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The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. “Optimized” H. pylori therapies achieve over 90% success in Spain.

We present a pancreatic plastic stent migration case and the difficulty of an endoscopic approach to remove it, this time resolved with a hand-made loop catheter using a straight cannula and a NovaGold guide.

Endoscopic ultrasound (EUS) guided drainage of pelvic collections is an alternative to percutaneous or surgical drainage. We present our experience using lumen-apposing metal stents (LAMS) for the drainage of postoperative pelvic abscesses.

Endoscopic recurrence in Crohńs disease occurs in up to 80% of patients during the first year after surgery. Due to this, these patients need close monitoring. Faecal calprotectin has been proposed to be used as a non-invasive marker to monitor inflammatory activity. Up to now the use of faecal markers in endoscopic recurrence has been scarcely studied and with contradictory results.This was a cross-sectional observational study of diagnostic validity. It included all patients with Crohńs disease (CD) and ileocolic resection retrospectively who had had an ileocolonoscopy and a determination of faecal calprotectin before this colonoscopy, from 2007 to 2015.Ninety-seven patients were included. We observed that the mean value of faecal calprotectin increased as the Rutgeerts score increased. The variable of that most statistical significance obtained in bivariate analysis was faecal calprotectin (p 0.0001). Area under curve (AUC) of faecal calprotectin in endoscopic recurrence was 0.74 (95% CI: 0.644-0.842), and an optimal cut-off of 60 mcrgr/gr, obtained a score of 0.45 using Youden test. This indicated that calprotectin would have 88% Sensitivity and 58% Specificity in detecting any recurrence, the NPV was approximately 83,9%. None of the other variables studied had a significant correlation.Faecal calprotectin predicts endoscopic recurrence in CD patients who have gone through surgery, however the cut-off point is still a problem so we cannot recommend calprotectin as a substitute of colonoscopy for CD monitoring and treatment adjustment.

Introduccion: Las transecciones ductales completas (TDC) de la via biliar no se consideran susceptibles de tratamiento endoscopico. Objetivo: Describir y evaluar la viabilidad de diversos abordajes endoscopicos para tratamiento de TDC. Material y Metodo: Desde septiembre-2010 se registran prospectivamente 248 CPRE por complicaciones postquirurgicas (estenosis/fugas) en 150 pacientes (69 trasplante hepatico TH, 81 Otras). Se identifican TDC en 17 pacientes (Mujeres = 9; edad = 59.6 [43 – 79] anos) con TDC (7 TH; 7 colecistectomia CCx; 3 Otras). Resultados: Se logro recanalizacion en 12/17 TDC (70%), por CPRE aislada en 5 (4 TH, 1 CCx), y por CPRE combinada con abordaje anterogrado por USE en 7 (2 TH, 4 CCx, 1 Otra), en 4 casos la ausencia de dilatacion biliar impidio abordaje USE y en otro no se logro recanalizacion a pesar de hepaticogastrostomia USE-guiada. Hubo 5 fracasos, remitidos a hepatico-yeyunostomia quirurgica. 10/12 casos recanalizados precisaron maniobras forzadas por via anterograda o retrograda: manipulacion con el cabo rigido de la guia, needle-knife, aguja de Artifon, retroperitoneoscopia transhepatica o anastomosis magnetica. Se requirieron 1.5 (1 – 5) CPREs hasta lograr la recanalizacion. Se drenaron endoscopicamente 2 bilomas asociados a TDC. Once pacientes han finalizado 12 ciclos de tratamiento con retirada definitiva de protesis (plasticas, n = 2; metalicas cubiertas ± plasticas, n = 10) tras 323(180 – 503) dias de tutorizacion. Tras un seguimiento medio de 353 (30 – 900) dias, hubo 3 recidivas (hepaticoyeyunostomia quirurgica, tratamiento endoscopico en curso, resuelta tras nuevo ciclo endoscopico, una cada uno). Como complicaciones se registraron 2 colangitis y 1 sangrado. Conclusiones: El 70% de las TDC postquirurgicas pueden recanalizarse endoscopicamente con metodos mecanicos forzados (guia rigida o agujas), diatermicos o magneticos. La USE permite rescatar para reconexion el 60% de los fracasos de la CPRE y el drenaje de bilomas. Los resultados definitivos del tratamiento endoscopico con protesis de las TDC parecen equiparables a los de las estenosis parciales.

This response discusses the article by Kim and colleagues entitled "endoscopic clip closure versus surgery for the treatment of iatrogenic colon perforations developed during diagnostic colonoscopy: a review of 115,285 patients". Iatrogenic colonoscopic perforation, although uncommon, implies serious management problems for endoscopists and surgeons. Nonoperative treatment currently is recommended under certain conditions, and endoscopic clips can primarily close iatrogenic perforations, helping to avoid surgery. Of the 27 colonoscopic perforation cases presented in the article by Kim and colleagues, 16 were managed by endoscopic clipping closure and 11 by primary surgery. Conservative treatment failed for three patients. Only perforation size obtained statistical significance among the nine variables contrasted between the 11 cases with primary surgery and the 13 cases with successful endoscopic clipping. The results for the three patients whose endoscopic closure failed are not reported. The authors of this letter think it would have been interesting if these three patients had been included in the analysis due to the high importance of discovering factors that can predict failure of endoscopic clipping for perforations. To call attention to possible late complications requiring surgery even when initial conservative management of endoscopic perforation succeeds, the authors of this letter present a case of a colocutaneous (actually, sigmoid-scrotal) fistula in a patient 2 weeks after an apparently successful closure of colonoscopic perforation with an “over-the-scope” clip.

Mucormycosis, although an infrequent fungal infection, has a high mortality in patients undergoing orthotopic liver transplantation. We present two cases of cutaneous Absidia mucormycosis in two successive patients undergoing liver transplantation in our hospital. In our literature search, we encountered only one published case of Absidia infection in liver transplantation.

Diffuse intestinal ganglioneuromatosis is a hamartomatous polyposis characterized by a disseminated, intramural or transmural proliferation of neural elements involving the enteric plexuses. It has been associated with MEN II, neurofibromatosis type 1 and hamartomatous polyposis associated with phosphatase and tensin homolog mutation. We report the case of a female patient with a history of a breast and endometrial tumor who presented in a colonoscopy performed for rectal bleeding diffuse ganglioneuromatosis, which oriented the search for other characteristic findings of Cowden syndrome given the personal history of the patient. The presence of an esophagogastric polyposis was also noted. Cowden syndrome is characterized by skin lesions, but it is rarely diagnosed by these lesions, because they are usually overlooked. Intestinal polyposis is not a major diagnostic criterion but it is very useful for early diagnosis. The combination of colonic polyposis and glucogenic acanthosis should orient the diagnosis to Cowden syndrome.