SEARCH FOR SMALL-BOWEL CAPSULE DIAGNOSTIC YIELD OPTIMIZATION CONDUCTED THROUGH OBSERVATIONAL ANALYSIS. / BÚSQUEDA DE OPTIMIZACIÓN DE LA CÁPSULA ENDOSCÓPICA MEDIANTE ANÁLISIS OBSERVACIONAL.

OBJECTIVES: To search for parameters susceptible to optimization when performing capsule endoscopy (CE) in a third level hospital with high volume and experience in this test. PATIENTS AND METHODS: Retrospective observational study, including 1325 CEs performed between 2017 and 2022. Overall diagnostic yield, effective diagnostic yield, by indication, place of request and waiting list, as well as complete examination rate and cleansing degree were analyzed. RESULTS: The overall diagnostic yield was 70.99%, while the effective diagnostic yield was 72.7%. Diagnostic yields varied between 60.2% and 77.9% depending on the indication and between 64.7% and 74.3% depending on the requesting center. The mean waiting list was 101.15 days, with a tendency to worse results when the waiting list was longer. A total of 77.8% of the examinations were complete. Completion rates were lower in patients >70 years of age (p=0.001), as well as in those with gastric transit >60 minutes (p=0.000). A total of 77.3% were clean, with debris that did not impede diagnosis being found in 16.9% and debris that did impede diagnosis in 5.8%. There was a relationship, although not significant, between cleansing degree and age. CONCLUSIONS: The diagnostic yields of CE in our center are in line with those previously reported. Differences were found according to the place of request. Waiting list could also influence diagnostic yield. Completion rates are lower in >70 years of age and when gastric transit is >60 minutes. Cleansing degree achieved is acceptable.

Immunomodulatory Therapy Does Not Increase the Risk of Cancer in Persons With Inflammatory Bowel Disease and a History of Extracolonic Cancers.

OBJECTIVES: Immunosuppressant therapies (IMTs; thiopurines, anti-tumor necrosis factor agents) may influence the immunologic control of cancer and might facilitate the spread and recurrence of cancer. This study assesses the impact of the use of IMTs on the development of incident cancers (recurrent or new) in patients with inflammatory bowel disease (IBD) and a history of malignancy. METHODS: Patients with IBD included in the ENEIDA registry with a history of cancer without being exposed to IMTs were identified and retrospectively reviewed and compared regarding further treatment with IMTs or not by means of a log-rank test. RESULTS: Overall, 520 patients with previous extracolonic cancer naive to IMTs before the diagnosis of cancer were identified. Of these, 146 were subsequently treated with IMTs (exposed), whereas 374 were not (nonexposed). The proportion of patients with incident cancers was similar in both exposed (16%) and nonexposed (18%) patients (P = 0.53); however, there was more than a 10-year difference in the age at index cancer between these 2 groups. Cancer-free survival was 99%, 98%, and 97% at 1, 2, and 5 years in exposed patients, and 97%, 96%, and 92% at 1, 2, and 5 years in non-exposed patients, respectively (P = 0.03). No differences in incident cancer rates were observed between exposed and nonexposed patients when including only those who were exposed within the first 5 years after cancer diagnosis. DISCUSSION: In patients with IBD and a history of cancer not related to immunosuppression, the use of IMTs is not associated with an increased risk of new or recurrent cancers even when IMTs are started early after cancer diagnosis.

Helicobacter pylori second-line rescue therapy with levofloxacin- and bismuth-containing quadruple therapy, after failure of standard triple or non-bismuth quadruple treatments.

BACKGROUND: The most commonly used second-line Helicobacter pylori eradication regimens are bismuth-containing quadruple therapy and levofloxacin-containing triple therapy, both offering suboptimal results. Combining bismuth and levofloxacin may enhance the efficacy of rescue eradication regimens. AIMS: To evaluate the efficacy and tolerability of a second-line quadruple regimen containing levofloxacin and bismuth in patients whose previous H. pylori eradication treatment failed. METHODS: This was a prospective multicenter study including patients in whom a standard triple therapy (PPI-clarithromycin-amoxicillin) or a non-bismuth quadruple therapy (PPI-clarithromycin-amoxicillin-metronidazole, either sequential or concomitant) had failed. Esomeprazole (40 mg b.d.), amoxicillin (1 g b.d.), levofloxacin (500 mg o.d.) and bismuth (240 mg b.d.) was prescribed for 14 days. Eradication was confirmed by (13) C-urea breath test. Compliance was determined through questioning and recovery of empty medication envelopes. Incidence of adverse effects was evaluated by questionnaires. RESULTS: 200 patients were included consecutively (mean age 47 years, 67% women, 13% ulcer). Previous failed therapy included: standard clarithromycin triple therapy (131 patients), sequential (32) and concomitant (37). A total of 96% took all medications correctly. Per-protocol and intention-to-treat eradication rates were 91.1% (95%CI = 87-95%) and 90% (95%CI = 86-94%). Cure rates were similar regardless of previous (failed) treatment or country of origin. Adverse effects were reported in 46% of patients, most commonly nausea (17%) and diarrhoea (16%); 3% were intense but none was serious. CONCLUSIONS: Fourteen-day bismuth- and levofloxacin-containing quadruple therapy is an effective (≥90% cure rate), simple and safe second-line strategy in patients whose previous standard triple or non-bismuth quadruple (sequential or concomitant) therapies have failed.

