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Introduction: several studies have pointed out the effectiveness of the PillCam© colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology. Aims and methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed. Results: a total of 144 subjects (67 women and 77 men); (52.17±16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified. In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4 %. The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn's Disease in 9 and ulcerative colitis in other 8 cases. Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agree-ment with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data.

Objective: to assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP). Material and method: this is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months' duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used. Results: one patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman). Conclusions: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.Objetivo: evaluar el rendimiento de la ecografía rectoanal (ERA) en el estudio del dolor anal crónico idiopático (DACI). Material y método: se trata de un estudio prospectivo y descriptivo en el que se han incluido 40 pacientes, 18 hombres y 22 mujeres, con edad media de 47 años, con clínica de dolor anal crónico de al menos 3 meses de evolución. A todos los pacientes se les había realizado una colonoscopia completa, en la que no se encontró anomalía que justificara la clínica. Se excluyeron del estudio pacientes con fisura anal y con hemorroides internas de cualquier grado, enfermedad supurativa perianal y cirugía pélvica. Se utilizó un ecógrafo ALOKA ProSound SSD-4000 al que se conectó un transductor radial multifrecuencia ASU-67 (7,5 y 10 MHz). Resultados: un paciente no toleró la exploración. En 8 pacientes (20% de los casos estudiados) se detectaron alteraciones en el estudio ecográfico: en 4 pacientes, 10% de los casos (1 hombre y 3 mujeres), hipertrofia del esfínter anal interno (EAI) y en 5 pacientes (4 mujeres y 1 hombre) rotura del complejo esfinteriano. En una mujer se observó rotura de EAI en canal alto e hipertrofia del mismo en el canal medio. Conclusiones: la ecografía rectoanal es una prueba sencilla, económica y útil para el estudio de la patología rectoanal. Si bien, en la mayoría de los casos estudiados no se han detectado lesiones en el canal anal ni en la pared rectal, en un porcentaje no desdeñable de pacientes hemos observado engrosamiento del EAI, que podría considerarse posible causa del dolor anal. Por tanto, consideramos que la ecografía rectoanal debe ser incluida en el estudio del dolor anal crónico idiopático.

