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Resumen Las estenosis neoplásicas de la vía biliar representan normalmente un grupo de tumores que se diagnostican en fases avanzadas y, por tanto, sin posibilidad de tratamiento quirúrgico con fines curativos de resecabilidad. El enfoque terapéutico paliativo endoscópico de las neoplasias biliares malignas persigue mejorar la calidad de vida de los pacientes en cuanto al dolor, prurito e ictericia, evitando así cuadros de colangitis o sepsis y engloba dos grandes procedimientos: el drenaje biliar mediante colangiopancreatografía retrógrada endoscópica (CPRE) y el drenaje mediante ecoendoscopia o ultrasonografía endoscópica (USE), que en los últimos años ha ido ganando importancia y se ha ido equiparando e incluso superando a otras técnicas complementarias como el drenaje percutáneo biliar. Ambos procedimientos son complementarias y permiten la colocación de prótesis o stents para permitir el adecuado drenaje del árbol biliar extra o intrahepático. El tipo de prótesis depende principalmente del tipo de paciente, de las características de la estenosis y el procedimiento endoscópico de drenaje a emplear, siendo generalmente las prótesis metálicas autoexpandibles las de mayor permeabilidad, durabilidad y las que presentan un menor número de efectos secundarios y reintervenciones. Habitualmente, las neoplasias malignas de la vía biliar requieren un abordaje mediante CPRE. Sin embargo, dicho procedimiento no siempre es posible por dificultad técnica, modificación anatómica quirúrgica previa o por infiltración neoplásica enteral, adoptando entonces el drenaje por ecoendoscopia un papel fundamental en el tratamiento paliativo de estos pacientes.

Objective To assess the effect of a 2-week treatment with dexibuprofen, in comparison with ibuprofen and diclofenac, on pepsinogen plasma concentrations and gastrointestinal mucosa, as well as the correlation of these changes with gastrointestinal mucosal injury. Methods 60 patients with rheumatologic disease in chronic therapy with NSAID, were included. After a 7-day run-in period patients were randomly assigned to receive a 14-day treatment with dexibuprofen (Group A; Day 1 - 3 = 400 mg t.i.d; Day 4 - 14 = 400 mg b.i.d.), ibuprofen (Group B; Day 1 - 3 = 800 mg t.i.d; Day 4 -14 = 800 mg b.i.d.) or diclofenac (Group C; Day 1 - 3 = 50 mg t.i.d; Day 4 - 14 = 50 mg b.i.d.). Upper gastrointestinal endoscopy (Day 15), capsule-endoscopy (Day 16, 7 patients of each group) and determination of pepsinogen plasma concentrations were performed (basal and Day 15). A semiquantitative scale was designed for the assessment of the gastrointestinal mucosa. Results No differences in plasma pepsinogen were found between treatment groups or gastrointestinal injury grades or between basal and post-therapy determinations. Dexibuprofen showed gastroduodenal mucosal injury in fewer patients (42.1%) than was the case with ibuprofen (5%; p = 0.003) and diclofenac (30%; p = N.S.). Dexibuprofen administration was also associated with more patients having no intestinal mucosal damage (42.86% vs. 28.7% in the diclofenac group and 14.29% in the ibuprofen group; p = 0.0175). The rate of clinical adverse events was similar in Groups A, B and C (28%, 38% and 34%). Conclusions Dexibuprofen showed a lower rate of gastroduodenal and intestinal mucosal injury. This effect was not mediated by modifications of plasma pepsinogen levels.

Background and Study Aims: The aim of this study was to assess the safety and usefulness of capsule endoscopy (CE) in pediatric patients with a suspicion of Crohn's disease. Patients and Methods: CE was used in 12 patients (four girls, eight boys; age 12 - 16; weight range 43-87 kg). The indication was a clinical suspicion of Crohn's disease not confirmed with traditional methods. Gastroscopy, colonoscopy, and small-bowel follow-through examinations were carried out in all of the patients, without any diagnostic findings. Ileoscopy was possible in 50% of the patients, and the ileal mucosa and biopsies were normal in all cases. Results: The capsule was easily swallowed by all of the patients. They all excreted the capsule normally, and no complications were observed in any case. CE identified lesions suggestive of Crohn's disease in seven of the 12 (58.3%), and the majority of the lesions were in the ileum. Conclusions: CE is safe in pediatric patients over 12 years of age. The procedure appears to be a very useful diagnostic tool in children with Crohn's disease.

Introduccion: La dilatacion de vias biliares es un hallazgo frecuente en pacientes con colestasis, aunque no siempre se evidencia su causa por las tecnicas de imagen convencionales (TAC/RMN). Objetivo: Determinar el rendimiento diagnostico de la ecoendoscopia y CPRE secuenciales cuando existe dilatacion de vias biliares. Material y Metodo: Se revisaron las historias clinicas (hallazgos de pruebas, complicaciones y diagnostico final) de pacientes con dilatacion de via biliar intra y/o extrahepatica en TAC/RMN, a quienes se solicito USE y CPRE del 1 de enero al 31 de diciembre del 2013. Los pacientes con datos incompletos fueron excluidos. Resultados: Se incluyeron 31 pacientes. En 17 (55%) se determino la causa de dilatacion con TAC/RMN y en 14 (45%), no. De estos 14, en 12 (86%) se llego al diagnostico con USE-CPRE. De los 31 pacientes, en 28 (90%) se determino la causa de la obstruccion con USE-CPRE, no siendo posible en 3 casos (10%); en dos no se diagnostico la causa con TAC/RMN ni con USE-CPRE, y en el tercero se observo una neoplasia que que no se confirmo con USE-CPRE. Se diagnosticaron 4 complicaciones (13%), 3 pacientes presentaron papilorragia leve que se controlo con tecnicas hemostaticas y uno, pancreatitis. Conclusiones: La USE y CPRE tienen un alto rendimiento diagnostico-terapeutico cuando existe dilatacion de vias biliares. Se registro una alta tasa de complicaciones pero estas fueron leves.

A 32-year-old male referring asthmatic bronchitis, corticoid-associated cicatricial pemphigoid, osteoporosis secondary to the use of corticoids and steroid cataracts, is sent to our Unit due to persistent oropharyngeal dysphagia. Conventional endoscopy is programmed in two different days and, subsequent to the failure of the procedure, oral approach is carried out in a vain attempt with a 5.9 mm endoscope. Transnasal route is then considered (Fig. 1), resulting successful as multiple ulcerous lesions and fibrous portions of the hypopharynx can be observed, which are hardly overcome. No other lesions were observed along the esophagic or gastric mucosa as well as the second duodenal portion. A posterior pharynx biopsy revealed the presence of subepidermal split, vesiculobullous mucosa with subepitelial hemorrhage and granulation tissue in the submucous (Fig. 2).