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To understand the current state of endoscopic ultrasonography (EUS) in Spain.Descriptive analysis from a national survey with 11 questions: 10 related to technique and 1 to the training and experience of the endoscopists.Sixty endoscopists from 48 of the 97 (49.5%) hospitals that perform EUS in Spain responded to the survey. A total of 28,678 procedures (20,311 diagnostic, 7,446 with puncture and 921 therapeutic) were recorded over the course of one year. Approximately 64% of the hospitals perform between 300 and 999 tests per year. All have radial and sectorial echoendoscopes, with a median of 2 (2-8) scopes. For cytological diagnosis, the 22-gauge needle is the most commonly used (98%) and, for histological diagnosis, the Procore (72%). The study of the pancreas and bile duct is the most common indication for diagnostic EUS (60%), followed by the staging of digestive tract neoplasms (20%). Approximately 72% of the hospitals perform on-site cytopathology evaluations and sedation is administered in equal parts by both endoscopists and anaesthetists. In terms of experience, 45% of echoendoscopists perform fewer than 300 annual exams and the median training duration is 6months (0.5-36).EUS is adequately implemented in Spain and good equipment is available. However, it is necessary to establish a standardised EUS training program since the one undertaken by many echoendoscopists could prove insufficient according to the standards established by Scientific Societies.

Endoscopic ultrasound (EUS) is a valuable diagnostic and therapeutic tool in many gastrointestinal disorders. It is a useful technique to assess vascular abnormalities in patients with chronic liver disease and portal hypertension and allows for a noninvasive evaluation of the hemodynamic changes linked to this condition. EUS improves the detection of gastric varices and collateral veins and provides assessment of variceal recurrence, risk of rebleeding and response to therapy. Furthermore EUS may be of help in guiding endoscopic therapy of varices, such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided glue injection or coiling of gastric varices. In addition, the ability of EUS to access the portal vein (PV) enables a broad spectrum of diagnostic and therapeutic interventions in patients with portal hypertension which have been shown to be feasible in animal models and in small, preliminary human studies.

Endoesophageal brachytherapy is a useful technique for the palliative treatment of dysphagia in advanced oesophageal cancer. This technique offers good results on dysphagia control and quality of life. We report the case of a patient treated with this technique presenting complete response to the dysphagia. We describe endoesophageal brachyterapy technique and we comment on the literature.

Laparoscopic resection is considered the treatment of choice for gastric subepithelial tumors. Occasionally, it is necessary to perform an intraoperative gastroscopy to localize the lesion. There are no data in the literature addressing the factors that can predict when a combined laparoscopic-endoscopic approach will be needed. A retrospective cohort study using a prospectively collected database was conducted. From January 2005 to December 2013, all the patients undergoing a laparoscopic gastric resection for subepithelial tumors irresectable by endoscopy were reviewed. Potential predictive factors for the need of an intraoperative endoscopy were analyzed. Thirty-eight consecutive patients (22 men and 16 women) with a mean age of 67 (41–86) years underwent laparoscopic gastric resection for subepithelial tumors. Fourteen (36.8 %) patients required intraoperative endoscopic assessment. The only significant factors related to the need of endoscopic assessment during surgery were tumor growth pattern (P = 0.002) and size (P = 0.001). An accurate description of tumor growth pattern and size by EUS is recommended in the preoperative assessment of gastric subepithelial tumors. Small tumors (≤18 mm) with an intraluminal growth may need a combined endoscopic-assisted laparoscopic management.

The incidence of acute pancreatitis (AP) is increasing. AP is one of the gastrointestinal diseases that most frequently requires hospital admission in affected individuals. In the last few years, considerable scientific evidence has led to substantial changes in the medical and surgical treatment of this disease. New knowledge of the physiopathology of AP indicates that its severity is influenced by its systemic effects (organ failure), especially if the disease is persistent, and also by local complications (fluid collections or necrosis), especially if these become infected. Treatment should be personalized and depends on the patient's clinical status, the location of the necrosis, and disease stage.

