Background: Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. Objective: This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. Methods: This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar’s test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). Results: The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. Conclusion: Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.

- BACKGROUND: Esophagogastroduodenoscopies and colonoscopies are the main diagnostic examinations for esophageal, stomach, and colorectal tumors. AIM: This study aimed to evaluate the estimates of the incidence of esophageal, stomach, and colorectal cancer; population growth; and esophagogastroduodenoscopies and colonoscopies performed by the Unified Health System (SUS), from 2010 to 2018, in the five regions of the country, and to analyze the relationship between these values. RESULTS: The colorectal tumor had a significant elevation, while the esophageal and gastric maintained the incidences. In the five regions, there was a significant increase in the number of colonoscopies; however, this increase did not follow the increase in the population in the North and Northeast regions. There was no significant increase in the number of esophagogastroduodenoscopies in the North, Northeast, Midwest, and South regions, and in the North region there was a decrease. In the Northeast region, there was a decreasing number, and in the South and Midwest regions, the number of examinations remained stable in the period. The Southeast region recorded an increase in the number of examinations following the population growth. CONCLUSION: The current number of esophagogastroduodenoscopies and colonoscopies performed by the SUS did not follow the population growth, in order to attend the population and diagnose esophageal, stomach, and colorectal tumors. Therefore, the country needs to have adequate and strategic planning on how it will meet the demand for these tests and serve the population well, incorporating new technologies.

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ABSTRACT Objective: to analyze the surgical treatment of patients with recurrent megaesophagus followed at the esophageal-stomach-duodenal outpatient clinic of the Hospital de Clínicas - UNICAMP. Methods: a retrospective study, from 2011 to 2017, with 26 patients with Chagas or idiopathic megaesophagus, surgically treated, and who recurred with dysphagia. Clinical, endoscopic and radiographic aspects were assessed and correlated with the performed surgical procedures. Results: 50% had dysphagia for liquids, 69% regurgitation, 65.3% heartburn, 69.2% weight loss and 69.2% had Chagas disease. In addition, 38.4% had megaesophagus stage 1 and 2 and 61.5% stage 3 and 4. Regarding the reoperations, 53% of them underwent Heller-Pinotti surgery by laparoscopy, Serra-Dória in 30.7% and esophageal mucosectomy in 7.9%. In 72% of the reoperations there were no postoperative complications, and 80% of the patients had a good outcome, with reduction or elimination of dysphagia. Among the reoperated patients undergoing the laparoscopic Heller-Pinotti technique, three reported little improvement of dysphagia in the postoperative period and among those who underwent Serra-Dória surgery, 100% had no dysphagia. It was observed that, when the time between the first procedure and the reoperation was longer, the better the surgical result was, with statistical significant decreased dysphagia (p=0.0013, p<0.05). Conclusions: there was a preference to perform laparoscopic re-miotomy and, as a second option, Serra-Dória surgery, for patients with recurrent megaesophagus. Esophagectomy or esophageal mucosectomy were reserved for more severe patients.

Instituição: FACULDADE DE CIENCIAS MEDICAS -UNICAMPRelato de Caso Paciente, 59 anos,masculino, tabagista e etilista. Com queixa de epigastralgia há 1 ano sendo que há 2 meses evolui com disfagia progressiva, inicialmente para sólidos progredindo para alimentos pastosos. Refere perda de 6 kg no período de 2 meses. Realizou EDA que diagnosticou lesão vegetante e infiltrativa de 6 cm de extensão À 29 cm da ADS, cujo anátomo-patológico evidenciou carcinoma espinocelular ulcerado do esôfago. Tomografia de estadiamento de tórax apresentou nódulos pulmonares. Nova EDA reafirmou o diagnóstico e broncoscopia de estadiamento não mostrou invasão para a árvore traqueobrônquica. Nova tomografia de tórax, 2 meses após a primeira, evidenciou 4 nódulos no lobo inferior direito podendo corresponder à lesão secundária. Logo, paciente foi submetido à gastrostomia endoscópica e encaminhado para terapia com quimiorradiação. EDA após terapia oncológica mostrou lesão actínica sem evidências de malignidade.Tomografia de tórax após término da terapia mostrou que os nódulos pulmonares mantiveram o tamanho e características, sem conclusão para malignidade pela equipe de cirurgia torácica. Paciente apresentou melhora da disfagia após quimiorradiação , mantendo somente disfagia para sólidos e mantendo nutrição pela gastrostomia. Após 2 anos decorridos do término da terapia oncológica, apresentou progressão da disfagia. Realizada nova EDA que evidenciou estenose completa do esôfago sem sinais de malignidade. Tomografia de re-estadiamento não apresentou indícios de doença metastática. Portanto, paciente foi submetido à Esofagectomia total por Videotoracoscopia seguida de reconstrução com tubo gástrico, evoluindo no pós-operatório sem intercorrências. Anátomo-patológico da peça cirúrgica evidenciou estenose actínica total da luz do esôfago sem sinais de malignidade. Discussão A neoplasia maligna de esôfago apresenta elevada mortalidade, devido à agressividade do tumor e diagnóstico tardio. A esofagectomia é a proposta terapêutica que apresenta maior índice de sucesso, essa pode ser feita após terapia neoadjuvante com radio e quimioterapia. Além disso, outra modalidade de cirurgia é a esofagectomia de resgate, esta é indicada para pacientes que foram submetidos a quimiorradiação definitiva devido ao estadiamento avançado da doença no momento do diagnóstico, mas obtiveram boa resposta com o tratamento proposto, e por isso, esses pacientes são selecionados para realizar a cirurgia, a qual não havia proposta antes do tratamento. ABCDExpress 2017;1(2):66Codigo: 64320 Acesso está disponível em www.revistaabcd.com.br e www.sbad2017.com.br Acesso pelo

A ata de defesa com as respectivas assinaturas dos membros da banca examinadora encontra-se no processo de vida acadêmica do aluno.

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