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espanolObjetivo: evaluar analitica y descriptivamente la evidencia publicada hasta la actualidad sobre el uso del polietilenglicol, solo o con electrolitos, en el tratamiento de pacientes con estrenimiento funcional. Metodologia: busqueda en las bases de datos MEDLINE, EMBASE y Cochrane hasta mayo de 2016 de todas las publicaciones que se ajustaran a los siguientes terminos: constipation and/or fecal impaction and (PEG or polyethilene or macrogol or movicol or idralax or miralax or transipeg or forlax or golytely or isocolan or mulytely) not colonoscopy. Lectura critica de los articulos seleccionados (unicamente en ingles o espanol) clasificando la descripcion de los mismos en funcion de grupos de edad (adulto/ edad pediatrica) y, dentro de ellos, en funcion de las caracteristicas de los estudios (evaluacion de eficacia frente a placebo, busqueda de dosis, seguridad, comparacion con otros laxantes, estudios observacionales y articulos de revision monograficos para poletilenglicol o metaanalisis). Resultados: se han seleccionado para analisis descriptivo 58 publicaciones; de ellas, 41 son ensayos clinicos, ocho son estudios observacionales y nueve son revisiones sistematicas o metaanalisis. Doce ensayos clinicos evaluan la eficacia frente a placebo, ocho frente a lactulosa, seis estudio de dosis, cinco comparan entre si el polietilenglicol con y sin electrolitos, dos comparan la eficacia con respecto a leche de magnesia y el resto de ensayos evaluan el polietilenglicol comparando con enemas (dos), ispagula (uno), tegaserod (uno), prucaloprida (uno), aceite de parafina (uno), combinaciones de fibras (uno) y Descurainia sophia (uno). Conclusiones: los preparados con polietilenglicol, unicos o asociados a electrolitos, son mas eficaces que el placebo en el tratamiento del estrenimiento funcional tanto en adultos como en edad pediatrica con gran seguridad y tolerancia. Constituyen el laxante osmotico mas eficaz (superior a la lactulosa) y de primera linea para el tratamiento de esta afeccion a corto y largo plazo. En la impactacion fecal son tan eficaces como los enemas, evitan la necesidad de ingreso hospitalario y son muy bien tolerados por los pacientes (fundamentalmente, en su presentacion sin electrolitos). EnglishObjective: The objective of this study was to evaluate in an analytical and descriptive manner the evidence published so far on the use of polyethylene glycol (PEG), with or without electrolytes, in the management of functional constipation and the treatment of fecal impaction. Methodology: Search on MEDLINE, EMBASE and Cochrane databases until May 2016 of all publications adjusted to the following terms: constipation AND/OR fecal impaction AND (PEG OR polyethylene glycol OR macrogol OR movicol OR idralax OR miralax OR transipeg OR forlax OR golytely OR isocolan OR mulytely) NOT colonoscopy. Critical reading of selected articles (English or Spanish), sorting their description according to group age (adult/pediatric age) and within those, in accordance with study features (efficacy evaluation versus placebo, doses query, safety, comparison with other laxatives, observational studies and monographic review articles of polyethylene glycol or meta-analysis). Results: Fifty-eight publications have been chosen for descriptive analysis; of them, 41 are clinical trials, eight are observational studies and nine are systematic reviews or meta-analysis. Twelve clinical trials evaluate PEG efficacy versus placebo, eight versus lactulose, six are dose studies, five compare polyethylene glycol with and without electrolytes, two compare its efficacy with respect to milk of magnesia, and the rest of the trials evaluate polyethylene glycol with enemas (two), psyllium (one), tegaserod (one), prucalopride (one), paraffin oil (one), fiber combinations (one) and Descurainia sophia (one). Conclusions: Polyethylene glycol with or without electrolytes is more efficacious than placebo for the treatment of functional constipation, either in adults or in pediatric patients, with great safety and tolerability. These preparations constitute the most efficacious osmotic laxatives (more than lactulose) and are the first-line treatment for functional constipation in the short and long-term. They are as efficacious as enemas in fecal impaction, avoid the need for hospital admission and are well tolerated by patients (mainly when administered without electrolytes).