BACKGROUND AND AIMS: Diagnostic yield of Small Bowel Capsule Endoscopy (SBCE) for the assessment of small bowel (SB) lesions is higher than radiologic imaging techniques. However, magnetic resonance enterography (MRE) data are scarce and inconclusive. Colon Capsule Endoscopy (CCE) is a new capsule modality. The primary aim of our study was to compare MRE and capsule endoscopy (CE) for the assessment of Crohn’s disease (CD). The secondary objectives were to compare the diagnostic accuracy of both CE modalities and changes in Montreal classification after each examination. METHODS: We included 47 patients with established (n = 32) or suspected CD (n = 15). MRE was performed first to rule out strictures. In patients with a suspected stricture by MRE, an Agile Patency Capsule was performed. SB disease activity was measured by MaRIA score (MRE) and Lewis Index (CE). RESULTS: SB lesions were found in 36 of47 patients with CE and in 21 of47 patients with MRE (76.6% vs 44.7%, P = 0.001). Jejunal inflammation was detected by CE in 31.9% of patients and by MRE in 6.4% of patients (15/47 vs 3/47; P = 0.03); lesions in ileum were detected in 57.4% of patients by CE, and in 21.3% of patients by MRE (27/ 47 vs 10/ 47; P = 0.04). Finally, in terminal ileum, CE showed lesions in 68.1% (32/47) of patients, whereas MRE detected lesions in 38.3% (18/ 47 patients), (P = 0.001). The original Montreal classification was changed in 53.1% of patients (25/ 47) based on CE findings and in 12.7% of patients (6/47) based on MRE findings (P < 0.05). CONCLUSIONS: In our cohort CE was significantly superior to MRE for detecting SB lesions, mainly superficial and proximal lesions. CE is useful for a appropriate patients’ classification according to Montreal classification.

Background/Objective To assess the relationship between the presence of ascites detected by endoscopic ultrasonography (EUS) and peritoneal carcinomatosis (PC) in patients with pancreatic adenocarcinoma. Methods Consecutive patients who underwent a EUS for preoperative staging of a pancreatic adenocarcinoma between 1998 and 2014 were retrospectively reviewed. The diagnosis of PC was confirmed by histopathology or peritoneal fluid cytology. The main outcome of the study was the relationship of ascites at EUS and PC in patients with pancreatic cancer. Secondarily, to evaluate the relationship between this finding and survival as well as the development of PC during follow-up. Results A total of 136 patients were included: 30 patients with local unresectable tumor or metastatic disease and 106 potentially-resectable candidates based on CT staging. EUS showed ascites in 27 (20%) patients, of whom 8 (29.6%) had PC. The sensitivity, specificity, PPV, NPV and accuracy of ascites by EUS in the detection of PC in this group of patients were 67%, 85%, 30%, 96% and 83%, respectively. Ascites detected by EUS was the only independent predictive factor of PC with an OR of 11 (CI 95%: 3–40). The detection of ascites by EUS was associated with a shorter survival (median survival time 7,3 months; range 0–60 vs 14.2 months; range 0–140) (p = 0.018) and earlier development of PC during follow-up (median 3.2 months, range 1.4–18.1 vs 12.7 months, range 5.4–54.8; p = 0.003). Conclusion The finding of ascites at EUS in patients with pancreatic adenocarcinoma is highly associated with PC and a poor outcome.

There is an opportunity for improvement in the recording and measuring of quality indicators. However, no previous experiences exist in our field in terms of their compliance in esophagogastroduodenoscopy (EGD).To analyse compliance with EGD quality criteria and evaluate improvement after conducting a training programme.Comparative study of 2 cohorts: one retrospective (control group) and one prospective (intervention group), before and after a training programme consisting of an information session and the report writing improvement programme. The quality indicators proposed by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology were used.A total of 1,200 EGDs were included in a sequential manner (600 in each group). Following the training programme, a significant improvement was observed in the following indicators: documented indication (93 vs. 99.8%; P0.01), documented full examinations (94.7 vs. 97.3%; P0.01), correct performance (63.7 vs. 87.9%; P0.01), appropriate biopsies according to protocols (57.9 vs. 83.8%; P0.01), photo-documentation of described lesions (84.1 vs. 94.9%; P0.01), photo-documentation per segment (52.9 vs. 70.5%; P0.01) and correct overall assessment (56,9 vs. 90.5%; P0.01). Biopsies for coeliac disease, documented indication, full examination and correct performance, if it went ahead, exceeded the recommended standard.A very simple training programme improves EGD quality indicators, with the majority reaching the standards recommended by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology.