Background and objectives: the diagnostic yield of push enteroscopy (PE) varies widely from 13 to 78% of cases, according to the various series. The aim of this retrospective cohort study was to determine the endoscopic and histological yield of PE in our health area. Patients and methods: a total of 355 consecutive patients (190 males/165 females; mean age 45 years, range 15-89) underwent PE over a 6-year period, from 1997 to 2003. PE was performed under sedation and without overtube. Small-bowel mucosa biopsies were taken in 199 explorations (56%). Clinical indications for PE included: chronic diarrhea (35%), occult digestive bleeding (ODB) or iron-deficiency anemia (28%), suspected small-bowel malignancy (16%), chronic abdominal pain (28/355; 8%), follow-up of polyposis or malabsorption syndromes (7%), and abnormal radiographic findings (6%). Results: PE detected lesions in 122 cases (34%); in 6 cases (6%) lesions were within the reach of esophagogastroduodenoscopy. A normal macroscopic appearance of the small intestinal mucosa with an abnormal histological study was seen in 16 patients (6%). Major findings included: malabsorptive diseases (14%), nonspecific enteropathy (5%), angiodysplasia (3,5%), lymphangiectasia (3%); jejunal polyps (2%), Crohn's disease (2%), intestinal tumors (2%), extrinsic jejunal strictures (0.5%), and other (10/355; 3%). Abnormal radiographic findings (62%), chronic diarrhea (37%) and ODB (31%) were the indications with a higher diagnostic yield. No major complications were seen. Conclusions: according to our experience, PE is a safe and useful tool for the evaluation of small-bowel disease, especially in some indications (abnormal radiographic findings, chronic diarrhea, and ODB). Small-bowel biopsy increases PE's diagnostic yield in patients with chronic diarrhea.Introducción y objetivos: el rendimiento diagnóstico de la enteroscopia por pulsión (EP) varía ampliamente (13-78%) según las series. El objetivo de este estudio retrospectivo fue determinar el rendimiento endoscópico e histológico de la EP en nuestra área sanitaria. Pacientes y métodos: un total de 355 pacientes consecutivos (190 hombres/165 mujeres; media de edad 45 años, rango 15-89), fueron sometidos a EP en un periodo de 6 años, entre 1997 y 2003. Las EP fueron realizadas bajo sedación y sin sobretubo, tomándose biopsias de la mucosa de intestino delgado en 199 exploraciones (56%). Las indicaciones clínicas fueron: diarrea crónica (126/355; 35%), hemorragia digestiva de origen oscuro o anemia ferropénica (99/355; 28%), sospecha de tumor intestinal (56/355; 16%), dolor abdominal crónico (28/355; 8%), seguimiento de síndromes de poliposis o cuadros malabsortivos (25/355; 7%), y confirmación de anormalidades radiográficas (21/355; 6%). Resultados: la EP identificó lesiones en 122 pacientes (34%), observándose lesiones al alcance del gastroscopio convencional en 6 casos (6%). En 16 pacientes (6%) el aspecto macroscópico de la mucosa intestinal fue normal, objetivándose hallazgos diagnósticos en el estudio histológico. Los principales hallazgos encontrados fueron: proceso malabsortivo (50/355; 14%), enteropatía inespecífica (19/355, 5%), angiodisplasia (13/355; 3,5%), linfangiectasia (10/355; 3%), pólipos yeyunales (6/355; 2%), enfermedad de Crohn (6/355; 2%), tumor intestinal (6/355; 2%), estenosis intestinal extrínseca (2/355; 0,5%), y otros (10/355; 3%). Las indicaciones con mayor rendimiento diagnóstico fueron: confirmación de anormalidades radiográficas (13/21; 62%), diarrea crónica (46/126; 37%), y hemorragia digestiva de origen oscuro (31/99; 31%). No se objetivaron complicaciones graves. Conclusiones: según nuestra experiencia, la EP es una técnica segura y útil para la evaluación de las patologías del intestino delgado, especialmente en ciertas indicaciones (anormalidades radiográficas, diarrea crónica, y hemorragia digestiva de origen oscuro). La biopsia intestinal aumenta el rendimiento diagnóstico de la EP en pacientes con diarrea crónica.

Radiation enteritis is a complex clinical entity secondary to the affectation of intestinal epithelial cells as a result of radiation in the management of pelvic malignancies that may occasionally cause intestinal strictures. We present the case of a 60 year-old woman who had been diagnosed ten years before with endometrial adenocarcinoma, and who underwent hysterectomy with double adnexectomy and subsequent radiation therapy. The patient consulted for abdominal pain and ferropenic anemia of several years' standing, and had negative results following radiographic and endoscopic conventional techniques, reason why she was subjected to a capsule endoscopy study that revealed the presence of an ulcerated ileal stricture, which caused the asymptomatic retention of the capsule within the ileum. A laparotomy was subsequently performed - the strictured segment was resected and the capsule retrieved. The histologic examination of the resected segment confirmed the capsule endoscopy-raised suspicion of radiation enteritis. This case shows the role capsule endoscopy may play in the diagnosis of this condition.La enteritis actínica es una entidad producida por la afectación de las células intestinales como consecuencia del tratamiento radioterápico de tumores abdomino-ginecológicos, que en ocasiones puede causar áreas estenóticas. Presentamos el caso de una mujer de 60 años, diagnosticada diez años antes de adenocarcinoma de endometrio, que fue tratada con resección intestinal y radioterapia abdomino-pélvica. La paciente acudió por dolor abdominal y anemia ferropénica de años de evolución, con técnicas radiológicas y endoscópicas convencionales negativas. La realización de una capsuloendoscopia reveló la presencia de una estenosis ileal ulcerada, que causó la retención asintomática de la cápsula en íleon. Se indicó de forma electiva la realización de una laparotomía con resección del segmento estenótico y extracción de la cápsula, confirmándose histológicamente la sospecha capsuloendoscópica de enteritis actínica. Este caso ilustra el papel que la capsuloendoscopia puede jugar en esta entidad de difícil diagnóstico.

