Clinical impact of capsule endoscopy on patients with suspected small bowel bleeding: Experience at a highly specialized hospital in Colombia.

INTRODUCTION AND AIMS: Capsule endoscopy is part of the diagnostic approach to patients with suspected small bowel bleeding and data on its clinical impact are still limited in developing countries. The primary aim of the present study was to determine its impact on subsequent diagnostic and therapeutic decisions. MATERIAL AND METHODS: A retrospective study was conducted that included all the patients that underwent capsule endoscopy with the PillCam™ SB 3 Capsule system due to suspected small bowel bleeding treated at the Hospital Universitario Fundación Valle del Lili between January 2011 and December 2020. RESULTS: A total of 158 patients met the inclusion criteria. Mean patient age was 63 years (interquartile range [IQR], 52-74), 53.6% of the patients were women, and high blood pressure was the most frequent comorbidity (43.7%). The main indication was overt bleeding (58.2%). Of all the capsule endoscopies carried out, 63.9% showed lesions that were potentially responsible for bleeding. Medical or surgical treatment was indicated in 63.3% of the case total. Rebleeding at 6 months occurred in 15 patients and there were 2 deaths due to gastrointestinal bleeding at 6 months. CONCLUSIONS: Capsule endoscopy has a high impact on patients with suspected small bowel bleeding, with respect to clinical decision-making, as well as rebleeding, hospitalization, and mortality outcomes. The positivity rate of lesions potentially responsible for bleeding was similar to that reported in developed countries.

Efficacy of octreotide in bleeding recurrence from small bowel angioectasia: A comparative study.

INTRODUCTION: Fifty percent of small bowel bleeding is caused by angioectasia and the rebleeding rate due to small bowel angioectasia (SBA) is 80%. Its endoscopic treatment is difficult. Beneficial effects of octreotide on gastrointestinal angioectasia have been described, but no studies have reported its efficacy in SBA. AIM: Our aim was to investigate the effectiveness of octreotide in the prevention of rebleeding due to SBA. MATERIAL AND METHODS: Sixteen patients with bleeding caused by SBA were assigned to treatment with octreotide 100 µg/24 h SC, for at least 6 months, and compared with a non-treatment group of 36 patients. The primary outcome was the rebleeding rate, and the secondary outcomes were the number of hospital readmissions, bleeding-related death, and adverse effects. RESULTS: Octreotide was administered for 10.5 ± 8.4 months. Follow-up was 12.9 ± 17.3 months and 15.3 ± 17.7 months, in the treatment and non-treatment groups, respectively (p = 0.09). At the end of follow-up, 4 (25%) treatment group patients and 26 (72.2%) non-treatment group patients presented with rebleeding (p = 0.002). In the treatment group and non-treatment group, the cumulative probability of remaining rebleeding-free at one year was 79% vs 44.2%, and 79% vs 34.6% at 2 years, respectively (p = 0.05). Through the multiple logistic regression analysis, treatment was the protective variable. Six patients presented with adverse events. One of those patients (6.25%) had a major adverse event. CONCLUSIONS: Our results suggest that treatment with octreotide could be efficacious in the prevention of rebleeding due to SBA.

Enteroscopia de doble balón: experiencia inicial en un hospital universitario / Double balloon enteroscopy: Initial experience in a university hospital

Resumen Introducción: el estudio de intestino delgado es un desafío, motivo de avance médico y de interés. La enteroscopia de doble balón (EDB) permite una visualización directa del intestino delgado. Objetivo: describir indicaciones, características del procedimiento, hallazgos, complicaciones y seguimiento de pacientes llevados a EDB en el Hospital de San José de Bogotá, entre noviembre de 2011 y abril de 2019. Metodología: estudio de serie de casos. Se incluyeron pacientes con indicación clínica o por imágenes diagnósticas sugerentes de lesión a nivel de intestino delgado. Se empleó estadística descriptiva. Resultados: se realizaron 45 enteroscopias a 44 pacientes, con una mediana de edad de 58 años. La principal indicación fue hemorragia digestiva potencial de intestino delgado (53,3 %) y diarrea crónica (11,1 %); fueron más frecuentes los procedimientos por vía anterógrada. La mayoría de los resultados fue normal (46,7 %); entre los hallazgos más frecuentes estuvieron los tumores (11,1 %), enfermedad de Crohn (8,9 %) y úlceras/erosiones (6,7 %). El rendimiento diagnóstico fue 53,3 %, la correlación con la videocápsula endoscópica (VCE) fue 37,5 % y con estudios de imagen, 42,9 %. No se presentaron complicaciones. Se hizo seguimiento al 91,1 % de los pacientes con una mediana de 56 meses y se observó la resolución de síntomas en el 78,1 %. La finalidad de la enteroscopia fue diagnóstica en el 84,4 %. Conclusiones: La EDB es útil en la evaluación del intestino delgado con posibilidad terapéutica. Los resultados son similares a los reportados en la literatura mundial. Si se realiza seguimiento, se puede definir la necesidad de repetición del procedimiento, realización de estudios adicionales u observar resolución de los síntomas.

