Meckel´s diverticulum bleeding detected by capsule endoscopy.

A 28-year-old man diagnosed with Charge syndrome and no history of NSAIDs ingestion was referred due to the presentation in the previous 24 h of melenic stools with a negative upper endoscopy. Physical examination was unremarkable, although laboratory tests showed anemia. On the second day, significant painless rectal bleeding and the decrease of hematocrit levels responding to blood transfusion were observed, so colonoscopy was recommended but completely rejected by the patient. Therefore, capsule endoscopy was performed, identifying a saccular image in the terminal ileum suggestive of a Meckel's diverticulum.

Practical aspects of high resolution esophageal manometry.

High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical applications.

Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections.

INTRODUCTION: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. OBJECTIVES: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. MATERIAL AND METHODS: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett's esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett's esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. RESULTS: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett's esophagus, 6 complete Barrett's esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. CONCLUSIONS: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples.

Hemorragia digestiva por divertículo de Meckel detectado mediante enteroscopia con cápsula endoscópica / Meckel´s diverticulum bleeding detected by capsule endoscopy

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Anorectal melanoma: An atypical cause of rectorrhagia / Causa atípica de rectorragia: melanoma anorrectal

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Linfoma folicular primario gastrointestinal: hallazgos endoscópicos y papel de la enteroscopia con cápsula / Primary follicular lymphoma of the gastrointestinal tract: Endoscopic findings and role of capsule endoscopy

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Aspectos prácticos para la manometría esofágica de alta resolución / Practical aspects of high resolution esophageal manometry

La manometría esofágica de alta resolución (MAR) está en fase de desarrollo, como se evidencia por las diferentes clasificaciones de Chicago. Con el fin de unificar criterios en algunos aspectos prácticos con limitada evidencia científica se llevó a cabo la Primera Reunión Nacional de Consenso en Manometría de Alta Resolución del Grupo Español de Motilidad Digestiva, en la que participaron un amplio grupo de expertos. Las propuestas se basaron en una encuesta previa con 47 preguntas, la exhaustiva revisión de la bibliografía disponible y la experiencia de los participantes. Se plantearon aspectos metodológicos sobre criterios de análisis poco definidos de algunos nuevos parámetros de alta resolución y otros aspectos no considerados, como la actividad espontánea o las ondas secundarias, elaborándose conclusiones finales con utilidad práctica (AU)

High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical application (AU)

Manifestaciones gastrointestinales en el síndrome de Cowden. Recomendaciones de cribado / Gastrointestinal manifestations in Cowden syndrome. Screening recommendations

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Resección endoscópica mucosa de lesiones superficiales altas: estudio de su eficacia y seguridad en 59 resecciones consecutivas / Endoscopic mucosal resection for proximal superficial lesions: efficacy and safety study in 59 consecutive resections

Introducción: la resección endoscópica mucosa es una técnica aceptada en el tratamiento de lesiones superficiales del tracto digestivo. Objetivos: evaluar la eficacia y seguridad de dicho procedimiento en el tracto digestivo superior. Material y métodos: se incluyeron en nuestro estudio 41 pacientes consecutivos (23 hombres y 18 mujeres, edad media de 60,6 años) a los que se les realizaron 59 resecciones en 69 sesiones. Se trataron las siguientes patologías: lesiones sobreelevadas con displasia de alto grado sobre esófago de Barrett (grupo A), displasia de alto grado en biopsias aleatorias del seguimiento de esófago de Barrett (grupo B) y lesiones superficiales gastroduodenales (grupo C). Las técnicas utilizadas fueron la resección con asa tras inyección submucosa, la asistida por bandas o por capuchón. Resultados: se resecaron 7 lesiones sobreelevadas con displasia de alto grado sobre esófago de Barrett, 6 esófagos de Barrett con displasia de alto grado de forma completa en 16 sesiones secuenciales de resección mucosa y 46 lesiones superficiales gastroduodenales (10 adenomas, 9 carcinomas gástricos superficiales, 18 carcinoides y 9 lesiones de diferente estirpe). Las resecciones se realizaron con éxito en el 100% de los dos primeros grupos y en el 97,9% del grupo C. Como complicaciones tuvimos 2 sangrados diferidos autolimitados (grupos A y B) y dos casos de estenosis con escasa relevancia clínica en el grupo B. Conclusiones: a) la resección endoscópica mucosa es una técnica eficaz en el tratamiento de lesiones superficiales del tracto digestivo superior; b) se trata de un procedimiento seguro, con un porcentaje de complicaciones muy bajo y que generalmente pueden ser manejadas de forma endoscópica; y c) al contrario que otras técnicas ablativas, permite el estudio anatomopatológico de las muestras(AU)

Introduction: endoscopic mucosal resection is an accepted technique for the treatment of proximal gastrointestinal tract superficial lesions. Objectives: to evaluate the efficacy and safety of this procedure in the proximal gastrointestinal tract. Material and methods: forty one consecutive patients (23 males and 18 females, mean age of 61 ± 11.5 years) were included in our study. Fifty nine resections were performed in these patients in 69 sessions. Lesions treated consisted of elevated lesions with high grade dysplasia in the context of Barrett’s esophagus (group A), high grade dysplasia appearing in random biopsies taken during the follow-up of Barrett’s esophagus (group B) and superficial gastroduodenal lesions (group C). Snare resection after submucosal injection, band ligator-assisted or cap-assisted mucosal resection were the chosen techniques. Results: we resected 7 elevated lesions with high grade dysplasia in the context of Barrett’s esophagus, 6 complete Barrett’s esophagus with high grade dysplasia in 16 sequential sessions and 46 gastroduodenal superficial lesions (10 adenomas, 9 gastric superficial carcinomas, 18 carcinoid tumours and 9 lesions of different histological nature). Resections in the two first groups were complete in 100% of the cases, and in 97.9% of the cases in group C. Complications included 2 cases of limited deferred bleeding (groups A and B) and another two cases of stenosis with little clinical relevance in Group B. Conclusions: a) endoscopic mucosal resection is an efficient technique for the treatment of proximal gastrointestinal tract superficial lesions; b) it is a safe procedure with a low percentage of complications, which can generally be managed endoscopically; and c) in contrast with other ablative techniques, endoscopic mucosal resection offers the possibility of a pathologic analysis of the samples(AU)