Influence of Ala54Thr polymorphism of fatty acid-binding protein 2 on histological alterations and insulin resistance of non alcoholic fatty liver disease.

A transition G to A at codon 54 of fatty acid binding protein type 2 (FABP2) produces an amino acid substitution (Ala 54 to Thr 54). This amino acid substitution was associated with modifications of insulin resistance, adipokines and insulin concentrations. The aim of this study was to evaluate the influence of Ala54Thr polymorphism in the FABP2 gene on the histological alterations of non-alcoholic fatty liver disease (NAFLD) and insulin resistance. Thirty subjects with the presence of biopsy-proven NAFLD were enrolled for this study. Glucose, Insulin, Insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, resistin, leptin, adiponectin, interleukin-6 and TNF-alfa serum levels were measured at basal time. A tetrapolar bioimpedance, BMI, waist circumference, waist to hip ratio, blood pressure and a prospective serial assessment of nutritional intake with 3 days written food records were examined. Genotype of Ala54Thr FABP2 gene polymorphism was studied. The mean age was 41.6 +/- 11 years and the mean BMI 29.2 +/- 6.6 with 24 males (80%) and 6 females (20%). Fifteen patients (50%) had the genotype Ala54/Ala54 (wild type group) and 15 (50%) patients Ala54/Thr54 (13 patients) or Thr54/Thr54 (2 patients) (mutant type group). Both genotype groups have the similar anthropometric parameters. Serum aspartate aminotransferase and alcaline phosfatase were higher in wild type group than mutant type group, with an unclear explanation. Dietary intake was similar in both groups. A non-statistical significant low levels of adiponectin in mutant group was observed. No differences were detected among other adipokines. There were no differences between genotypes in histological results of inflammation (portal or lobular inflammation) or grade of steatosis or fibrosis. In conclusion, the present study demonstrates that the polymorphism Ala54Thr of FABP in patients with NAFLD doesn't predict liver histological changes, nor both insulin resistance and serum adipokines variations.

Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding.

OBJECTIVE: We analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. METHODS: We retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. RESULTS: Capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. CONCLUSIONS: The performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients.

Hallazgos digestivos altos de la cápsula endoscópica en la hemorragia digestiva de origen oscuro / Upper gastrointestinal findings detected by capsule endoscopy in obscure gastrointestinal bleeding

Objetivo: hemos analizado los hallazgos que la cápsula endoscópicaaportó de las zonas accesibles a una gastroscopia que podríanjustificar un sangrado digestivo oscuro, así como la evoluciónde estos enfermos tras la nueva gastroscopia recomendadapara determinar si una segunda gastroscopia previa a la cápsulapodría añadir beneficios en el manejo de esta patología.Métodos: estudiamos de forma retrospectiva 82 pacientes alos que se efectuó cápsula endoscópica como estudio de hemorragiaoscura que contaban con una única gastroscopia.Los hallazgos que la cápsula apreció en tramos altos se dividieronen normales, leves/conocidos y severos-desconocidos que recomendaronuna segunda gastroscopia. Estos últimos casos fueronseguidos.Resultados: la cápsula endoscópica no objetivó hallazgosesofágicos desconocidos. En un 63% no evidenció lesiones gastroduodenales,en un 20% estas eran leves o conocidas y en un17% se recomendó una nueva gastroscopia al encontrar patologíadesconocida y que podría motivar la hemorragia digestiva a estenivel. La información motivó cambios en el tratamiento en un85% de este grupo, con mejoría en el 78%. La cápsula endoscópicaencontró alteraciones intercurrentes llamativas en el intestinodelgado en sólo un 14%.Conclusiones: una segunda gastroscopia previa a una cápsulaendoscópica en el estudio de la hemorragia oscura ofrecería beneficiosen términos diagnósticos y a la hora de introducir cambiosterapéuticos que consiguen buenos resultados clínicos.El análisis detallado de los fotogramas del tracto digestivo altoes obligado, ya que puede aportar información relevante y conimportancia en el manejo de estos pacientes(AU)