Abstract Introduction: The study of the small bowel is a challenging task that has sparked interest and progress in medicine. In this context, double balloon enteroscopy (DBE) has allowed the direct visualization of the small intestine. Objective: To describe indications, procedure characteristics, findings, complications, and follow-up of patients taken to DBE at the Hospital de San José, Bogotá, between November 2011 and April 2019. Methodology: Case series study. Patients with a clinical indication or diagnostic images suggestive of small bowel lesion were included. Descriptive statistics were used. Results: 45 enteroscopies were performed in 44 patients, with a median age of 58 years. The main indication was potential small bowel bleeding (53.3%) and chronic diarrhea (11.1%). Anterograde procedures were more frequent. Most of the results were normal (46.7%); tumors (11.1%), Crohn's disease (8.9%), and ulcers/erosions (6.7%) were among the most frequent findings. The diagnostic yield was 53.3% and the correlation with capsule endoscopy (CE) was 37.5%, and with imaging studies 42.9%. There were no complications. 91.1 % of patients were followed up on after a median of 56 months, with 78.1 % reporting symptom remission. The aim of enteroscopy was diagnostic in 84.4%. Conclusions: DBE is useful in the evaluation of the small intestine with a therapeutic possibility. The results are similar to those reported in the world literature. Follow-up can define the need for repeating the procedure, performing further studies, or symptom resolution.

Utilidad clínica de la videocápsula endoscópica en el estudio de patologías de intestino delgado en Colombia: resultados de un registro nacional / Clinical utility of the small bowel capsule endoscopy in the study of small bowel diseases in Colombia: Results of a national registry

Introducción: La videocápsula endoscópica (VCE) ha revolucionado el estudio de las patologías de intestino delgado. El objetivo de este estudio es determinar las indicaciones, hallazgos y rendimiento diagnóstico de la VCE en un registro nacional. Pacientes y métodos: Se realizó un estudio observacional, de corte transversal analítico, analizando los registros de VCE en siete centros del país, se recolectaron diferentes variables. Resultados: Se evaluaron 1.883 estudios de VCE. La edad promedio fue 55,4 años (5,6-94,2). Las indicaciones más frecuentes fueron sospecha de sangrado de intestino delgado (SID) (64,4%), estudio enfermedad de Crohn (15,2%) y diarrea crónica (11,2%). El 54,3% de VCE se prepararon con laxantes. Las lesiones más frecuentes fueron erosiones/úlceras (31,6%), angiectasias (25,7%) y parasitosis (2,7%). El rendimiento diagnóstico (P1+P2, clasificación de Saurin) de VCE en SID fue 60,6%, siendo mayor en SID evidente (66,0%) comparado con SID oculto (56,0%) (P=0,003). Los estudios con mejor preparación presentaban mayor detección de lesiones (93,8% vs. 89,4%) (OR=1,8; IC: 95%: 1,2-2,6; P=0,004). La tasa de complicación de VCE fue 3,1%, con visualización completa del ID en 96,6% y tasa de retención en ID de 0,7%. El 81,5% de VCE se realizaron en forma ambulatoria, y presentaron mayor visualización completa de ID que las hospitalarias (97,1% vs. 94,3%) (OR=2,1; IC: 95%; 1,2-3,5; P=0,008). Conclusiones: Las indicaciones, hallazgos y rendimiento diagnóstico de VCE en Colombia son similares a los reportados en la literatura universal, con alto porcentaje de estudios completos y baja tasa de complicaciones.(AU)

