Browsing by Author "Rollán, Antonio"
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Item Diagnóstico precoz de cáncer gástrico. Propuesta de detección y seguimiento de lesiones premalignas gástricas: protocolo ACHED(Sociedad Médica de Santiago, 2014) Rollán, Antonio; Cortés, Pablo; Calvo, Alfonso; Araya, Raúl; Bufadel, María Ester; González, Robinson; Heredia, Carolina; Muñoz, Pablo; Squella, Freddy; Nazal, Roberto; Gatica, María de los Ángeles; Gobelet, Jaquelina; Estay, René; Pisano, Raúl; Contreras, Luis; Osorio, Ingrid; Estela, Ricardo; Fluxá, Fernando; Parra-Blanco, AdolfoAn expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5 ) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populationsItem Endoscopic band ligation versus propranolol for the primary prophylaxis of variceal bleeding in cirrhotic patients with high risk esophageal varices(2010) Pérez-Ayuso, Rosa María; Valderrama, Sebastián; Espinoza, Manuel; Rollán, Antonio; Sánchez, René; Otarola, Francisco; Medina, Brenda; Riquelme, ArnoldoBackground. Gastroesophageal variceal bleeding is a common complication of portal hypertension. Currentguidelines recommend β-blockers for primary prophylaxis. However, evidence suggests that endoscopic va-riceal ligation (EVL) reduce bleeding episodes. Aims. To compare endoscopic EVL with propranolol (PPL)for primary prophylaxis of variceal bleeding. Methods. We conducted a randomized controlled trial. Over a9-year period, 75 patients with cirrhosis and high-risk esophageal varices (HREV) were recruited and alloca-ted to EVL (n=39) or PPL (n=36). Primary outcome was variceal bleeding. Secondary outcomes were survi-val, source of bleeding and serious adverse events. Analyses were made by intention-to-treat. Results.Baseline characteristics were similar. Medium follow-up was 1647±1096 days. Complete follow-up wasachieved in 85% of patients. Variceal bleeding occurred in 12% of EVL and in 25% of PPL group (p=0.17).The actuarial risks of bleeding after 2 years were similar in both groups. Overall mortality was 51% in EVLand 33% in PPL group (p=0.17). Patients in the EVL group showed a lower rate of esophageal variceal blee-ding (5.1% v/s 25%, p=0.027) and a higher rate of subcardial variceal bleeding compared with PPL group(7.7% v/s 0%, p=0.027). Serious adverse events related to EVL occurred in 2 patients, including 1 death.Conclusions. The present study supports that PPL should be considered the first choice in primary pro-phylaxis of variceal bleeding offering similar effects and lower severe adverse events compared with EVLItem Experiencia de educación continua en línea en gastroenterología para médicos no especialistas(2019) Isbej, Lorena; Uribe, Javier; Carrasco, Olga; Villarroel, Isaac; Pizarro, Margarita; Jirón, María Isabel; Sanhueza, Edgar; Álvarez, Manuel; Hernández, Cristián; Díaz, Luis; Cerda, María; Kramer, Tomás; Munizaga, Fernando; Riquelme, Arnoldo; Rollán, Antonio; Monsalve, XimenaBackground: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and methods: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.