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Resumen Objetivo La ecografia intestinal se considera una alternativa para la evaluacion de la recurrencia posquirurgica (RPQ) de la enfermedad de Crohn. El objetivo de este estudio es evaluar la correlacion entre los hallazgos ecograficos y endoscopicos. Metodos Se recogieron de forma retrospectiva los datos de pacientes con enfermedad de Crohn y reseccion ileocecal en los que se habia realizado una colonoscopia y una ecografia intestinal para la deteccion de RPQ. La RPQ se evaluo empleando el indice de Rutgeerts (IR). Los hallazgos ecograficos analizados fueron el grosor de la pared intestinal, la hiperemia parietal por Doppler, la desestructuracion del patron de capas y la proliferacion fibrograsa. Resultados Se incluyo a un total de 31 pacientes, 15 (48,4%) sin recurrencia (IR? Conclusiones En nuestra experiencia, la ecografia tiene una alta rentabilidad diagnostica para la deteccion de RPQ y puede considerarse en muchas ocasiones como una alternativa valida y no invasiva a la ileocolonoscopia.

Chronic immune-mediated diseases, including inflammatory bowel disease (IBD), present an increased risk of developing early atherosclerosis and cardiovascular events (CVE) at early age.To describe the baseline and 1-year cardiovascular profile of patients with IBD according to the biologic treatment received, taking into account the inflammatory activity.It is a retrospective, observational study that included 374 patients. Cardiovascular risk factors (CVRF) and CVE were collected at the baseline visit and at one-year follow-up to describe the cardiovascular risk according to the biological treatment received, also assessing clinical and biological remission.A total of 374 patients were included: 146 (38.73%) were treated with Infliximab, 128 (33.95%) with adalimumab, 61 (16.18%) with ustekinumab and 42 (11.14%) with vedolizumab. The changes in blood glucose levels are [86.31mg/dL (84.57-88.06) vs. 89.25mg/dL (87.54-90.96), P=.001] for those treated with antiTNFα and [86.52mg/dL (83.48-89.55) vs. 89.44mg/dL (85.77-93.11), P=.11] in the other group. In the group treated with antiTNFα total cholesterol values at baseline visit are [169.40mg/dL (164.97-173.83) vs. 177.40mg/dL (172.75-182.05) at one year of treatment, P=.001], those of HDL [50.22mg/dL (48.39-52.04) vs. 54.26mg/dL (52.46-56.07), P=.001] and those of triglycerides [114.77mg/dL (106.36-123.18) vs. 121.83mg/dL (112.11-131.54), P=.054]. Regarding weight, an increase was observed, both in those patients treated with antiTNFα [71.39kg (69.53-73.25) vs. 72.87kg (71.05-74.70), P.001], and in the group treated with ustekinumab and vedolizumab [67.59kg (64.10-71.08) vs. 69.43kg (65.65-73.04), P=.003]. Concerning CVE, no significant differences were observed neither according to the drug used (p=0.36), nor according to personal history of CVE (P=.23) nor according to inflammatory activity (P=.46).Our results on a real cohort of patients with IBD treated with biologic drugs show a better control of certain cardiovascular parameters such as CRP or HDL, but a worsening of others such as total cholesterol or triglycerides, regardless of the treatment. Therefore, it is possibly the disease control and not the therapeutic target used, the one that affect the cardiovascular risk of these patients.

Intestinal ultrasound is considered to be a valid alternative for the evaluation of post-operative recurrence (POR) of Crohn's disease. The aim of this study is to assess the correlation between ultrasound and endoscopic findings.Patients with Crohn's disease were retrospectively recruited who had undergone ileocecal resection, and for whom a colonoscopy and intestinal ultrasound had been performed for the detection of POR. Recurrence was assessed using the Rutgeerts score (RS). The ultrasound findings analysed were bowel wall thickness (BWT), parietal hyperaemia using power Doppler, loss of layer pattern and mesenteric fat hypertrophy.A total of 31 patients were included, of which 15 (48.4%) had no POR (RS2b) and 16 (51.6%) had POR (RS≥2b). A statistically significant association was identified between BWT and the presence of endoscopic recurrence (a mean of 2.75mm vs. 5.68mm, P0.001). There was also a statistically significant difference in hyperaemia between the 2groups (P=0.03). For wall thickness, an area under the ROC curve (AUC) of 92.9% was obtained, and with a cut-off point of 3.4mm, a sensitivity of 100% and specificity of 86.6%. When comparing with the most frequent biomarkers (fecal calprotectin and serum CRP), a higher AUC was obtained for wall thickness (72.3% and 72.3% vs. 92.9%).In our experience, ultrasound has high diagnostic efficacy in the detection of POR and can be considered a valid non-invasive alternative to endoscopy.

