e16515 Background: Esophageal cancer is a highly lethal entity. Within this group of tumors, squamous cell carcinoma (SCC) and esophageal adenocarcinoma (ACE) represent 95% of the total. For most of the twentieth century, the SCC predominated throughout the world, however, this trend has changed dramatically in Western countries, including ours. Mexican patients with esophageal cancer are diagnosed at later stages of the disease and have worse therapeutic outcomes than reported in the world literature. Methods: Retrospective, observational and descriptive study. The research subjects were obtained from the population of patients who attended the service of the Centro Universitario Contra el Cancer of the University Hospital "Dr. José Eleuterio González” between 2012 and 2017 (sample size calculated n = 120).The clinical and demographic characteristics of patients with esophageal cancer in our population were described. The results from international guides (AIMS65, New International Score, Glasgow-Blatchford scale and Rockall pre-endoscopic) were used to compare cut-off points with our population and their correlation with mortality. Results: A total of 179 research subjects were included in the study. The average age was 55 years, 62% male and 38% female. Various demographic characteristics such as in-hospital mortality (n = 42, 23.5%), 30-day mortality (n = 36, 20.1%), re-bleeding (n = 49, 27.4%) and transfusions (n = 99, 55.3%) were studied as incidence of positive cases to the event. We also studied the mean days of hospital stay (4.6 days), systolic blood pressure (108 mmHg) and diastolic blood pressure (66mmHg), hemoglobin (8.9 g / dL), among others. The type of bleeding was variceal in 122 subjects, and non-variceal in 57. In total, 117 subjects were treated with endoscopic treatment and 53, without endoscopic treatment. The Glasgow Blatchford scale obtained a higher discriminative score (AUROC 0.73) to predict in-hospital mortality in our subjects, compared to ASA (0.72 p < 0.001), New International score (0.76 p < 0.001) and AIMS65 (0.66 p < 0.001). Conclusions: The used scales had no positive predictive value for bleeding risk. The Glasgow Blatchford scale was the only score that showed an AUROC of 0.65 p < 0.001 to predict the efficiency of transfusion in patients compared to the other scores that showed no significant value. ASA was the predictive discriminative score (AUROC 0.73) for a 30-day in-hospital mortality (p < 0.001), followed by the Glasgow Blatchford scale (0.61 p < 0.04).
INTRODUCTION: Gastroesophageal variceal hemorrhage is an important complication from portal hypertension. Nearly 20% of this type of bleeding is from gastric varices (GVs), which is considered more profuse and severe compared to esophaeal variceal bleeding. There are many treatment modalities for GVs active bleeding. The use of tissue adhesives like cyanoacrylate is gaining acceptance for the treatment of GVs with a safe profile. The aim of this study is to determine the effectiveness of cyanoacrylate application in active GV bleeding. METHODS: We retrospectively reviewed the clinical data of 58 patients who underwent cyanoacrylate application in the setting of active GVs bleeding from January 2016 to July 2018. The outcomes of our study were initial hemostasis, inpatient bleeding, early rebleeding and 6-week mortality. The safety of the procedures was followed as well. RESULTS: A total of 75 procedures of cyanoacrylate injection were performed in 58 patients over a period of 3 years (January 2016-July 2018). Thirty-seven male patients (63.7%) with a mean age of 55.9 ± 13.8 years old were included. The mean duration of follow-up was 122 ± 2 days (range 1 to 719 days). From the total of patients enrolled, 32 (55.1%) and 11 (18.9%) were Child Pugh B and C, respectively. The main symptoms in these patients were hematemesis in 29 (50.0%), melena in 7 (12.0%), or both in 19 (32.7%). In the 58 patients evaluated, the different types of GVs were registered; many patients had more than one type of GVs according to Sarin´s classification. GV prevalence in our patients was GOV2 (43.1%), IGV1 (41.3%), GOV1 (22.4%) and IGV2 (10.3%). The success of the index endoscopic hemostatic procedure was 96.5%. A second endoscopy was performed in 58.6% of patients within 24 hours to assure complete blood vessel occlusion and no residual bleeding; a second cyanoacrylate injection was needed in 12% patients (20.6%). The inpatient and early rebleeding was 18.9% and 17.2%, respectively. The overall mortality was 18.9%. Adverse events were not detected in the current study. CONCLUSION: Cyanoacrylate injection is an effective therapeutic and safe option in acute GVs bleeding. We suggest an aggressive approach therapy in patients with active GVs bleeding, since it portends a higher incidence of recurrence; a second-look endoscopy, the use of endoscopic ultrasound and a thorough evaluation of rebleeding should be considered.
e15536 Background: Squamous cell carcinoma and adenocarcinoma represent approximately 95% of malignant tumors of the esophagus. For most cases of the 20th century, squamous cell carcinoma was the predominant lineage. In the 1960s, squamous cell carcinoma accounted for more than 90% of all esophageal tumors in the United States of America, and adenocarcinoma was considered so uncommon that some oncological associations questioned its existence. However over time the incidence of esophageal adenocarcinoma (predominantly in the distal esophagus and gastroesophageal junction) has increased dramatically in Western countries, with adenocarcinoma now causing more than 60% of all esophageal cancers in the United States of America, unlike the rest of the world, where squamous cell carcinoma continues to predominate. Squamous cell carcinoma and adenocarcinoma differ in a significant number of clinical features, including tumor location and predisposing factors. Smoking and alcoholism are major risk factors for the development of squamous cell carcinoma, while the Barrett's esophagus with intestinal metaplasia (a complication of gastroesophageal reflux disease), obesity, and smoking are the risk factors related to adenocarcinoma of the esophagus. Objectives: To determine the incidence of esophageal adenocarcinoma in Mexico and its main characteristics, such as epidemiology, histological type and main risk factors. Methods: A descriptive analysis was conducted in which the histological type, age of diagnosis, location, age of the patients and risk factors were compared. Results: Average age on the studied population was 67.4 years (minimum 37, maximum 91); 74.3% of the subjects were male and 20.4%, female. It was found that the predominant histological type was Adenocarcinoma in 40.7% against 28.3% of the Epidermoid. Average age of diagnosis was at 65.88 years (minimum 37, maximum 89). In frequency of localization, lower third in 22.1%, union GE in 20.4%, middle third in 15%, and upper third in 12.4%). The predominant risk factors in our study were smoking (31%), alcoholism (36.3%) and GERD (12.4%). Conclusions: Oesophageal adenocarcinoma continues to be the most prevalent presentation of esophageal cancer in our population, despite epidemiological changes over time.
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