<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2444-6483</journal-id>
<journal-title><![CDATA[Endoscopia]]></journal-title>
<abbrev-journal-title><![CDATA[Endoscopia]]></abbrev-journal-title>
<issn>2444-6483</issn>
<publisher>
<publisher-name><![CDATA[Asociación Mexicana de Endoscopia Gastrointestinal A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2444-64832019000600260</article-id>
<article-id pub-id-type="doi">10.24875/end.m19000106</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Colonoscopia de intercambio mínimo de agua y su impacto en el índice de detección de pólipos: estudio aleatorizado]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alfaro-García]]></surname>
<given-names><![CDATA[Amilcar Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Antonio-Manrique]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chávez-García]]></surname>
<given-names><![CDATA[M.A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cerna-Cardona]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Secretaría de Salud Hospital Juárez de México (HJM) Servicio de Endoscopia]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2019</year>
</pub-date>
<volume>31</volume>
<fpage>260</fpage>
<lpage>266</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2444-64832019000600260&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2444-64832019000600260&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2444-64832019000600260&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción: La colonoscopia sigue siendo el método más importante para los programas de escrutinio de cáncer colorrectal, su impacto en la reducción de la incidencia y mortalidad de esta enfermedad se debe a la posibilidad de detectar y resecar lesiones precancerosas. El índice de detección de pólipos es directamente proporcional a la tasa de detección de adenoma. Se han descrito diferentes técnicas que facilitan la intubación cecal y mejoran la visualización de la mucosa. La técnica de intercambio mínimo de agua (CIM) combina el concepto original de intercambio de agua, en la que se aspira el aire del lumen colónico para posteriormente infundir agua; sin embargo, en esta técnica la cantidad de agua que se infunde es menor, mediante una presión constante en el botón de la válvula de aire y agua del endoscopio, aspirando cuando sea necesario.  Objetivos: Comparar índice de detección de pólipos mediante colonoscopia de intercambio mínimo (CIM) y colonoscopia convencional con aire ambiente (CC). Objetivos secundarios: Comparar el índice y tiempo de canulación cecal, los requerimientos de fármacos sedantes y satisfacción del paciente.  Material y métodos: Estudio prospectivo, controlado, aleatorizado, simple ciego. Se realizó la aleatorización de los pacientes mediante un programa electrónico en 2 grupos: primer grupo donde se utilizó la técnica convencional con insuflación de aire ambiente, segundo grupo en los que se utilizó la técnica de intercambio mínimo, los pacientes desconocían el tipo de técnica que se utilizó. La dosis que se utilizó de medicamento sedante fue a criterio del anestesiólogo. Se utilizó un cronómetro para medir el tiempo de canulación cecal. Previo a su egreso, se solicitó al paciente llenar el formulario GHAA-9mc y se aplicó la escala de Likert para definir las molestias que percibió durante el procedimiento. Criterios de exclusión: Pacientes con mala preparación intestinal (escala de Boston &lt;6), sospecha de perforación u oclusión intestinal, cirugía previa de colon, hemorragia gastrointestinal severa, cáncer colorrectal documentado, enfermedad inflamatoria intestinal penetrante o estenosante, pacientes que no aceptaron el procedimiento. El cálculo del tamaño de la muestra se realizó con el programa Win episcope versión 2.0. Se estudiaron 84 pacientes (42 por cada grupo). Los datos demográficos se describieron utilizando la media y desviaciones estándar. El test exacto de Fisher y la prueba de Chi Cuadrado se utilizaron para comparar datos categóricos. Se utilizó la prueba T de student para comparar las medias de las variables numéricas. Se consideró significativo un valor de p &lt;0.05. Todos los datos fueron procesados con el programa SPSS 23 (IBM SPSS Statistics)  Resultados: Las características generales de los pacientes fueron similares entre los dos grupos, la media de edad fue de 58.5 ±12.6 en el grupo de CIM y 57.2 ±13.6 en el grupo de CC. No encontramos diferencias en cuanto al índice de detección de pólipos entre los grupos estudiados, para el grupo de CIM el indice de detección fue de 14.4%, y para el grupo C.C. fue de 21.5%, con una mayor proporción de detección de pólipos en hemicolon derecho, no hubo diferencias en el índice de canulación cecal entre ambos grupos (95.2% vrs 92.9%); sin embargo, con la técnica de CIM el tiempo de canulación cecal fue menor (695 seg vrs 869 seg) y requirieron menos maniobras como cambios de posición o compresión abdominal para llegar al ciego. La dosis de fármacos utilizados durante la sedación fue mayor en el grupo de C.C. (p&lt; 0.05). La satisfacción del paciente medido con la escala GHAA-9mc fue mayor en el grupo de colonoscopia de intercambio mínimo que en el grupo de C.C. (35.6 ±3 vrs 29.9 ±3, p&lt;0.001). Respecto a la escala de Likert para determinar el grado de molestias percibidas por el paciente, el grupo CIM tenían una mayor proporción de pacientes con calificación muy bueno o excelente (33 y 31% respectivamente).  