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IECED starts 2020 with new global recognitions



Once again International Acknowledgment exalts this nation in the medical-scientific field thanks to the Ecuadorian Institute of Digestive Diseases (IECED). This 2020 IECED gets three international awards, which will be awarded within the World Endoscopy Congress (ENDO 2020) which is considered one of the most important in the world of digestive endoscopic medicine. The event, which will take place from March 7th to 10th in Rio de Janeiro (Brazil), as part of its previous agenda begins with a competition where more than 700 works from all over the world were received and only the top 25 were selected to be presented in the congress.


IECED got the second place with its study called “Prophylactic endoscopic ultrasound-guiaded gallbladder drainage in patients with unresectable malignant biliary obstruction and cystic duct orifice involvement: a randomized controlled trial”, which was led by Dr. Carlos Robles-Medranda, director of the IECED and the Pentax Training Center Ecuador, and his team of doctors: Roberto Oleas, Miguel Puga -Tejada, Juan Alcívar, Juan Olmos, Jorge Baquerizo and Hannah Pitanga.


It is a novel technique for palliative treatment in patients with terminal cancer of the pancreas and / or cholangiocarcinoma (mostly older adults), which up until now it had not been written in the traditional literature to be applied. “In patients with pancreatic cancer or cholangiocarcinoma, the cystic duct of the bile duct is usually obstructed, being compressed by a tumor that is unresectable (it means it cannot be removed or operated due to its malignancy), preventing the bile to pass naturally  and may cause the gallbladder to swell ... If it occurs it is serious for their condition,  since they are unsuitable candidates for surgery and with high mortality ... So, what we propose in the IECED is that prophylaxis is performed as a primary treatment, to drain the gallbladder and only then it will prevent its inflammation and  other complications such as bile accumulation and subsequent acute cholecystitis will develop”, says Dr. Carlos Robles-Medranda, who will be in charge of the study exposition.


To test their hypothesis a randomized study was carried out in 39 patients in the center, of which twenty (20) had no gallbladder drained and nineteen (19) had a prophylactic drainage of the gallbladder. As a result it was shown that 25% of patients who were not drained, the gallbladder developed acute cholecystitis which aggravated their condition from day one and led to hospitalization and emergency surgery via laparoscopy, and in some other cases they could not be operated due to the high risk of mortality. Meanwhile 100% of the patients to whom prophylactic drainage was applied did not develop complications nor did they have to be hospitalized, and the procedure gave them a better quality of life.



Early detection is the key

Left: Echoendoscopy of pancreatic lesion with puncture and biopsy. Right: Confocal image compatible with Intraductal Papillary Mucinous Neoplasm.


Two honorable mentions are added to this achievement which will also be exhibited during the ENDO 2020 World Congress. The second award-winning study is “EUS-THROUGH-THE-NEEDLE TECHNOLOGIES IN THE DIAGNOSIS AND MALIGNANCY DETECTION OF PANCREATIC CYSTS: A COMPARATIVE STUDY BETWEEN DIFFERENT TECHNOLOGIES”.


According to experts, pancreatic cystic lesions are lesions that develop in the pancreas which have a potential development of malignancy. Therefore, it is important to detect them early through the technique of Ecoendoscopy (or Endoscopic Ultrasound).

"The more accurate and early the diagnosis is the development of cancer can be avoided or detected in early stages, to provide a more effective treatment and possible cure for pancreatic cancer", says Dr. Roberto Oleas, a researcher at IECED.


In the study, which was carried out between 2013 and 2018, 2812 echoendoscopies were performed. 856 were from pancreatic lesions and 129 were cystic lesions that were subjected to analysis (47 cases with conventional echoendoscopy and 82 cases with all types of latest generation technologies offered by the IECED).

In patients undergoing diagnosis through conventional echoendoscopy, malignancy could only be detected in 17% of case. Meanwhile with the use of new technologies, the malignant detection was superior reaching more than 80% of effectiveness.

To name a few of the techniques used were:

Echoendoscopy with puncture and fine needle aspiration.- It allows fluid to be extracted with a needle to study it. With this technique it was shown that malignancy can be detected in 71% of cases.Echoendoscopy with confocal endomicroscopy.- The confocal probe is passed to see the cyst walls at a microscopic level and determine their characteristics. With this technique it was shown that malignancy can be detected in 86% of cases.

Echoendoscopy with biopsy with micro forceps.- Biopsies can be taken from the cyst walls. With this technique it was shown that malignancy can be detected in 83% of cases. Echoendoscopy with Cystoscopy. - A camera is inserted to look inside the cyst. With this technique it was shown that malignancy can be detected in 81% of cases.

This implies that the use of new technologies helps more effectively in the early detection of malignancies in order to offer the patient a more appropriate and timely treatment.


Bleeding control


Left: Gastric ulcer with visible vessel. Right: Ulcer treated with Ovesco clip.


Finally, we have the third award-winning study "OVER-THE-SCOPE CLIP SYSTEM AS A FIRST-LINE THERAPY FOR HIGH-RISK BLEEDING PEPTIC ULCERS: A CASE-MATCHED CONTROL STUDY”.

Peptic ulcers, which are one of the main causes of intestinal bleeding, are commonly located in the duodenum or stomach, the most important thing is to stop the bleeding and prevent the risk of re-bleeding.


“The conventional treatment implies the use of hemostatic clips and adrenaline injection, but sometimes those ulcers are very large where a clip will not be enough because the diameter of the clip is very small or because the bleeding is located in a very difficult position for placement. Given this, the alternative treatment is the OVESCO CLIP, also called bear trap, which sucks and covers the entire ulcer”, says Dr. Carlos Robles-Medranda, gastroenterologist and interventional endoscopist.

The study evaluated 95 patients with high-risk peptic ulcers of bleeding and re-bleeding, where conventional treatment was applied to one group of patients and another group was treated directly with the OVESCO clip.

As a result it was determined that the ovesco clip is equally effective as the traditional treatment for ulcers with regular bleeding while, for high-risk ulcers, the most appropriate treatment is the placement of the ovesco clip.

Another interesting finding lies in the timeframe of treatment. In those patients to whom conventional treatment was applied, the intervention time was 21 to 40 minutes while with the ovesco clip the treatment was reduced to 11 minutes. That is more than 50%, which helps patients to have less recovery time, less use of anesthesia, less adverse events and less chance of bleeding among other benefits.

In conclusion, according to this study, the use of OVESCO CLIP as a primary treatment for high-risk bleeding ulcers is highly effective.

With these awards the IECED begins the new year on the right track, demonstrating that Ecuador is also a reference for global digestive and endoscopic medicine.


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