Aim: to study the usefulness and safety of capsule endoscopy as a diagnostic tool in various small bowel disorders. Design: a retrospective analysis of a series of cases. Material and methods: between August 2001 and August 2002, 92 capsule endoscopy procedures were performed in 88 patients (53M/39F, age: 43.87 ± 16.78). Indications included: chronic diarrhea (n = 33); unknown abdominal pain (n = 29); occult gastrointestinal bleeding or iron-deficiency anemia (n = 13); abdominal discomfort in NSAID takers (n = 7); staging of gastrointestinal tumors (n = 4), and asymptomatic controls (n = 2). Previously performed gastroscopy, colonoscopy, and small-bowel follow-through were not conclusive in all patients. Results: most frequently relevant findings included: jejuno-ileal apthas and ulcerations (29 patients), vascular malformations (13 patients), and intestinal neoplasm (6 patients). The groups with a higher rate of findings related to this indication were occult gastrointestinal bleeding (76.92%) and chronic diarrhea (67.85%), with the lowest rate in the abdominal pain group (34.48%). Therapeutic strategy was directly changed in 36 of 88 patients (40.90%) because of capsule-endoscopic findings. The only observed complication was the failed excretion of one of the capsules because of an unknown ulcerated intestinal stricture. Conclusions: capsule endoscopy is a safe procedure which can study the entire small bowel, meaning a valuable tool for the management of patients with suggestive signs and symptoms of intestinal disorders.Objetivo: estudiar la utilidad y seguridad de la cápsula endoscópica como prueba diagnóstica en distintas patologías de intestino delgado. Diseño: análisis retrospectivo de una serie de casos. Material y métodos: entre agosto de 2001 y agosto de 2002 se realizaron 92 cápsulo-endoscopias a 88 pacientes (53H/39M, edad: 43,87± 16,78). Las indicaciones fueron: diarrea crónica (n = 33); dolor abdominal no filiado (n = 29); hemorragia digestiva de origen oscuro o anemia ferropénica (n = 13); molestias abdominales en pacientes consumidores de AINE (n = 7); estudio de extensión de tumores gastrointestinales (n = 4); y controles asintomáticos (n = 2). Todos los pacientes fueron sometidos previamente a tránsito intestinal, gastroscopia y colonoscopia, cuyos hallazgos no fueron concluyentes para el diagnóstico. Resultados: los hallazgos relevantes más frecuentemente encontrados fueron ulceraciones y aftas yeyunoileales (29 pacientes), malformaciones vasculares (13 pacientes) y neoplasias intestinales (6 pacientes). Los grupos con mayor tasa de hallazgos relacionados con la indicación fueron el de hemorragia digestiva de origen oscuro (76,92%) y el de diarrea crónica (67,85%), mostrando el grupo de pacientes con dolor abdominal el porcentaje más bajo (34,48%). En el 40,90% de casos (36/88) se cambió directamente la estrategia terapéutica del paciente a la luz de los resultados capsuloendoscópicos. La única complicación observada consistió en la falta de excreción de una de las cápsulas por la existencia de una estenosis ulcerada no conocida. Conclusiones: la cápsula endoscópica es una técnica segura y capaz de estudiar el intestino delgado en su totalidad, suponiendo una valiosa herramienta para el manejo de pacientes con clínica sugestiva de patología intestinal.