Introduction: The small bowel capsule endoscopy (SBCE) has revolutionised the study of small bowel diseases. The objective of this study is to determine the indications, findings and diagnostic yield of SBCE in a national registry. Patients and methods: An observational, analytical cross-sectional study was carried out, analysing the SBCE records at seven centres in the country, where different variables were collected. Results: 1,883 SBCEs were evaluated. The average age was 55.4 years (5.6-94.2). The most frequent indications were suspicion of small bowel bleeding (SBB) (64.4%), study of Crohn's disease (15.2%) and chronic diarrhoea (11.2%). 54.3% were prepared with laxatives. The most frequent lesions found were erosions/ulcers (31.6%), angioectasias (25.7%) and parasitosis (2.7%). The diagnostic yield (P1+P2, Saurin classification) of SBCE in SBB was 60.6%, being higher in overt SBB (66.0%) compared to occult SBB (56.0%) (P=.003). The studies with better preparation showed higher detection of lesions (93.8% vs. 89.4%) (OR=1.8, CI: 95%: 1.2-2.6; P=.004). The SBCE complication rate was 3.1%, with complete SB visualisation at 96.6% and SB retention rate of 0.7%. 81.5% of SBCEs were performed on an outpatient basis, and presented a greater complete SB visualisation than hospital ones (97.1% vs. 94.3%) (OR=2.1, CI: 95%, 1.2-3.5; P=.008). Conclusions: The indications, findings and diagnostic performance of SBCEs in Colombia are similar to those reported in the literature, with a high percentage of complete studies and a low rate of complications.(AU)

Clinical utility of the small bowel capsule endoscopy in the study of small bowel diseases in Colombia: Results of a national registry. / Utilidad clínica de la videocápsula endoscópica en el estudio de patologías de intestino delgado en Colombia: resultados de un registro nacional.

INTRODUCTION: The small bowel capsule endoscopy (SBCE) has revolutionised the study of small bowel diseases. The objective of this study is to determine the indications, findings and diagnostic yield of SBCE in a national registry. PATIENTS AND METHODS: An observational, analytical cross-sectional study was carried out, analysing the SBCE records at seven centres in the country, where different variables were collected. RESULTS: 1,883 SBCEs were evaluated. The average age was 55.4 years (5.6-94.2). The most frequent indications were suspicion of small bowel bleeding (SBB) (64.4%), study of Crohn's disease (15.2%) and chronic diarrhoea (11.2%). 54.3% were prepared with laxatives. The most frequent lesions found were erosions/ulcers (31.6%), angioectasias (25.7%) and parasitosis (2.7%). The diagnostic yield (P1+P2, Saurin classification) of SBCE in SBB was 60.6%, being higher in overt SBB (66.0%) compared to occult SBB (56.0%) (P=.003). The studies with better preparation showed higher detection of lesions (93.8% vs. 89.4%) (OR=1.8, CI: 95%: 1.2-2.6; P=.004). The SBCE complication rate was 3.1%, with complete SB visualisation at 96.6% and SB retention rate of 0.7%. 81.5% of SBCEs were performed on an outpatient basis, and presented a greater complete SB visualisation than hospital ones (97.1% vs. 94.3%) (OR=2.1, CI: 95%, 1.2-3.5; P=.008). CONCLUSIONS: The indications, findings and diagnostic performance of SBCEs in Colombia are similar to those reported in the literature, with a high percentage of complete studies and a low rate of complications.

Diagnostic agreement between video capsule endoscopy and single and double balloon enteroscopy for small bowel bleeding at a tertiary care hospital in Bogota, Colombia. / Concordancia diagnóstica entre la videocápsula endoscópica y enteroscopia mono y de doble balón en la hemorragia de intestino delgado en un hospital de alta complejidad en Bogotá, Colombia.