Introduction: Gastric polyps are usually asymptomatic lesions incidentally discovered during endoscopy. Objective: To study the frequency of different types of gastric polyps in our population and their possible association with other factors. Patients and methods: Retrospective study of gastroscopies performed in a tertiary hospital over a ten-year period. Demographics, medical history, indication for gastroscopy and morphological and histological characteristics of polyps were collected. Results: Gastric polyps were found in 827 out of 41253 (2%) reviewed gastroscopies, corresponding to 709 patients. Mean age was 65.6 years, and 62% were female. 53.9% of patients had multiple polyps. The most common location was the fundus and 813% were smaller than 1 cm. Histopathology was obtained in 607 patients: hyperplastic polyps were the most common (42.8%), followed by fundic gland polyps (37.7%). Factors independently associated with hyperplastic polyps were age and single polyp, size > 6 mm and location other than fundus. In contrast, fundic gland polyps were associated with reflux and multiple polyps, size < 6 mm and located in fundus. Adenomas were independently associated with single polyp. Conclusions: Fundic gland and hyperplastic polyps are the most common in our population and have characteristic features that can guide histological diagnosis. With single polyps it is advisable to take biopsies to rule out adenoma. (C) 2017 Elsevier Espana, S.L.U., AEEH y AEG. All rights reserved.

Background. Individuals with a family history of colorectal cancer (CRC) have an increased risk of CRC. We evaluated the diagnostic yield of CCE in the detection of lesions and also two different colon preparations. Methods. A prospective multicenter study was designed to assess CCE diagnostic yield in a cohort of asymptomatic individuals with a family history of CRC. CCE and colonoscopy were performed on the same day by 2 endoscopists who were blinded to the results of the other procedure. Results. Fifty-three participants were enrolled. The sensitivity, specificity, PPV, and NPV of CCE for detecting advanced adenomas were 100%, 98%, 67%, and 100%. Sensitivity, specificity, PPV, and NPV of CCE for the diagnosis of individuals with polyps were 87%, 97%, 93%, and 88%, respectively. CCE identify 100% of individuals with significant or advanced lesions. Overall cleanliness was adequate by 60.7% of them. The PEG-ascorbic boost seems to improve colon cleanliness, with similar colonic transit time. Conclusion. CCE is a promising tool, but it has to be considered as an alternative technique in this population in order to reduce the number of colonoscopies performed. More studies are needed to understand appropriate screening follow-up intervals and optimize the bowel preparation regimen.

MAIN RECOMMENDATIONSFor pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.Strong recommendation, moderate quality evidence.In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.Weak recommendation, low quality evidence.In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.Strong recommendation, low quality evidence.For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.Strong recommendation, low quality evidence.For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.Weak recommendation, low quality evidence.For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound [EBUS]-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.Strong recommendation, moderate quality evidence.In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.Weak recommendation, low quality evidence.