Objective: we analyzed our experience with the use of capsule endoscopy in areas that can be explored with gastroscopy to justify obscure bleeding, as well as the outcome after a new recommended gastroscopy in order to determine if a second gastroscopy before the capsule study can provide any benefit in the management of this disease. Methods: we retrospectively studied 82 patients who were explored with capsule endoscopy for obscure gastrointestinal bleeding who had undergone previously only one gastroscopy. Findings in the zones which were accessible by gastroscopy were normal, mild/known and severe/unknown. In the latter cases we recommended a second gastroscopy, and their treatment and outcome were subjected to further study. Results: capsule endoscopy did not find any unknown esophageal findings. In 63% of cases, no gastric or duodenal lesions were shown; in 20%, lesions were mild or had been previously diagnosed, and in 17%, a new gastroscopy was recommended due to the discovery of an unknown condition which could be the cause of the obscure bleeding. This new information brought about a change in treatment for 78% of patients in this group, all of whom improved from their illness. Capsule endoscopy found significant intercurrent alterations in the small intestine in only 14% of cases. Conclusions: the performance of a second gastroscopy, previous to capsule endoscopy, in the study of obscure gastrointestinal bleeding can offer benefits in diagnostic terms and may introduce therapeutic changes. A detailed analysis of the upper tract frames in intestinal capsule endoscopy studies is mandatory since it may provide relevant information with clinical impact on the management of these patients(AU)

Medida del tamaño de las lesiones con cápsula endoscópica: un problema por resolver / No disponible

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Public opinion survey after capsule endoscopy: patient s point of view on its utility.

AIM: When programming a medical test such as capsule endoscopy (CE), finding the closest point between the patient's experience and his/her expectation is essential to improve any further explorations. For this purpose we designed a form which tries to collect the information required. MATERIAL AND METHODS: From December 2003 to January 2005 we examined the small intestine of 98 patients with the help of CE. Later they were sent an anonymous questionnaire in July 2005, which included 10 questions upon the origin and previous knowledge of the patient about this technique, their tolerance to it, and the value they attached to it with regard to finding a new diagnosis and assigning different treatments, and also the incidence in the positive or negative evolution of their disease in particular and of medicine in general. RESULTS: Answer rate reached 58% and was slightly higher among women and people over 70 years; 80% of repliers had been informed about CE by a physician, while nearly all the rest had received previous information from the media; 37% had had symptoms for more than 12 months, while only 17% had suffered them for one month before the exploration. A bit over 30% did not know what the specific diagnostic field of the test was (most of them women and young people), although most of them were not surprised by the procedure. Over 75% showed "acceptable" or "excellent" tolerance, while 5.5% (most of them young people) found it hard to bear. The opinion about its utility in the diagnosis was 37%, and although 70% thought that CE had revealed nothing new about their pathology, over 60% declared feeling better after the test; 84% pointed out that it had achieved a breakthrough for their quality of life (most of them men and very old people), and only 13% thought it was worthless. However, nearly all the answers agreed in that CE was an "important" or "very important" diagnostic device. CONCLUSIONS: After the test using CE, the diagnostic benefit detected by the patient is not the same as that shown by technical studies. Nevertheless, the test can be highly satisfactory for the patient in particular, and also in an overall view. CE is a well-tolerated test, applied in our setting to chronic diseases and that, contrary to what we supposed, is explained to patients mainly by a physician. Most of them are not familiar with its specific indications.

