Resumo A transformação da ecoendoscopia (EUS) de um método de diagnóstico a ferramenta terapêutica revolucionou a abordagem na gastroenterologia. As terapêuticas guiadas por EUS, nomeadamente as obstruções pancreatobiliares, constituem agora alternativas às abordagens cirúrgicas e percutâneas. Esta modalidade terapêutica permite também a drenagem da vesícula biliar em doentes que não são candidatos cirúrgicos. Além disso, ao utilizar as suas capacidades únicas de imagem, a EUS permite a drenagem em casos de obstrução da saída gástrica, bem como realizar a ablação de lesões císticas pancreáticas. O crescente progresso da gastrenterologia permite o desenvolvimento de procedimentos terapêuticos minimamente invasivos num ambiente multidisciplinar. Nesta revisão, propusemos-nos a descrever as atuais indicações e inovações através da EUS.

Abstract The transcendence of endoscopic ultrasound (EUS) from diagnostic to therapeutic tool has revolutionized management options in the field of gastroenterology. Through EUS-guided methods, pancreaticobiliary obstruction can now be utilized as an alternative to surgical and percutaneous approaches. This modality also allows for gallbladder drainage in patients who are not ideal operative candidates. By utilizing its unique imaging capabilities, EUS also allows for drainage access points in cases of gastric outlet obstruction as well as windows to ablate pancreatic cystic lesions. As technical progress continues to evolve, interventional gastroenterology continues to push the envelope of minimally invasive therapeutic procedures in a multidisciplinary setting. In this comprehensive review, we set out to describe current indications and innovations through EUS.

ABSTRACT Background: self-expandable metal stents are often used for the palliative treatment of dysphagia in patients with advanced esophageal cancer and an anticipated limited survival. Due to previous reports of a high rate of adverse event when used long-term, concerns have been raised with regard to the use of self-expandable metal stents in patients with a longer survival. Aim: assess the role of esophageal self-expandable metal stents in patients with advanced esophageal cancer that have survived longer than six months. Methods: retrospective study of patients with advanced esophageal cancer with a self-expandable metal stent and a stent placement time greater than six months. Results: forty-two patients were followed up for 298 days. There was a clinical improvement in all patients. However, 59% of patients experienced an adverse event. The median stent patency was 236 days. Endoscopic management was attempted in all self-expandable metal related adverse events, with a clinical success rate of 100%. However, the previously treated adverse event recurred in seven patients. Multivariate analysis showed that strictures that were traversable with an ultrathin gastroscope were associated with a higher risk of adverse events (p = 0.035). Conclusions: long-term esophageal stenting in patients with advanced esophageal cancer is associated with a high prevalence of adverse events without an impact on mortality; most cases can be managed endoscopically.

RESUMO A colonoscopia é um dos procedimentos mais feitos. Sedação e analgesia diminuem a ansiedade e o desconforto e minimizam riscos. Em razão disso, os pacientes preferem que o exame seja feito sob anestesia, embora não tenha sido determinada a melhor combinação de fármacos. A associação de benzodiazepínicos com opioides é usada para aliviar a dor e o desconforto do paciente. Mais recentemente, o propofol assumiu posição de destaque. Este estudo, prospectivo e randomizado, é único na literatura médica e especificamente comparou o uso do propofol e fentanil associado ou não ao midazolam na sedação para colonoscopia feita por anestesiologistas. Os objetivos do estudo foram avaliar os efeitos colaterais da sedação, as condições de alta, a qualidade da sedação e o consumo de propofol durante a colonoscopia, com ou sem o midazolam como pré-anestésico. Envolveu 140 pacientes submetidos à colonoscopia, no Hospital Universitário da Universidade Federal de Juiz de Fora. Os pacientes foram divididos em dois grupos. O Grupo I recebeu, por via endovenosa, midazolam como pré-anestésico, cinco minutos antes da sedação, seguido do fentanil e propofol. O Grupo II recebeu, por via endovenosa, anestesia com fentanil e propofol. Os pacientes do Grupo II apresentaram maior incidência de reação (motora ou verbal) à introdução do colonoscópio, bradicardia, hipotensão arterial e maior consumo de propofol. A satisfação dos pacientes foi maior no Grupo I. De acordo com a metodologia empregada, a associação de midazolam ao propofol e fentanil para sedação em colonoscopia reduz o consumo de propofol e cursa com maior satisfação do paciente.

ABSTRACT Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5 min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction.

Despite extensive worldwide use of standard esophagogastroduodenoscopy (EGD) examinations, gastric cancer (GC) is one of the most common forms of cancer and ranks as the most common malignant tumor in East Asia, Eastern Europe and parts of Latin America. Current limitations of using non systematic examination during standard EGD could be at least partially responsible for the low incidence of early GC diagnosis in countries with a high prevalence of the disease. Originally proposed by Emura et al., systematic alphanumeric-coded endoscopy (SACE) is a novel method that facilitates complete examination of the upper GI tract based on sequential systematic overlapping photo-documentation using an endoluminal alphanumeric-coded nomenclature comprised of eight regions and 28 areas covering the entire surface upper GI surface. For precise localization or normal or abnormal areas, SACE incorporates a simple coordinate system based on the identification of certain natural axes, walls, curvatures and anatomical endoluminal landmarks. Efectiveness of SACE was recently demonstrated in a screening study that diagnosed early GC at a frequency of 0.30% (2/650) in healthy, average-risk volunteer subjects. Such a novel approach, if uniformly implemented worldwide, could significantly change the way we practice upper endoscopy in our lifetimes.

A pesar del uso globalizado y masivo de la Esofagogastroduodenoscopia estándar (EGD), el cáncer gástrico (CG) sigue siendo uno de los cánceres más comunes y continúa posicionado como el tumor maligno más frecuente en el Este de Asia, Este de Europa y partes de América Latina. Las limitaciones actuales de usar un examen no sistemático durante la EGD pueden parcialmente ser responsables de la baja incidencia del diagnóstico de CG temprano en países con una alta prevalencia de la enfermedad. Originalmente propuesta por Emura et al., la Endoscopia Sistemática Alfanumérica Codificada (SACE) es un nuevo método que facilita el examen completo y sistemático del tracto gastrointestinal alto basado en la foto-documentación secuencial con imágenes parcialmente superpuestas y que, usando una nomenclatura alfanumérica endoluminal compuesta de ocho regiones y 28 áreas proporciona el cubrimiento del total de la superficie gastrointestinal durante una endoscopia alta. Para la localización precisa tanto de zonas normales o anormales, SACE incorpora un sistema sencillo de coordenadas basado en la identificación de ciertos ejes naturales, paredes, curvaturas y puntos de referencia anatómicos endoluminales. La efectividad de SACE fue recientemente demostrada en un estudio de tamizaje que diagnosticó CG temprano con una frecuencia de 0,30% (2/650) en voluntarios sanos con riesgo promedio. Este nuevo método de examen endoscópico si se aplica de manera uniforme en el mundo, podría considerablemente aumentar la detección temprana del cáncer gástrico y cambiar significativamente la manera en que realizamos endoscopia digestiva en en nuestra era.