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Revista colombiana de Gastroenterología

Print version ISSN 0120-9957On-line version ISSN 2500-7440

Rev Col Gastroenterol vol.20 no.2 Bogotá June 2005

 

Comentario al artículo: “ASGE guideline: the role of endoscopy in the diagnosis, stating, and management of colorectal cancer”

Comentario: María Teresa Galiano de Sánchez (1)

(1) MD., Gastroenteróloga, Clínica de Marly. Bogotá, Colombia.

This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well designed prospective trials, emphasis is given to results from large series and reports from recognized experts.

Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear: Clinical consideration may justify a course of action at variance to these recommendations.

Colorectal cancer (CRC) is the 4th most commonly diagnosed cancer and the second leading cause of cancer related death in the United States. It has been estimated that in 2003 approximately 147,500 cases of CRC were diagnosed and over 57,000 men and women died from this malignancy. During the past decade, great emphasis has been placed on the use of colonoscopy for the early detection and the removal of adenomatous polyps to reduce the incidence and the mortality of CRC. Once CRC has developed, colonoscopy also has an important role in the diagnosis and subsequent disease management. This guideline represents a summary of recommendations on the role of endoscopy in the diagnosis, the stating, and the treatment of CRC. Recommendations for CRC screening and surveillance are discussed in a previous documental by the American Society for Gastrointestinal Endoscopy.

Gastrointestinal Endoscopy. Vol 61, Nº 1: 2005.

En resumen, los autores concluyen los siguientes puntos con recomendaciones basadas en evidencia: (A) ensayos prospectivos controlados, (B) estudios observacionales, (C) opinión de expertos.

•  La colonoscopia es esencial en el diagnostico del cáncer colorrectal (B).

•  Biopsias múltiples deben ser obtenidas de toda lesión sospechosa y las lesiones polipoides deben ser removidas (A).

•  El ultrasonido endoscópico es seguro en la estadificación locorregional preoperatoria del cáncer rectal y es de gran utilidad en guiar la terapia (A).

•  La obstrucción colónica maligna puede ser tratada endoscópicamente de manera efectiva para paliación o como fuente para cirugía con la colocación de stents metálicos expandibles o con terapia con láser (B).

•  Los factores histopatológicos desfavorables de pólipos colónicos malignos asociados con un alto riesgo de metástasis a ganglios linfáticos o de recurrencia local después de resección endoscópica incluyen los siguientes: histopatología pobremente diferenciada, invasión linfática o vascular, cáncer en el margen de resección, y resección incompleta (B).

•  Los pólipos pediculados malignos confinados a la submucosa pueden ser considerados adecuadamente tratados por resección endoscópica si se removieron completamente y si no hay evidencia de características histológicas desfavorables (B).

•  Los pólipos sesiles malignos confinados a la submucosa y sin evidencia de factores histológicos desfavorables tienen un pequeño incremento de riesgo de mestástasis a ganglios linfáticos y de recurrencia local, comparados con pólipos pediculados similares luego de resección endoscópica. La resección endoscópica de estos pólipos sesiles puede ser adecuada si la resección fue completa y en bloque; sin embargo, la resección quirúrgica debe ser considerada para asegurar el tratamiento definitivo (B).

•  La displasia de alto grado puede ser tratada adecuadamente con resección endoscópica (B).

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Recibido: 08-06-2005 Aceptado: 10-06-2005

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