Enrique Pérez-Cuadrado-Martínez

Role of capsule endoscopy in suspected celiac disease: A European multi-centre study

AIM To analyze the diagnostic yield (DY), therapeutic impact (TI) and safety of capsule endoscopy (CE). METHODS This is a multi-centre, observational, analytical, retrospective study. A total of 163 patients with suspicion of celiac disease (CD) (mean age = 46.4 ± 17.3 years, 68.1% women) who underwent CE from 2003 to 2015 were included. Patients were divided into four groups: seronegative CD with atrophy (Group-I, n = 19), seropositive CD without atrophy (Group-II, n = 39), contraindication to gastroscopy (Group-III, n = 6), seronegative CD without atrophy, but with a compatible context (Group-IV, n = 99). DY, TI and the safety of CE were analysed. RESULTS The overall DY was 54% and the final diagnosis was villous atrophy (n = 65, 39.9%), complicated CD (n = 12, 7.4%) and other enteropathies (n = 11, 6.8%; 8 Crohn’s). DY for groups I to IV was 73.7%, 69.2%, 50% and 44.4%, respectively. Atrophy was located in duodenum in 24 cases (36.9%), diffuse in 19 (29.2%), jejunal in 11 (16.9%), and patchy in 10 cases (15.4%). Factors associated with a greater DY were positive serology (68.3% vs 49.2%, P = 0.034) and older age (P = 0.008). On the other hand, neither sex nor clinical presentation, family background, positive histology or HLA status were associated with DY. CE results changed the therapeutic approach in 71.8% of the cases. Atrophy was associated with a greater TI (92.3% vs 45.3%, P < 0.001) and 81.9% of the patients responded to diet. There was one case of capsule retention (0.6%). Agreement between CE findings and subsequent histology was 100% for diagnosing normal/other conditions, 70% for suspected CD and 50% for complicated CD. CONCLUSION CE has a high DY in cases of suspicion of CD and it leads to changes in the clinical course of the disease. CE is safe procedure with a high degree of concordance with histology and it helps in the differential diagnosis of CD.

Short article: Capsule endoscopy in graft-versus-host disease

Introduction The gold standard in the diagnosis of gastrointestinal graft-versus-host disease (GVHD) after allogenic hematopoietic stem cell transplantation is conventional endoscopy with histopathological assessment. The role of capsule endoscopy (CE) is uncertain. The aim of the present study was to investigate the accuracy of CE in this setting, comparing the clinical, endoscopic and histological data. Methods This was a retrospective single-centre study that included 57 (mean age: 47.18±15.05 years, 57.89% men) patients presenting with GVHD who underwent a valid CE and histopathological analysis by conventional endoscopy between January 2004 and July 2016. The endoscopic scored findings, clinical data and histopathological diagnosis were compared using duodenal histology as the gold standard. Results CE detected mild (n=4, 7.02%), moderate (n=6, 10.53%) and severe (n=21, 36.84%) grades, with a higher diagnostic yield than conventional endoscopy (54.39 vs. 28.07%, P<0.001). A positive CE predicted positive histology (80.64 vs. 15.38%, P<0.001) with a sensitivity, specificity, negative predictive value and accuracy of 86.21, 78.57, 84.62 and 82.46%. This procedure detected more mild-to-moderate histological lesions than conventional endoscopy (8.77 vs. 3.51%, P=0.25). In addition, 16% of patients with a previous normal endoscopy with biopsies had a pathological CE and there were eight (25.81%) patients with positive CE images unreachable by conventional endoscopy. Conclusion CE is a useful device in GVHD, achieving high accuracy values and diagnostic yield. However, its results may be interpreted in conjunction with clinical and histological features, particularly in mild-to-moderate stages.

Role of capsule endoscopy in alarm features and non-responsive celiac disease: A European multicenter study

The role of capsule endoscopy (CE) in established celiac disease (CD) remains unclear. Our objective was to analyze the usefulness of CE in the suspicion of complicated CD.

Guidelines for reviewers of The Spanish Journal of Gastroenterology (REED)

The peer review continues to be the most widespread procedure in the evaluation of scientific papers. We present the evaluation criteria of original articles and the responsibilities of the reviewers regarding the authors and the Editor.

Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model

Double balloon enteroscopy (DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.

The Role of Emergency Endoscopy in Small Bowel Bleeding: A Review

There is no consensus on the timing and management of emergency overt obscure gastrointestinal bleeding. Emergency capsule endoscopy and balloon-assisted enteroscopy have a high diagnostic and therapeutic yield in these situations. Most lesions detected by small bowel endoscopy are amenable to endoscopic haemostasis, although some lesions still require surgery or interventional radiology. The management of these patients is varied, and doubt persists about which technique should be preferred as first-line treatment. This narrative review analyses the usefulness and impact of small bowel endoscopic techniques in the emergency setting for severe overt obscure gastrointestinal bleeding.

Intermediate-risk patients with three to four small adenomas should be considered low risk for colorectal cancer screening

Intermediate‐risk patients following a colorectal cancer screening program may have differential risk of advanced lesions depending on the findings of an index colonoscopy. The aim of the present study was to comparatively assess advanced colorectal neoplasia risk at the first follow‐up colonoscopy among the different intermediate‐risk subgroups with a focus on patients with three to four adenomas.

Manejo endoscópico mediante sobreclip ovesco de una perforación colonoscópica durante un procedimiento diagnóstico

Figura 1 – Campo quirúrgico. Sobre la torunda, se comprueba el sellado perfecto de la perforación sigmoidea y la ausencia de peritonitis local o general. La perforación colonoscópica iatrogénica durante un procedimiento diagnóstico o terapéutico es una de las complicaciones más temidas por el endoscopista y ocurre entre el 0,1 y el 0,3% de los casos. Normalmente se suelen dar en recto-sigma, al inicio de la exploración, y motivan controversias en su manejo, con una alta morbimortalidad. Presentamos un caso tratado con el sistema de sobreclip OVESCO. Mujer de 74 años con antecedentes de diabetes, histerectomı́a e intervención por adenocarcinoma de sigma 9 años antes. Se realiza colonoscopia programada bajo sedación superficial en el seguimiento de la neoplasia colónica. La paciente estaba bien preparada y asintomática al inicio de la prueba. Durante las maniobras, al inicio de la exploración, al avanzar unos 30 cm sobre mucosa normal, se produce una perforación con el extremo del tubo del colonoscopio entrando claramente en cavidad peritoneal y retirándose inmediatamente el mismo. A continuación se decide montar el sistema OVESCO (Ovesco Endoscopy GmbH, Tübingen, Alemania) en un nuevo colonoscopio y se coloca el clip bajo control endoscópico considerándose sellada la perforación. Posteriormente, se valora la posibilidad de solicitar una TC con contraste oral y rectal para descartar posibles fugas, pero la paciente presenta signos de irritación peritoneal progresiva y distensión abdominal creciente, por lo que se decide de forma conjunta con Cirugı́a General una laparotomı́a urgente. Durante la intervención exploradora se comprueba que el punto de perforación en el sigma, de 1 cm de diámetro aproximadamente, se encuentra correctamente sellado y no hay datos de peritonitis (fig. 1). A los pocos dı́as la paciente queda asintomática y tolera dieta, permitiendo el alta hospitalaria. Ante una perforación colónica durante un procedimiento diagnóstico o terapéutico de hasta 2 cm, el cierre endoscópico mediante sobreclips como el OVESCO es una opción a tener en cuenta en su manejo para evitar la salida de contenido