INTRODUCTION: Video capsule endoscopy and balloon-assisted enteroscopy are complementary diagnostic methods in the study of small bowel bleeding, and different factors can affect their diagnostic yield. AIMS: To define the level of agreement between video capsule endoscopy and enteroscopy in small bowel bleeding, according to the type of lesion, in a cohort of patients at a tertiary care referral center. MATERIALS AND METHODS: A retrospective study was conducted that included 428 capsule endoscopies performed within the time frame of 2011 and 2019 at our healthcare institution. Seventy-four video capsule endoscopies, followed by enteroscopy, in 71 patients suspected of presenting with small bowel bleeding, were analyzed. RESULTS: Mean patient age was 63.9 ± 13.5 years and 42 patients were women. The two diagnostic procedures were performed. Overall diagnostic yield of positive findings between video capsule endoscopy and enteroscopy was 86.5% vs. 58.1%, respectively (p = 0.0527). Agreement between video capsule endoscopy and enteroscopy for positive pathologic findings was weak (Ik = 0.17, 95% CI: -0.0097-0.3543), but according to lesion type, it was good for inflammatory lesions (Ik = 0.71, 95% CI: 0.5182-0.9119) and moderate for angiectasias (Ik = 0.45, 95% CI: 0.2469-0.6538) and tumors (Ik = 0.40, 95% CI: 0.1217-0.6794). The results between the two methods differed in 38 patients (51.3%). There was complete intestinal capsule retention in one patient (1.4%) and active bleeding in 13 (17.6%). CONCLUSIONS: The present study showed that the two techniques had a similar overall detection rate for small bowel lesions, but the type of lesion was the main factor that could modify diagnostic agreement.

Retención de videocápsula endoscópica, una nueva enfermedad médico-quirúrgica: serie de casos.

BACKGROUND: The endoscopic video capsule (EVC), a minimally invasive method of study of the gastrointestinal system indicated in occult gastrointestinal bleeding, has as main complication the retention of endoscopic capsule (CR), currently it is managed with direct extraction using double-balloon enteroscopy; however, when it fails due to its location or associated pathologies, the surgical intervention results in the most successful approach. OBJECTIVE: To evaluate clinical characteristics and management of patients with video capsule endoscopy retention. METHOD: From January 2001 to December 2018, a retrospective search was carried out in three centers, of patients with CR diagnosis, clinical variables and approach were evaluated, in addition to a critical review of the literature. RESULTS: 15 patients with a diagnosis of CR (eight 8 women and seven men), average age 65 (range: 45-77). Seven required surgical management, three endoscopic and five medical management. CONCLUSIONS: The CR is a new pathology of low prevalence, the surgical management resulting from a second therapeutic line when the removal of the VCE has not been possible endoscopically, this pathology requires special attention in the patient's medical history and symptoms for diagnosis and management.

ANTECEDENTES: La videocápsula endoscópica (VCE), método mínimamente invasivo de estudio del sistema gastrointestinal indicado en hemorragia digestiva oculta, tiene como principal complicación la retención de la cápsula endoscópica (RCE). Actualmente se maneja con extracción directa empleando enteroscopia de doble balón; sin embargo, cuando falla por su localización o por patologías asociadas, la intervención quirúrgica resulta el método de mayor éxito. OBJETIVO: Evaluar las características clínicas y el manejo de pacientes con RCE. MÉTODO: De enero de 2001 a diciembre de 2018 se realizó un búsqueda retrospectiva, en tres centros, de pacientes con diagnóstico de RCE. Se evaluaron variables clínicas y de manejo, y además se realizó una revisión crítica de la literatura. RESULTADOS: Se hallaron 15 pacientes con diagnóstico de RCE (ocho mujeres y siete hombres), con una edad promedio de 65 años (rango: 45-77). Siete requirieron manejo quirúrgico, tres manejo endoscópico y cinco manejo médico. CONCLUSIONES: La RCE es una patología nueva de baja prevalencia. El manejo quirúrgico resulta ser una segunda línea terapéutica cuando la extracción de la VCE no ha sido posible endoscópicamente. Para su diagnóstico y manejo, esta patología requiere una especial atención a la historia clínica, los antecedentes y los síntomas de los pacientes.

Heterotopia de mucosa gástrica en el intestino delgado, hallazgo en videocápsula endoscópica. Reporte de caso / An endoscopic videocapsule finding of heterotopia of the gastric mucosa of the small intestine

Resumen Introducción: la heterotopia de mucosa gástrica se refiere a la localización ectópica de mucosa gástrica en cualquier parte del tracto gastrointestinal. Es una causa poco frecuente de úlceras gastrointestinales y sangrado digestivo oculto. La videocápsula endoscópica se ha convertido en una herramienta fundamental para el estudio del intestino delgado. Métodos: estudio descriptivo de reporte de caso. La información de la historia clínica, reporte de patología y estudios endoscópicos, se extrajo de las bases de datos de la Fundación Valle del Lili. Resultados: paciente masculino de 71 años, en quien se realizó videocápsula endoscópica por un sangrado digestivo oculto y se encontraron segmentos de estenosis y úlceras en el yeyuno. La histopatología reveló la presencia de mucosa gástrica heterotópica. Conclusión: la heterotopia de mucosa gástrica debe considerarse como una causa posible de sangrado del intestino delgado.

