Indications for and diagnostic yield of capsule endoscopy in the elderly. / Indicaciones y rendimiento diagnóstico de la cápsula endoscópica en el anciano.

INTRODUCTION AND AIMS: The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients. MATERIALS AND METHODS: All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed. RESULTS: Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001). CONCLUSIONS: Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield.

Push-enteroscopy series: diagnostic and therapeutic efficacy.

OBJECTIVE: To analyse the diagnostic efficacy of oral push-type enteroscopy (PE) according to indications. To assess evolution in patients with occult gastrointestinal bleeding (OGIB) according to findings and endoscopic therapy. METHODS: 204 PE performed in 167 patients: OGIB: 117, Crohn's disease: 34, radiological abnormalities: 21; chronic diarrhoea: 12; intestinal sub-occlusion: 11; polyposis: 7; other: 2. We followed clinical outcome in 72 patients after PE for OGIB. They were separated according to findings and endoscopic therapy: no findings: 32; no treated angiodysplasia: 10; treated angiodysplasia: 20; other lesions: 10. We evaluated the number of admissions and transfusional requirements before and after PE, re-bleeding and surgical treatment. Statistics were performed using Student's t test and Chi-square test (statistical significance p < 0.05). RESULTS: We diagnosed lesions in 65.8% PE for OGIB, angiodysplasia being the more frequent finding (33.3%). We found lesions before Treitz in 15.4% A higher diagnostic efficacy was seen in active bleeding (83.4%) versus anaemia (52.2%), p < 0.05. After PE both admissions and transfusional requirements decreased in all subgroups specially in treated angiodysplasias and other lesions, nearly reaching statistical significance (p = 0.07). Re-bleeding occurred in 50% of non-treated lesions versus 20-25% in treated lesions. We found lesions in 47% of PE for Crohn's disease, in 52.4% for radiological abnormalities, in 41.6% for chronic diarrhoea and in 0% for intestinal sub-occlusion. CONCLUSIONS: PE is efficient in the diagnosis and therapy of patients with OGIB, Crohn's disease and radiological abnormalities. Its usefulness is controversial in the study of chronic diarrhoea and intestinal sub-occlusion.

[Variability and lengthening of reaction time in the early diagnosis of subclinical hepatic encephalopathy]. / Variabilidad y alargamiento del tiempo de reacción en el diagnóstico precoz de la encefalopatía hepática subclínica.

A prospective study was made of the psychophysiological technique reaction time as regards the parameters of duration and variability, by evaluating the average of 10 consecutive sequences in two groups of patients. The first group was formed by cirrhotics (diagnosed by histology) of different Child stages (N: 31) (A: 18, B: 6, C: 7) who had different clinical neurological manifestations that varied from asymptomatic to hepatic encephalopathy (EH) that permitted the degree of necessary collaboration. The second group -controls- included normal subjects (N: 31) with normal liver function and absence of gastrointestinal pathology. In both groups other CNS pathology and/or anterior or concomitant psychotropic drug use were excluded. The difference in the duration of reaction time between the control group and cirrhotics was statistically significant (more prolonged in cirrhotics), as was the difference between the control group and Child A cirrhotics. During the evolution of the cirrhotic group (follow-up of 6 months), it was found that individual variations in reaction time for each case greater larger as liver function deteriorated (higher Child grade), and that there were progressively larger deviations from Child A to Child C. In conclusion, reaction time is useful in discriminating subclinical hepatic encephalopathy in cirrhotics (longer duration), although its major application may be the prognosis of established hepatic encephalopathy, as determined by the increasing variability observed with greater deterioration of liver function.

[Complications of the intragastric balloon prosthesis]. / Complicaciones de la prótesis balón intragástrica.

The intragastric balloon prosthesis (PBIG) is being used as a mechanical treatment for obesity; an evaluation of its physiopathological implications, efficiency, and complications is still incomplete. In order to investigate in our area the incidence of complications of this endoscopic treatment, we have used the Danish model "Danish Obesity Treatment" (DOT) (Ballobes) inflated with air, in a prospective study in which forty obese patients were treated during three months. We draw the attention upon a gastric ulcer, a spontaneous anal extrusion-migration, and a duodenal ulcer. We establish the safety of the method, the literature is reviewed, we discuss the cause and treatment of these lesions, and we conclude indicating the low morbidity and the absence of major complications such as oesophageal perforation or intestinal obstruction occurring with other prosthesis models.

Eficacia diagnóstica y terapéutica en una sere de enteroscopia de pulsión oral / Push-enteroscopy series: diagnostic and therapeutic efficacy

Objetivo: analizar la eficacia diagnóstica de la videoenteroscopia de pulsión oral (VPO) según la indicación y la evolución de pacientes con hemorragia digestiva de origen oscuro (HDOO) según hallazgos y tratamiento endoscópico. Métodos: 204 VPO realizadas a 167 pacientes: HDOO: 117; enfermedad de Crohn: 34; anormalidades radiológicas: 21; diarrea crónica: 12; suboclusión intestinal: 11; poliposis: 7; otros: 2.Fueron seguidos 72 pacientes tras VPO por HDOO dividiéndolos según hallazgos y tratamiento endoscópico: sin hallazgos: 32; angiodisplasias no tratadas: 10; tratadas: 20; lesiones distintas a angiodisplasias: 10. Se valoró el número de ingresos y requerimientos trasfusionales pre y post-VPO, resangrados y cirugía. Estudio estadístico mediante t de Student y Chi cuadrado (significación estadística p<0,05). Resultados: se diagnosticaron lesiones en 65,8 por ciento VPO por HDOO, siendo las angiodisplasias las más frecuentes (33,3 por ciento) y las lesiones pre-Treitz (15,4 por ciento). Existe tendencia a mayor eficacia diagnóstica en pacientes con sangrado activo (83,4 por ciento) frente anemia (52,2 por ciento) alcanzando significación estadística p<0,05. Tras VPO disminuyen los ingresos y requerimientos trasfusionales en todos los grupos, más en el de angiodisplasias tratadas y otras lesiones sin alcanzar significación estadística p=0,07. Resangró el 50 por ciento de pacientes con lesiones no tratadas frente un 20-25 por ciento en tratados. Se observaron lesiones en 47 por ciento de VPO por enfermedad de Crohn, 52,4 por ciento por alteraciones radiológicas, 41,6 por ciento por diarrea crónica y 0 por ciento por suboclusión intestinal. Conclusión: la VPO es eficaz en el diagnóstico y tratamiento de pacientes con HDOO, enfermedad de Crohn y alteraciones radiológicas, siendo cuestionable su utilidad en estudio de diarrea crónica y suboclusión intestinal (AU)