Objective: to assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP). Material and method: this is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months' duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used. Results: one patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman). Conclusions: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

Introduction: PillCam© colon capsule endoscopy (CCE) enables the study of colonic diseases in a safe and non-invasive way, although there are aspects that need to be improved. Current methods of bowel preparation lead to discordant rates of adequate cleansing and CCE excretion., Aims: To compare the efficacy of colon cleansing using two different regimes (2L PEG plus ascorbic acid versus 4L PEG alone) for PillCam Colon (C2) capsule endoscopy., Methods: Fifty eight patients included in this prospective study and randomized to: Group A, PEG plus ascorbic acid regimen (n = 28, 12 F/16 M) or group B, PEG alone regimen (n = 30, 14 F/16 M). The degree of cleansing was categorized into "excellent-good" or "fair-poor", according to Leighton´s recently published preparation scale. CCE excretion rate and colon cleansing were assessed. Patients underwent to PillCam colon of second generation (C2)., Results: Cleansing was considered to be excellent-good in 78 % of cases in group A and in 64 % of cases in group B, with no significant difference between the groups (p = 0.252). Nevertheless, when the grade of cleansing was analyzed in segments, a significant difference was found in the cecum and transverse colon. No differences were observed in the bubble effect between preparations. The excretion rate was 93 % in group A versus 70 % in group B (p = 0.043)., Conclusions: These results suggest that a 2L PEG plus ascorbic acid regimen is at least as effective as a 4L PEG regimen. This regimen may be considered an effective alternative which would improve compliance because a smaller volume is required.

Introduction: several studies have pointed out the effectiveness of the PillCam colon capsule endoscopy (CCE) compared with the colonoscopy in the study of the colonic pathology., Aims and Methods: the objective of our study was to assess the agreement in the diagnosis of CCE with conventional colonoscopy as well as its sensitivity and specificity, and to describe the findings of the CCE in our clinical practice. Consecutive patients with abdominal symptoms were included in the study. The CCE was performed as previously reported (with PEG and sodium phosphate as laxative agents). The nature and location of the findings, colonic transit time, complications, cleanliness degree and consistency with diagnostic colonoscopy, when performed, were analyzed., Results: a total of 144 subjects (67 women and 77 men); (52.17 ± 16.71 years) with the following indications were included: screening of Colorectal cancer (88 patients), control after polipectomy (24), incomplete colonoscopy (7), rectal bleeding (10), anemia (8), diarrhea (7). The CCE exploration was complete in 134/144 cases (93%), with no case of retention. The preparation was good-very good in 88/134 (65,6%), fair in 26/134 (19,4%) and poor in 20/134 (15%) of the cases. The average colonic transit was of 140.76 min (9-603). Any adverse effect was notified.In 44 cases a colonoscopy was carried out after CCE (results were hidden from another endoscopist). Compared to colonoscopy, the rate of agreement was 75,6%, the sensitivity was 84% and the specificity 62,5%, PPV was 77,7% and NPV was 71,4%.The colonic findings in 134 CCE were: in 34 cases CCE it did not show lesions, diverticulosis in 63 explorations, polyps in 43, angiodysplasias in 15, Crohn's Disease in 9 and ulcerative colitis in other 8 cases., Conclusions: the CCE is an effective and reliable technique for the detection of lesions in colon, and because of its high agreement with the colonoscopy, it could be useful in clinical practice. Further studies with large seria and cost-effectiveness analysis are needed to confirm these data.

Objective: To assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP)., Material and Method: This is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used., Results: One patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman)., Conclusions: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

Background and Objectives: The diagnostic yield of push enteroscopy (PE) varies widely from 13 to 78% of cases, according to the various series. The aim of this retrospective cohort study was to determine the endoscopic and histological yield of PE in our health area., Patients and Methods: A total of 355 consecutive patients (190 males/165 females; mean age 45 years, range 15-89) underwent PE over a 6-year period, from 1997 to 2003. PE was performed under sedation and without overtube. Small-bowel mucosa biopsies were taken in 199 explorations (56%). Clinical indications for PE included: chronic diarrhea (35%), occult digestive bleeding (ODB) or iron-deficiency anemia (28%), suspected small-bowel malignancy (16%), chronic abdominal pain (28/355; 8%), follow-up of polyposis or malabsorption syndromes (7%), and abnormal radiographic findings (6%)., Results: PE detected lesions in 122 cases (34%); in 6 cases (6%) lesions were within the reach of esophagogastroduodenoscopy. A normal macroscopic appearance of the small intestinal mucosa with an abnormal histological study was seen in 16 patients (6%). Major findings included: malabsorptive diseases (14%), nonspecific enteropathy (5%), angiodysplasia (3,5%), lymphangiectasia (3%); jejunal polyps (2%), Crohn s disease (2%), intestinal tumors (2%), extrinsic jejunal strictures (0.5%), and other (10/355; 3%). Abnormal radiographic findings (62%), chronic diarrhea (37%) and ODB (31%) were the indications with a higher diagnostic yield. No major complications were seen., Conclusions: According to our experience, PE is a safe and useful tool for the evaluation of small-bowel disease, especially in some indications (abnormal radiographic findings, chronic diarrhea, and ODB). Small-bowel biopsy increases PE's diagnostic yield in patients with chronic diarrhea.