Resumen Introduccion Para la realizacion de colangiopancreatografia retrograda endoscopica (CPRE) es necesario el uso de contrastes radiologicos, utilizandose habitualmente contrastes yodados. La pauta de actuacion ante pacientes que han sufrido reacciones adversas a contrastes yodados y que van a recibir una CPRE es controvertida. Objetivo Evaluar la seguridad y eficacia de un contraste basado en gadolinio en pacientes con reacciones alergicas previas a contrastes yodados durante la realizacion de CPRE. Material y metodos Se realizaron 13 procedimientos en 11 pacientes con antecedentes de reacciones adversas previas a contrastes yodados. Se utilizo gadobutrol como agente de contraste, un compuesto basado en el gadolinio, sin utilizar profilaxis previa. Resultados Las CPRE fueron completadas satisfactoriamente en todos los casos, obteniendose 13 colangiogramas y un pancreatograma. La calidad de imagen obtenida fue buena, equiparable a la obtenida con los contrastes yodados utilizados habitualmente, y permitiendo realizar el diagnostico y la terapeutica endoscopica sin suponer una limitacion. No se encontraron efectos adversos relacionados con el contraste y tampoco complicaciones post-CPRE. Conclusiones El gadobutrol, un contraste basado en gadolinio, es una alternativa segura y eficaz en pacientes alergicos a contrastes yodados.

Resumen Introduccion El carcinoma de celulas en anillo de sello de la ampolla de Vater es una entidad infrecuente, con menos de 20 casos descritos en la literatura. El objetivo de este articulo es presentar dos pacientes con esta patologia y realizar una revision de los estudios previos. Observacion clinica Los dos pacientes ingresaron por ictericia obstructiva. En la ecografia y la tomografia computarizada abdominales se aprecio una dilatacion de la via biliar intra y extrahepatica. En la duodenoscopia, se visualizo una masa excrecente de la ampolla de Vater que, histologicamente, presentaba celulas con caracteristicas tipicas de celulas en anillo de sello. Se realizaron una duodenopancreatectomia cefalica con linfadenectomia y una pancreatectomia total respectivamente. Discusion El carcinoma de celulas en anillo de sello de la ampolla de Vater ha sido descrito unicamente en casos aislados en la literatura. Por este motivo, sus caracteristicas clinicopatologicas y su pronostico aun no estan bien definidos.

Resumen El objetivo del presente estudio fue determinar la utilidad de la ligadura con bandas elasticas en la prevencion de la recidiva hemorragica por varices esofagogastricas. Se incluyo a 65 pacientes que sobrevivieron a un episodio hemorragico por varices. Veintinueve (45%) eran Child A, 25 (38%) B y 11 (17%) C; el virus C y el alcohol fueron la etiologia de la cirrosis en el 45 y el 31% de los casos, respectivamente. La primera sesion de ligadura se realizo entre el tercer y el quinto dia despues del episodio hemorragico, y las sesiones posteriores a intervalos de 3-4 semanas. Las sesiones de ligadura se realizaron con profilaxis antibiotica. Se aplico una media de 2,7 bandas por sesion (rango, 1-5), y la media de sesiones por paciente hasta erradicar las varices fue de 2,5 (rango, 1-6). La tasa de recidiva hemorragica fue del 24,6% (16 episodios). En conclusion, la ligadura endoscopica con bandas elasticas es una tecnica util para la erradicacion de varices esofagicas y en la prevencion de recidiva hemorragica.

Radiologic contrasts are required during endoscopic retrograde cholangiopancreatography (ERCP). The most frequently used are iodine-based contrast media. Controversy still surrounds the optimal strategy in patients with previous adverse reactions to iodine contrasts that need to undergo an ERCP.To evaluate the safety and efficacy of a gadolinium-derived contrast medium in patients with previous reactions to iodine-derived agents during ERCP.Thirteen ERCP were performed in 11 patients with well-established adverse reactions to iodine compounds. ERCP was carried out with gadobutrol, a non-ionic gadolinium compound and without prophylaxis.In all patients, ERCP were satisfactorily completed. Thirteen cholangiograms and one pancreatogram were obtained. All procedures were technically successful, allowing diagnosis and endotherapy. The quality of the images was good, similar to those obtained with standard contrast media, and did not represent a limitation. No contrast-related adverse events were observed, and there were no post-ERCP complications.Gadolinium-derived agents are a safe and effective alternative in iodine-allergic patients.

Signet ring cell carcinoma of the ampulla of Vater is a rare entity and less than 20 cases have been described in the literature. We report the cases of two patients with this disease and provide a literature review of previous studies.We describe two patients with obstructive jaundice. Abdominal ultrasonography and abdominal computed tomography showed dilatation of the intrahepatic and common bile duct. Duodenoscopy indicated a protruding mass on the ampulla of Vater. Histopathological examination showed round cells and their nuclei were located on one side with prominent signet-ring features. One patient underwent a cephalic pancreatoduodenectomy with lymphadenectomy and the other a total pancreatectomy.Signet ring cell carcinoma of the ampulla of Vater has only been described in isolated cases in the literature. Therefore, the clinicopathological features and prognosis of this disease have not yet been well defined.