Abstract Introduction: Heterotopia of the gastric mucosa refers to an ectopic location of gastric mucosa in any part of the gastrointestinal tract. It is a rare cause of gastrointestinal ulcers and occult digestive bleeding. Endoscopic videocapsules have become fundamental tools for study of the small intestine. Methods: This is a descriptive case study based on information from the medical history, pathology report and endoscopic studies extracted from the databases of the Fundación Valle del Lili in Cali, Colombia. Results: An endoscopic videocapsule was used to examine a 71-year-old male patient who suffered from occult digestive bleeding. Segments of stenosis and ulcers were found in the jejunum and histopathology revealed heterotopic gastric mucosa. Conclusion: Heterotopy of the gastric mucosa should be thought of as a possible cause of bleeding in the small intestine.

Uso de nuevas técnicas y procedimientos endoscópicos en el diagnóstico y seguimiento de la enfermedad celíaca / Use of new techniques and endoscopic procedures in the diagnosis and monitoring of celiac disease / Uso de novas técnicas e procedimentos endoscópicos no diagnóstico e monitoramento da doença celíaca

Resumen: Desde que inició la toma de biopsias a través de métodos endoscópicos para el diagnóstico de enfermedad celíaca (EC), se ha intentado describir distintos marcadores macroscópicamente visibles que sugirieran o confirmaran la presencia de atrofia vellositaria en la zona estudiada. Algunos de estos signos son altamente específicos pero su sensibilidad es baja por lo que, por si solos, tienen escaso valor en el algoritmo diagnóstico. El objetivo de esta revisión es analizar la evidencia científica existente sobre la utilidad de las nuevas tecnologías y técnicas endoscópicas en la identificación de marcadores de atrofia vellositaria en el diagnóstico y seguimiento de la enfermedad celíaca Método. Se llevó a cabo una revisión descriptiva de bibliografía donde se buscaron artículos originales en las bases de datos Pubmed y LILACS en el periodo 2006-2016. Resultados. El valor de la cromoendoscopía digital para la búsqueda de marcadores endoscópicos de atrofia vellositaria ha sido escasamente estudiado La sensibilidad de NBI con magnificación se estima entre 83 y 95%. Los únicos trabajos con OBI e I-Scan evidenciaron especificidad y sensibilidad perfectas, pero únicamente en pacientes con alta probabilidad de ser celiacos o portadores de atrofia severa. Con respecto a la microscopía endoscópica, la endocitoscopía no parece mejorar el desempeño de la endoscopía de manera significativa, sin embargo, con solo dos trabajos con bajo número de pacientes, la endomicroscopía laser confocal ha mostrado mayor sensibilidad en la detección de marcadores de atrofia. La VCE tiene alta especificidad (95-100%) pero menor sensibilidad (89%) y su mayor utilidad se encuentra en objetivar alteraciones que están más allá del alcance de la endoscopía tradicional y valorar su extensión. No existen trabajos que evalúen específicamente su presencia con enteroscopía doble balón, balón único o espiral. Conclusiones. Algunas de las nuevas técnicas y tecnologías parecen ser altamente específicas pero poco sensibles en la detección de marcadores endoscópicos de atrofia vellositaria. Son necesarios más estudios para determinar el valor de técnicas de microscopía endoscópica como herramienta diagnóstica a futuro.

Abstract: Since endoscopic methods are used for biopsying the duodenum at diagnosis or follow-up in celiac disease, attempts have been made to find macroscopically visible markers that suggest or confirm the presence of villous atrophy in the studied area. Some of these signs are highly specific but their sensitivity is low so that, if alone, they have little value in the diagnostic algorithm. The objective of this review is to analyze the existing scientific evidence on the usefulness of new technologies and endoscopic techniques in the identification of markers of villous atrophy in the diagnosis and follow-up of celiac disease. Method. A descriptive review of literature was conducted, where original articles were sought in Pubmed and LILACS databases in the period 2006-2016. Results. The value of digital chromoendoscopy for the search of endoscopic markers of villous atrophy has barely been studied. Sensitivity of NBI with magnification is estimated between 83 and 95%. The only studies with OBI and I-Scan showed perfect specificity and sensitivity, but only in patients with high probability of being celiac or with severe atrophy. Regarding endoscopic microscopy, endocytoscopy does not seem to improve performance in a significant way, however, with only two studies with a small number of patients, confocal laser endomicroscopy has shown greater sensitivity in the detection of atrophy markers. The VCE has high specificity (100%) but low sensitivity and its greatest utility is finding alterations that are beyond the scope of traditional endoscopy and assess its extent. There are no studies that specifically evaluate the presence of the same signs with double balloon enteroscopy, single balloon or spiral. Conclusions. Some of the new techniques and technologies appear to be highly specific but less sensitive in the detection of endoscopic markers of villous atrophy. More studies are needed to determine the value of endoscopic microscopy techniques as a diagnostic tool in the future.