Radiation enteritis is a complex clinical entity secondary to the affectation of intestinal epithelial cells as a result of radiation in the management of pelvic malignancies that may occasionally cause intestinal strictures. We present the case of a 60 year-old woman who had been diagnosed ten years before with endometrial adenocarcinoma, and who underwent hysterectomy with double adnexectomy and subsequent radiation therapy. The patient consulted for abdominal pain and ferropenic anemia of several years standing, and had negative results following radiographic and endoscopic conventional techniques, reason why she was subjected to a capsule endoscopy study that revealed the presence of an ulcerated ileal stricture, which caused the asymptomatic retention of the capsule within the ileum. A laparotomy was subsequently performed--the strictured segment was resected and the capsule retrieved. The histologic examination of the resected segment confirmed the capsule endoscopy-raised suspicion of radiation enteritis. This case shows the role capsule endoscopy may play in the diagnosis of this condition.

Aim: To study the usefulness and safety of capsule endoscopy as a diagnostic tool in various small bowel disorders., Design: A retrospective analysis of a series of cases., Material and Methods: Between August 2001 and August 2002, 92 capsule endoscopy procedures were performed in 88 patients (53M/39F, age: 43.87 +/- 16.78). Indications included: chronic diarrhea (n=33); unknown abdominal pain (n=29); occult gastrointestinal bleeding or iron-deficiency anemia (n=13); abdominal discomfort in NSAID takers (n=7); staging of gastrointestinal tumors (n=4), and asymptomatic controls (n=2). Previously performed gastroscopy, colonoscopy, and small-bowel follow-through were not conclusive in all patients., Results: Most frequently relevant findings included: jejuno-ileal aphtas and ulcerations (29 patients), vascular malformations (13 patients), and intestinal neoplasm (6 patients). The groups with a higher rate of findings related to this indication were occult gastrointestinal bleeding (76.92%) and chronic diarrhea (67.85%), with the lowest rate in the abdominal pain group (34.48%). Therapeutic strategy was directly changed in 36 of 88 patients (40.90%) because of capsule-endoscopic findings. The only observed complication was the failed excretion of one of the capsules because of an unknown ulcerated intestinal stricture., Conclusions: Capsule endoscopy is a safe procedure which can study the entire small bowel, meaning a valuable tool for the management of patients with suggestive signs and symptoms of intestinal disorders.

Wireless endoscopy consists of a small-sized device which allows gastrointestinal tract images to be taken as it physiologically advances along its lumen after being orally ingested. Its primary contribution is the study of small bowel conditions, a gastrointestinal tract segment in which diagnosis difficulties still arise when using current tests, including enteroscopy. Preliminary studies in animals and healthy subjects have revealed data on image quality, sensitivity, specificity, and safety that demonstrate the benefits of this new technique. This review discusses technical aspects, indications and contraindications, as well as studies reported so far on this endoscopic diagnostic procedure.

Sump syndrome consists on an entity in which the distal portion of the biliary tree does not drainage by the major papilla, so food and bile are retained and infections could appear leading to cholangitis. The real incidence of the sump syndrome after side-to-side choledocoduodenostomy is unknown, but has been described less than 10%. Several procedures have been used to solve it but at present endoscopic sphincterotomy is of choice the treatment of this condition that is followed by a good outcome. When major papilla can not be negotiated, an endoscopic approach consisting in a biliary endoscopic <> procedure could be used, negotiating the biliary tree by the side-to-side choledocoduodenostomy in this case. We report a clinical case of a patient with a side-to-side choledocoduodenostomy because of choledocolithiasis who developed a sump syndome. He was treated by a biliary endoscopic <> procedure because a papillary stenosis did not allow a transpapillar access to the biliary tree.