Introduction: Capsule endoscopy (CE) has become a first-line tool for small bowel (SB) examination. However, adverse events (AEs), such as CE retention or aspiration, may occur. The aims of this study were to evaluate incidence, clinical outcomes and therapeutic approaches of CE-related AEs in the largest series published to date. Methods: Data from 5428 procedures performed at 12 institutions between August 2001 and January 2012 were retrospectively analyzed. Baseline patient characteristics; procedure; type, localization and symptoms before/after AEs; previous patency tests performed; therapeutic management and patient´s outcome were recorded. Results: The overall incidence of CE-related AEs was 1.9%: 2.0% for SB, 0.9% for esophageal and 0.5% for colon CE. The incidence of capsule retention was significantly higher than capsule aspiration (1.87% vs. 0.003%; p < 0.05), in patients suffering from inflammatory bowel disease (IBD) than in obscure GI bleeding (OGIB) (3.3% vs. 1.5%; p < 0.05) and in patients with the combination of nausea/vomiting, abdominal pain and distension. The SB was the most frequent localization of retention (88.2%). The use of patency tests -except for Patency© capsule- before CE was not a good predictor for AEs. Most of the patients with AEs developed no or mild symptoms (97%) and were managed by non-surgical methods (64.4%). Conclusions: CE-related AEs are uncommon and difficult to predict by imagiological examinations. SB retention, that is usually asymptomatic, is the most frequent AE. In absence of symptoms, non-surgical management of CE-related AEs is recommended.

espanolIntroduccion y objetivo: la capsula endoscopica y la enteroscopia de doble balon son tecnicas de reconocido valor en el estudio de la hemorragia digestiva media, habiendo numerosos factores que pueden afectar a su rendimiento diagnostico. El objetivo del presente estudio es el de caracterizar y definir los niveles de concordancia entre ambas focalizando en el tipo de lesion, en una gran cohorte de pacientes de un centro de referencia. Material y metodo: entre los anos 2004-2014 se administraron 1.209 capsulas en 1.078 pacientes y se realizaron 381 enteroscopias en 361 pacientes con hemorragia digestiva media. Resultados: en 332 pacientes (edad media: 65,22 ± 15,41, 183 hombres) se realizaron ambos procedimientos. Ambas tecnicas tuvieron un rendimiento diagnostico similar (70,5% vs. 69,6%, p = 0,9). El rendimiento diagnostico global de la enteroscopia fue superior en pacientes con una capsula previa positiva (79,3% vs. 27,9%, p 0,55-0,77]), tumores (0,66 [95% IC: 0,55-0,76]) y moderada para ulceras (0.56 [95% IC: 0,46-0,67]). Los diverticulos (0,39 [95% IC: 0,29-0,5] tuvieron una concordancia razonable. Los resultados entre ambos procedimientos difirieron en 73 pacientes (22%). Conclusiones: el presente estudio evidencia que aunque el rendimiento de la capsula endoscopica y la enteroscopia de doble balon de forma global sean similares, hay numerosos factores que pueden modificar estos valores, siendo el principal el tipo de lesion. EnglishBackground and aim: Capsule endoscopy and doubleballoon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. Material and method: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. Results: Both procedures were carried out in 332 patients (mean age: 65.22 ± 15.41, 183 men) and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9). Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p 0.46-0.67]). Diverticula (0.39 [95% CI: 0.29-0.5]) achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%). Conclusions: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.

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- ?, n = 19), seropositive CD without atrophy (Group- ?, n = 39), contraindication to gastroscopy (Group-?, n = 6), seronegative CD without atrophy, but with a compatible context (Group-?, 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 ? to ? 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. © The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. Yes

A 56-year-old woman with positive genetic testing of hereditary nonpolyposis colorectal cancer (HNPCC), many familiarhistory of different neoplasia (Fig. 1), and a personal history of hysterectomy due to an endometrial cancer was referred toour Unit because of anemia with a positive fecal occult blood test. Both, gastroscopy and colonoscopy were performed withthe only result of less than 10 hyperplastic colonic polyps without signs of recent bleeding. An abdominal CT was also per-formed and was completely normal. According to these results, it was indicated a capsule endoscopy that showed a stenoticpolypoid lesion near of the Treitz angle. The capsule stayed retained and its battery went off at this point. With the objectiv eof making a histological diagnosis and removing the capsule endoscopy, a double balloon endoscopy was performed, and