RECOMMENDATIONSFor routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

Background The incidence of bacteremia after endoscopic ultrasonography (EUS) or EUS-guided fine-needle aspiration (EUS-FNA) is between 0% and 4%, but there are no data on this topic in cirrhotic patients. Aim To prospectively assess the incidence of bacteremia in cirrhotic patients undergoing EUS and EUS-FNA. Patients and methods We enrolled 41 cirrhotic patients. Of these, 16 (39%) also underwent EUS-FNA. Blood cultures were obtained before and at 5 and 30 min after the procedure. When EUS-FNA was used, an extra blood culture was obtained after the conclusion of radial EUS and before the introduction of the sectorial echoendoscope. All patients were clinically followed up for 7 days for signs of infection. Results Blood cultures were positive in 16 patients. In 10 patients, blood cultures grew coagulase-negative Staphylococcus, Corynebacterium species, Propionibacterium species or Acinetobacterium Lwoffii, which were considered contaminants (contamination rate 9.8%, 95% CI: 5.7–16%). The remaining 6 patients had true positive blood cultures and were considered to have had true bacteremia (15%, 95% CI: 4–26%). Blood cultures were positive after diagnostic EUS in five patients but were positive after EUS-FNA in only one patient. Thus, the frequency of bacteremia after EUS and EUS-FNA was 12% and 6%, respectively (95% CI: 2–22% and 0.2–30%, respectively). Only one of the patients who developed bacteremia after EUS had a self-limiting fever with no other signs of infection. Conclusion Asymptomatic Gram-positive bacteremia developed in cirrhotic patients after EUS and EUS-FNA at a rate higher than in non-cirrhotic patients. However, this finding was not associated with any clinically significant infections.

Primary intestinal lymphangiectasia (PIL) is a rare protein losing gastroenteropathy that usually affects children and teenagers. There are only a few cases described in the literature. The diagnosis is confi rmed by the presence of intestinal lymphangiectasia based on endoscopic fi ndings and histology.

Introduccion: Las tecnicas de reseccion endoscopica requieren la inyeccion de liquido en la submucosa para separar la lesion de la capa muscular propia. Esto reduce el riesgo de complicaciones como la lesion termica y la perforacion. Objetivo: Evaluar el uso de una sustancia nueva que combina el acido hialuronico, sulfato de condroitina y poloxamero 407 para la inyeccion submucosa. Material y Metodo: Se realizaron dos experimentos en un modelo porcino. En el experimento ex vivo se realizaron 48 habones submucosos en estomagos frescos con gelafundina (n = 16) y con la nueva sustancia diluida a dos concentraciones diferentes: 50% (n = 16) y 80% (n = 16). La duracion del habon se midio desde el momento de la retirada de la aguja tras la inyeccion. En el modelo in vivo, 10 habones submucosos gastricos se crearon mediante la inyeccion de 2 ml de la nueva sustancia al 80% y el animal se sacrifico 30 minutos despues de la ultima inyeccion. Resultados: Los habones submucosos realizados con la nueva sustancia al 80% y 50% de concentracion duraron mas que con gelafundina (23,1 ± 15,6; 13,1 ± 6,6; 3,9 ± 1,5 minutos, respectivamente; p = 0,001). En el estudio in vivo, todos los habones excepto uno fueron macroscopicamente visibles en el momento de la necropsia, con una mediana de 49,5 minutos (rango 35 – 65). No se observo ninguna lesion o necrosis en la mucosa o la muscular propia. Conclusiones: La combinacion de acido hialuronico, sulfato de condroitina y poloxamero 407 produce un habon submucoso de larga duracion y no parece inducir dano agudo en el tejido por lo que podria ser adecuado para la inyeccion submucosa.