Resumo: Desde o início das biópsias através de métodos endoscópicos para o diagnóstico de CD, uma tentativa foi feita para descrever diferentes marcadores macroscopicamente visíveis que sugerem ou confirmam a presença de atrofia vilosa na área estudada. Alguns desses sinais são altamente específicos, mas sua sensibilidade é baixa, por si só, eles têm pouco valor no algoritmo de diagnóstico. O objetivo desta revisão é analisar a evidência científica existente sobre a utilidade de novas tecnologias e técnicas endoscópicas na identificação de marcadores de atrofia vilosa no diagnóstico e monitoramento da doença celíaca. Método. Foi realizada uma revisão descritiva da literatura onde os artigos originais foram pesquisados ​​nas bases de dados Pubmed e LILACS no período 2006-2016. Resultados. O valor da cromoendoscopia digital para a busca de marcadores endoscópicos de atrofia vilosa foi mal estudado. A sensibilidade do NBI com ampliação é estimada entre 83 e 95%. O único trabalho com OBI e I-Scan mostrou especificidade e sensibilidade perfeita, mas apenas em pacientes com alta probabilidade de serem celíacos ou portadores de atrofia grave. Em relação à microscopia endoscópica, a endocitoscopia não parece melhorar o desempenho da endoscopia de forma significativa, no entanto, com apenas dois estudos com um número reduzido de pacientes, a endomicroscopia confocal laser mostrou maior sensibilidade na detecção de marcadores de atrofia. O VCE tem alta especificidade (95-100%), mas menor sensibilidade (89%) e sua maior utilidade é objetivar alterações que estão além do alcance da endoscopia tradicional e avaliam sua extensão. Não há estudos que avaliem especificamente sua presença com balão duplo, bola única ou enteroscopia espiral. Conclusões. Algumas das novas técnicas e tecnologias parecem ser altamente específicas, mas não muito sensíveis na detecção de marcadores endoscópicos de atrofia vilosa. Mais estudos são necessários para determinar o valor das técnicas de microscopia endoscópica como ferramenta de diagnóstico no futuro.

Sangrado del intestino delgado: enfoque y tratamiento / Small Bowel Bleeding: Approach and Treatment

Resumen Actualmente, se pueden identificar lesiones del intestino delgado que antes eran inaccesibles. La principal herramienta diagnóstica es la videocápsula endoscópica por el alto valor predictivo negativo. Con los avances en los métodos endoscópicos, la clasificación del sangrado gastrointestinal ha cambiado. Es así como la definición del sangrado oscuro, que antes incluía al originado en el intestino delgado, se ha relegado cuando su origen no se puede identificar tras la realización de una esofagogastroduodenoscopia, colonoscopia y estudios del tracto digestivo medio, tales como videocápsula endoscópica, enteroscopia de empuje, enteroscopia profunda, enteroscopia intraoperatoria, enterorresonancia, enterotomografía, angiografía y gammagrafía.

Abstract Intestinal lesions that were previously inaccessible can now be identified. The most important new diagnostic tool is the endoscopic videocapsule because of its high negative predictive value. With advances in endoscopic methods, the classification of gastrointestinal bleeding has changed so that definition of occult and obscure bleeding that previously included bleeding originating in the small intestine has been relegated to cases for which the origin cannot be identified after performing esophagogastroduodenoscopy, colonoscopy and studies of the middle digestive tract such as endoscopic videocapsule, push enteroscopy, deep enteroscopy , intraoperative enteroscopy, MRI enterography, CT enterography, angiography and scintigraphy.