Unlabelled: A relevant percentage of patients with malignant biliary obstruction are not candidates for surgery when the diagnosis is made. Endoscopically placed biliary stents have shown their efficacy in the palliative management of these patients although they do not seem to increase their survival. We report on a retrospective analysis of 37 patients with malignant biliary obstruction treated with endoscopic biliary stents. The distal third (62%) of the main life duct was the most frequent common location for the obstruction, and pancreatic cancer was the most frequent cause of obstruction (64%). Twenty three plastic (13-7F and 10-10F) and 14 metallic stents were placed initially. Forty four percent of the plastic stents (all of them 7F, none 10F) were removed after 39 days against 30% of the metallic stents after a mean period of 60 days. Global survival was 153 days (110 in the plastic stents' group versus 195 in the metallic one, p: NS). We could only make a complete follow up in 52% of the patients., Conclusions: endoprotheses are a good palliative treatment for malignant biliary obstruction. When plastic stents are used they should have a wide calibre (10F or greater). Metallic stents result in an increase of survival time without statistical significance.

Unlabelled: Pain in chronic pancreatitis is due to intraglandular neural affection and to pancreatic duct drainage obstruction with an increased intraductal pressure. To achieve pain relief, medical, surgical and endoscopic procedures have been developed., Aim: To evaluate the efficacy of pancreatic duct stenting in patients with narcotic-dependent pain due to chronic pancreatitis., Patients and Method: From May-1994 to May-1996, ten patients (medium age: 47.5 yr) with alcoholic chronic pancreatitis were selected for this procedure. Pancreatography showed single or multiple Wirsung strictures in all cases. Papillotomy and pancreatic duct sphincterotomy were performed before stenting. Strictures were negotiated with a 7F dilating catheter over a guide wire, and intraductal calculi were removed as well. We used 7F plastic stents with variable lengths (5-10 cm), that were exchanged when the patient presented pain recurrence. Stent survival time was defined as the patient's pain-free time., Results: In 6 of the 10 patients stent placement was carried out successfully. A single distal Wirsung stricture was diagnosed in 3 patients while in the remaining 3 there were several strictures associated to ductal lithiasis in two of them. Mean time to achieve pain relief was 3 days and mean stent survival time was 166.5 days. There were no complications due to the procedure., Conclusions: When placed through the stricture, endoscopic pancreatic stent drainage is effective in achieving pain relief. It is a safe procedure with no complications in our short series.

We report the case of a 55-year-old female patient, previously cholecystectomized, who was admitted to the Hospital because of recurrent biliary abdominal pain, cholestasis and common bile duct enlargement by ultrasonography. 48 hours after an endoscopic sphincterotomy the patient developed abdominal pain and fever. CT scan demonstrated air and an infected liquid collection in the retroperitoneum. Although a percutaneous drainage was attempted, the persistence of the symptoms and the low drainage outflow of the infected material made surgical treatment necessary. Duodenal perforation in endoscopic sphincterotomy is an unusual but severe complication that leads to a high mortality rate if surgical treatment is not applied promptly. Sometimes retropneumoperitoneum can be satisfactory solved just with a conservative medical therapy, but if there is a suspected or confirmed infected collection surgical treatment must be applied promptly.

We report our experience of two years (February 1993-February 1995) in the endoscopic treatment with self-expanding prosthesis (Ultraflex) of 21 patients with inoperable malignant oesophageal stenosis. 23 prosthesis were implanted enabling swallowing in less than 24 h. There were no major complications. In two occasions the prosthesis was obstructed by tumoral growth needing replacement. The prosthesis was occluded by solid food in four cases, which were resolved endoscopically.