Encuesta de opinión tras estudio con cápsula endoscópica: percepción de su utilidad por el enfermo / Public opinion survey after capsule endoscopy: patient s point of view on its utility

Objetivo: a la hora de programar la realización de una pruebacomo la cápsula endoscópica, la máxima aproximación entre laexperiencia que le supuso al enfermo y sus expectativas es vitalpara mejorar en futuras exploraciones.Con este fin, hemos diseñado un formulario que trata de recogeresta información.Material y métodos: de diciembre del 2003 a enero del2005 se estudió el intestino delgado mediante cápsula endoscópicaen 98 enfermos. Se les envió un cuestionario anónimo de 10preguntas en julio del 2005 que incidía en aspectos relacionadoscon el origen y la información previa del paciente respecto a latécnica, el tiempo de presencia de sus síntomas, la tolerancia y elvalor atribuido en cuanto al hallazgo de nuevos diagnósticos, instauraciónde tratamientos diferentes y la evolución positiva o node su enfermedad y de la medicina en general.Resultados: la tasa de respuesta llegó al 58%, siendo algo superioren mujeres y mayores de 70 años. El 80% de los respondedoreshabían conocido la cápsula endoscópica por un médico especialista,mientras que en la casi totalidad del resto fue a travésde los medios de comunicación. Un 37% tenía síntomas desde hacíamás de 12 meses, refiriendo menos de un 17% haberlos padecidosólo durante el mes previo a la exploración. Algo más de un30% no sabían cuál era el campo diagnóstico específico de laprueba (sobre todo mujeres y jóvenes), aunque la mayoría no sesorprendió por el procedimiento de ejecución. Más del 75% manifestaronuna tolerancia buena o muy buena, encontrándola durade soportar sólo un 5,5% (jóvenes principalmente). La percepciónde utilidad diagnóstica se sitúa en un 37%, y, aunque el 70%creían que la cápsula endoscópica no había conseguido ningunanovedad en el abordaje de su patología, algo más del 60% reconocíanencontrarse mejor tras su realización. El 84% señaló quehabía supuesto un paso importante o muy importante en su calidadde vida (sobre todo varones y edades extremas), con sólo un13% que calificó su valor como nulo. Sin embargo, casi la totalidadde las respuestas apuntaron que veían a la cápsula endoscópicacomo un método diagnóstico importante o muy importante enel arsenal tecnológico médico.Conclusiones: tras la ejecución de una cápsula endoscópica,la rentabilidad diagnóstica percibida por el enfermo no coincidecon la reflejada en estudios de competencia técnica. Sin embargo,la prueba es capaz de originar una amplia adherencia y satisfacciónen el paciente de manera personal y en una visión general.La cápsula endoscópica es una exploración bien tolerada, aplicadaen nuestro medio en el estudio de entidades crónicas y que,al contrario de lo presumido, llega a ser conocida en los sujetossobre los que se realiza sobre todo a través de un médico especialista.Un gran porcentaje desconoce su indicación específica

Aim: when programming a medical test such as capsule endoscopy(CE), finding the closest point between the patient’s experienceand his/her expectation is essential to improve any furtherexplorations.For this purpose we designed a form which tries to collect theinformation required.Material and methods: from December 2003 to January2005 we examined the small intestine of 98 patients with thehelp of CE. Later they were sent an anonymous questionnaire inJuly 2005, which included 10 questions upon the origin and previousknowledge of the patient about this technique, their toleranceto it, and the value they attached to it with regard to findinga new diagnosis and assigning different treatments, and also theincidence in the positive or negative evolution of their disease inparticular and of medicine in general.Results: answer rate reached 58% and was slightly higheramong women and people over 70 years; 80% of repliers hadbeen informed about CE by a physician, while nearly all the resthad received previous information from the media; 37% had hadsymptoms for more than 12 months, while only 17% had sufferedthem for one month before the exploration. A bit over 30% didnot know what the specific diagnostic field of the test was (most ofthem women and young people), although most of them were notsurprised by the procedure. Over 75% showed “acceptable” or“excellent” tolerance, while 5.5% (most of them young people)found it hard to bear. The opinion about its utility in the diagnosiswas 37%, and although 70% thought that CE had revealed nothingnew about their pathology, over 60% declared feeling betterafter the test; 84% pointed out that it had achieved a breakthroughfor their quality of life (most of them men and very oldpeople), and only 13% thought it was worthless. However, nearlyall the answers agreed in that CE was an “important” or “very important”diagnostic device.Conclusions: after the test using CE, the diagnostic benefitdetected by the patient is not the same as that shown by technicalstudies. Nevertheless, the test can be highly satisfactory for thepatient in particular, and also in an overall view.CE is a well-tolerated test, applied in our setting to chronic diseasesand that, contrary to what we supposed, is explained to patientsmainly by a physician. Most of them are not familiar with itsspecific indications

Fístula pancreaticobronquial como primera manifestación de seudoquistes pancreáticos / Pancreaticobronchial fistula as the first manifestation of pancreatic pseudocysts

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Fístula colédoco-renal en colangiocarcinoma localmente avanzado / Choledocho-renal fistula in locally advanced cholangiocarcinoma

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