic CRC. The CRC isassociated with the accumulation of mutations in tumor suppressor genes (p53, APC,SMAD, SCC, NM23), oncogenes (MYC and RAS) and DNA repair genes (MSH1, MSH6and MLH2) these genetic alterations make this type of cancer a polygenic disorder,making it a classic model for studying the genetic basis of cancer.

Helicobacter pylori infecta más del 50% de la población mundial y se ha asociado al desarrollo de patologías gastroduodenales como: gastritis crónica, úlceras duodenales y gástricas, cáncer gástrico y linfoma de tejido linfoide asociado a mucosas. En los últimos años han aparecido un número considerable de publicaciones que plantean la existencia de una relación entre Helicobacter pylori y patologías que se alejan del sistema digestivo (extraintestinales) tal es el caso de las patologías cardiovasculares (como la enfermedad isquémica coronaria), dermatológicas (como la rosácea), tipo endocrino y enfermedades inmunológicas, entre otras. En este escrito se abordará principalmente las patologías de tipo cardiovascular.

La infección por Helicobacter pylori afecta alrededor del 50% de la población mundial y es el principal agente etiológico de la gastritis crónica, la ulcera péptica, la duodenal y el cáncer gástrico. Cerca del 30% de los casos son resistentes al tratamiento con antibióticos y se requiere un estricto seguimiento durante el tratamiento. El objetivo de este estudio fue determinar la frecuencia, las características clínicas y sociodemográficas relacionadas con el abandono del tratamiento en un grupo de pacientes sometidos a esofagastroduodenoscopia y diagnosticados con infección por H. pylori en ciudades del eje cafetero 2018. El método utilizado es un estudio observacional, descriptivo y longitudinal. Entre los resultados se observó que, de la totalidad de pacientes (N: 94), el 74,5% debió tratarse (70/94) y, de estos, el 88,6% estuvo en tratamiento (62/70). Al finalizar el estudio, se observó que aproximadamente el 84% de los pacientes que recibieron tratamiento lograron terminarlo (52/62). Se concluye que la frecuencia de abandono fue del 16% y, al comparar las características tanto sociodemográficas como clínicas entre los que terminaron y no terminaron su tratamiento, no hubo ninguna relación significativa.