Conclusiones: La técnica de colonoscopia de intercambio mínimo de agua no demostró superioridad en la tasa de detección de pólipos, ni en la tasa de canulación cecal; sin embargo, hubo un menor tiempo de canulación cecal, menor requerimiento de cambios de posición, compresión abdominal, dosis de medicamentos sedantes y mayor satisfacción del paciente.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction: Colonoscopy remains the most important method for screening programs for colorectal cancer, its impact in reducing the incidence and mortality of this disease is due to the possibility of detecting and resecting precancerous lesions. The detection rate of polyps is directly proportional to the adenoma detection rate. Different techniques have been described that facilitate cecal intubation and improve the visualization of the mucosa. The technique of minimum water exchange combines the original concept of water exchange, in wich the air from the colonic lumen is aspirated to later infuse water; however, in this technique, the amount of water infused is less, by constant pressure on the button of the air/water valve of the endoscope, sucking when necessary.  Objectives: To compare the detection rate of polyps with minimal exchange colonoscopy (CIM) and conventional colonoscopy with ambient air (CC). Secondary objectives: Compare the rate and time of cecal cannulation, the requirements of sedative drugs and patient satisfaction.  Material and methods: Prospective, controlled and randomized study. The patients were randomized by means of an electronic program in 2 groups: first group with the conventional technique, second group with minimum exchange technique, patients did not know the type of technique used. The dose that was used for the sedative medication was at the discretion of the anesthesiologist. A chronometer was applied to measure the cecal cannulation time. Prior to discharge, the patient was asked to complete the GHAA-9mc form and the Likert scale was applied to define the discomfort perceived during the procedure.  Exclusion criteria: Poor intestinal preparation (Boston scale &lt;6 points), suspected intestinal perforation or occlusion, previous colon surgery, severe gastrointestinal bleeding, documented colorectal cancer, penetrating or stenosing inflammatory bowel disease, patients who did not accept the procedure. The calculation of the sample size was made with the Win episcope version 2.0 program. 84 patients were studied (42 for each group). Demographic data are described using the mean and standard deviations. The Fisher&#8217;s exact test and the Chi-square test were used to compare categorical data. Student test was applied to compare the means of the numerical variables. A value of p &lt;0.05 was considered significant. All data were processed with the SPSS 23 program (IBM SPSS Statistics)  Results: The general characteristics of the patients were similar between the two groups; the mean age was 58.5 ± 12.6 in the MIC group and 57.2 ± 13.6 in the CC group. We did not find differences in the polyp detection rate between the groups studied, for the MIC group the detection rate was 14.4%, and for the group C.C. the rate was 21.5%, with a greater proportion of detection of polyps in right hemicolon, there were no differences in the rate of cecal cannulation between both groups (95.2% vrs 92.9%); however, with the CIM technique the cecal cannulation time was shorter (695 sec vrs 869 sec) and they required less maneuvers such as position changes or abdominal compression to reach the cecum. The dose of drugs used during sedation was higher in the C.C. (p &lt;0.05). Patient satisfaction with the GHAA-9mc scale was greater in the minimal exchange colonoscopy group than in the C.C. (35.6 ± 3 vrs 29.9 ± 3, p &lt;0.001). Regarding the Likert scale to determine the degree of discomfort perceived by the patient, the CIM group had a higher proportion of patients with very good or excellent grades (33 and 31% respectively).  Conclusions: The colonoscopy technique of minimal water exchange showed no superiority in the detection rate of polyps, nor in the rate of cecal cannulation; however, there is a shorter cannulation time, less requirement for position changes, abdominal compression, sedative medication doses and greater patient satisfaction.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Colonoscopia]]></kwd>
<kwd lng="es"><![CDATA[Agua]]></kwd>
<kwd lng="es"><![CDATA[Aire]]></kwd>
<kwd lng="es"><![CDATA[Pólipos]]></kwd>
</kwd-group>
</article-meta>
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