Enfermedad de Crohn fibroestenótica en íleon medio como manifestación inicial de la enfermedad. Reporte de un caso / A Case Report of Fibro-Stenotic Crohn's Disease in the Middle Ileum as the Initial Manifestation

Resumen La enfermedad de Crohn (EC) es una enfermedad inflamatoria intestinal que puede afectar todo el tracto gastrointestinal; el intestino delgado es el segmento afectado en cerca del 50% de los pacientes, en los cuales el íleon terminal es el área más comúnmente comprometida por la enfermedad. Las estenosis intestinales son una complicación frecuente en la EC y aproximadamente 30% a 50% de los pacientes presentan estenosis o lesiones penetrantes al momento del diagnóstico. Las técnicas endoscópicas convencionales no permiten evaluar las lesiones del intestino delgado; es por esto que se desarrollaron técnicas como la enteroscopia y la videocápsula endoscópica, teniendo cada una de ellas sus ventajas e indicaciones. Se presenta un caso de un paciente con EC con fibroestenosis localizada en el íleon medio. No es una localización frecuente para este tipo de lesiones.

Abstract Crohn's disease (CD) is an inflammatory bowel disease that can affect the entire gastrointestinal tract. The small intestine is affected in about 50% of patients among whom the terminal ileum is the area most commonly affected. Intestinal stenosis is a common complication in CD and approximately 30% to 50% of patients present stenosis or penetrating lesions at the time of diagnosis. Because conventional endoscopic techniques do not allow evaluation of small bowel lesions, techniques such as enteroscopy and endoscopic video-capsule were developed. Each has advantages and indications. We present the case of a patient with CD with localized fibrostenosis in the middle ileum which is not a frequent site for this type of lesion.

Linfangiectasias en yeyuno como causa de sangrado digestivo oscuro manifiesto / Clinical case of lymphangiectasia in jejunum as a cause of manifest obscure gastrointestinal bleeding / Clinical case of lymphangiectasia in jejunum as a cause of manifest obscure gastrointestinal bleeding

El sangrado digestivo oscuro constituye entre 10 y 20% de todas las causas de sangrado digestivo. La etiología está claramente relacionada con el grupo etario en que se presente. Las linfangiectasias del yeyuno son una causa rara de sangrado digestivo, pero puede llegar a ser de alta mortalidad en caso de que no se detecte tempranamente. Reportamos un caso de un paciente joven sin historia previa de enfermedad, con sangrado digestivo manifestado por melenas, con anemización severa, con estudios endoscópicos iniciales normales, en quien hacemos abordaje con estudios para intestino delgado (video cápsula endoscópica y enteroscopia anterógrada de doble balón), con los que hacemos el diagnóstico y es llevado a cirugía, con adecuada evolución clínica y curación de la enfermedad. (Acta Med Colomb 2015; 40: 158-161).

Obscure gastrointestinal bleeding is between 10 to 20% of all causes of gastrointestinal bleeding. The etiology is clearly related to the age group in which it is presented. Lymphangiectasia in jejunum is a rare cause of gastrointestinal bleeding, but can have high mortality if not detected early. A case of a young patient with no history of previous disease presenting gastrointestinal bleeding manifested by melaena, with severe anemia and normal initial endoscopic studies, is presented. The diagnosis was made by endoscopic video capsule and antegrade double-balloon enteroscopy and surgery was performed with adequate clinical evolution and cure of the disease. (Acta Med Colomb 2015; 40: 158-161).

Cápsula y enteroscopia en hemorragia digestiva / Capsule endoscopy and enteroscopy in gastrointestinal bleeding

Video capsule endoscopy and double balloon enteroscopy have their main application in the so-called obscure gastrointestinal bleeding, clinical condition in which bleeding is most likely originated in the small intestine. Both methods achieve good diagnostic performance with a favorable safety profile. The capsule is simpler to perform and examines the entire small bowel in a high proportion of cases, but without possibility of therapies. The double-balloon enteroscopy allows multiple types of endoscopic therapy of bleeding lesions, but is more complex to perform, requires sedation/anesthesia and most often does not achieve a complete review of the entire small bowel. Currently, both methods are considered complementary in the approach to the diagnosis and treatment of patients with obscure gastrointestinal bleeding. In most patients the ideal approach would be capsule endoscopy for diagnosis, followed by double balloon enteroscopy with therapeutic intent.

La videocápsula endoscópica y enteroscopia de doble balón tienen su aplicación principal en la denominada hemorragia digestiva de origen oscuro, situación clínica en la que el sangrado se origina muy probablemente en el intestino delgado. Ambos métodos logran buen rendimiento diagnóstico y con un perfil de seguridad muy favorable. La cápsula es más simple de realizar y examina todo el intestino delgado en una alta proporción de los casos, pero carece de posibilidad de efectuar terapias. La enteroscopia de doble balón permite realizar múltiples tipos de terapéutica endoscópica de las lesiones sangrantes, pero es más compleja de realizar, requiere de sedación/ anestesia y la mayor parte de las veces no logra un examen completo de todo el intestino delgado. En la actualidad se consideran métodos complementarios en el enfrentamiento diagnóstico y en el tratamiento de pacientes con hemorragia digestiva de origen oscuro. En la mayoría de los pacientes la aproximación ideal sería realizar primero una cápsula endoscópica para diagnóstico, seguida de enteroscopia de doble balón con intención terapéutica.

Enteroscopia doble balón y videocápsula endoscópica en el diagnóstico de patologías del intestino delgado: hospital universitario de maracaibo. 2007-2010 / Double-balloon enteroscopy and endoscopic video capsule in the diagnosis of diseases of the small intestine: maracaibo university hospital. 2007-2010

Introducción: La Enteroscopia Doble Balón (EDB) y la Videocápsula Endoscópica (VCE) se introdujeron en el Hospital Universitario de Maracaibo desde 2007 y 2008, respectivamente. Se analizó y comparó el desempeño de estas pruebas para diagnosticar enfermedades del intestino delgado. Pacientes y Métodos: Se revisaron retrospectivamente los casos sometidos a EDB superior (EDBS), EDB inferior (EDBI) y/o VCE, desde su implementación hasta enero de 2010. Resultados: En 94 casos (55 ♂ y 39 ♀; 10-89 años) se realizaron 155 procedimientos: 52 EDBS, 8 EDBI, 16 VCE y 79 procedimientos combinados. Indicaciones predominantes: Hemorragia de origen oscuro, hemorragia digestiva superior o inferior, anemia, diarrea crónica y sospecha de tumoración intestinal. Visualización completa del tracto entérico: 86,7% (EDBS), 57,7% (EDBI) y 100% (VCE). Biopsias, terapias y/o cromomarcaje: 58,2% (EDBS) y 23,1% (EDBI). Diagnósticos endoscópicos predominantes: Malformaciones vasculares, enteropatías de aspecto parasitario, neoplasias malignas, enteropatías ulcerosas y erosivas. Concordancia indicación/diagnóstico: 74,3% (EDBS), 57,7% (EDBI) y 70% (VCE). Conclusiones: La EDB y la VCE constituyen herramientas eficientes con ventajas particulares para diagnosticar patologías del intestino delgado: La EDB permite realizar procedimientos adicionales; la VCE ofrece mayor probabilidad de visualizar todo el tracto entérico. En casos concretos, combinar estar pruebas podría aumentar su eficiencia diagnóstica y terapéutica.

Introduction: Double Balloon Enteroscopy (DBE) and Endoscopic Viocapsule (EVC) were introduced in the University Hospital of Maracaibo since 2007 and 2008, respectively. Their performance in diagnosing small bowel diseases were analyzed and compared. Patients and Methods: Cases undergoing upper DBE (UDBE), lower DBE (LDBE) and/or CE, were retrospectively reviewed since the introduction of these techniques, until January 2010. Results: In 94 cases (♂: 55; ♀:39; Ages: 10 to 89), 155 diagnostic procedures were performed: 52 UDBE, 8 LDBE, 16 EVC and 79 combined procedures. Predominating indications: obscure gastrointestinal bleeding, upper and/or lower gastrointestinal bleeding, anemia, chronic diarrhea, and suspicion of an intestinal tumor. Full visualization of small bowel: 86.7% (UDBE), 57.7% (DBUE) and 100% (EVC). Biopsies, therapies and/or India ink tattooing: 58.2% (UDBE) and 23.1% (DBLE). Predominant endoscopic diagnoses: vascular malformations, parasitic enteropathies, malign tumor, ulcerative enteropathies and erosive enteropathies. Agreement indication/diagnosis: 74.3% (UDBE), 57.7% (LDBE) and 70% (EVC). Conclusions: DBE and EVC constitute efficient methods with particular advantages for diagnosing small bowel pathologies: DBE allows additional procedures; EVC provides a greater chance of full visualization of small intestine. In specific cases, combination of these tests could improve their diagnostic and therapeutic efficiency.