Introduccion: la carcinomatosis peritoneal (CP) impacta en el manejo de los pacientes con adenocarcinoma de pancreas pero su diagnostico puede ser dificil. Objetivo: Evaluar el valor de la ascitis detectada por USE para el diagnostico de CP en los pacientes con adenocarcinoma de pancreas. Material y Metodo: Revision retrospectiva de los pacientes con adenocarcinoma de pancreas explorados con USE entre 1998 – 2014. Criterios de exclusion: ausencia de cirugia, otras enfermedades causantes de ascitis y USE incompleta. Todos los pacientes tenian una TC previa. El diagnostico de CP fue confirmado por histologia o citologia del liquido peritoneal. Resultados: De 515 pacientes con C. pancreas explorados por USE, se incluyeron 136 (57% hombres y edad media de 66 ± 12 anos). Las causas de exclusion fueron: ausencia de cirugia (n = 373), cirrosis (n = 5) y USE incompleta (n = 1). De los 136 pacientes incluidos, 54 tuvieron una enfermedad irresecable: CP (n = 12), invasion vascular (n = 25) y metastasis (n = 17). La USE detecto ascitis en 27 (19%) pacientes y 8 tenian CP (30%), siendo la sensibilidad, especificidad, VPP, VPN y la precision de la ascitis por USE en la deteccion de CP del 66,7%, 84,7%, 29,6%, 96,3% y 83,1%, respectivamente. La ascitis detectada por USE fue el unico factor predictivo independientes de CP (33,3% vs. 66,7%; p < 0,001). La presencia de ascitis en la USE se asocio a una menor supervivencia (mediana: 7,3 vs. 14,2 meses; p = 0,018) y desarrollo de CP mas precoz en el seguimiento (mediana: 8,7 vs. 17,2 meses; p = 0,003). Conclusiones: La ascitis detectada por USE en los pacientes con adenocarcinoma de pancreas es un factor pronostico de CP y se asocia a una menor supervivencia. El elevado VPN de la USE en el diagnostico de CP hace que la seleccion de pacientes adecuados para cirugia curativa sea muy fiable.

BACKGROUND AND STUDY AIMS Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are well-recognized techniques for the study of pancreatic cystic lesions (PCLs). However, little evidence exists on their impact on clinical care. The aim of this study is to determine how often EUS and EUS-FNA alter the diagnosis and management of patients with PCLs. PATIENTS AND METHODS Eight physicians expert in pancreatic diseases were asked to report their diagnoses and management recommendations for 49 different PCLs. Clinical information was sequentially disclosed in a stepwise manner - progressively from clinical data plus computed tomography or MRI (level 1), to EUS (level 2) and EUS-FNA results including cytology, carcinoembryonic antigen, and amylase levels (level 3). RESULTS EUS led to a change in the diagnosis and management in 30% [95% confidence interval (CI): 26-35%] and 19% (95% CI: 16-23%) of cases, respectively, usually to a more intensive approach (14%; 95% CI: 11-18%). EUS-FNA altered the diagnosis and management in an additional 39% (95% CI: 34-44%) and 21% (95% CI: 17-25%) of the evaluations, respectively. EUS-FNA also increased the consensus in the diagnosis among the specialists that ranged from fair with computed tomography/MRI (κ-index=0.32) to substantial with EUS-FNA (κ-index=0.43). CONCLUSION EUS and EUS-FNA impact the diagnosis and management of patients with PCLs; therefore, both are necessary in the workup of these patients. EUS-FNA markedly improves the agreement between physicians in terms of diagnosis, but not management. This study highlights the need for more research and standardization in the field.

Introduction Premalignant gastric lesions have an increased risk to develop gastric cancer. Objective To evaluate the usefulness of systematic endoscopy that includes chromoendoscopy with a double dye staining technique for the detection of dysplasia in patients with premalignant gastric lesions. Patients and methods This longitudinal, prospective study was performed in patients with gastric atrophy, intestinal metaplasia or dysplasia who were referred for endoscopy less than 6 months after the initial diagnosis. The second endoscopy was performed in three phases: phase 1, exhaustive and systematic review of the mucosa with photographic documentation and biopsies of suspicious areas; phase 2, chromoendoscopy with a double dye staining technique using acetic acid 1.2% and indigo carmine 0.5%; phase 3, topographic mapping and random biopsies. Results A total of 50 patients were included. Nine (18%) had atrophic gastritis, 38 (76%) had intestinal metaplasia, and 3 (6%) had low-grade dysplasia. Systematic endoscopy with chromoendoscopy using a double dye staining technique detected more patients with dysplasia (9 versus 3, p < .05), and a larger number of biopsies with the diagnosis of dysplasia were obtained. This occurred for visible (6 vs. 0, p < .05) and non-visible lesions (6 vs. 3, p = NS). In one patient, initial low-grade dysplasia was not detected again in the systematic endoscopy, giving a global endoscopic performance for the detection of lesions of 92%. Conclusions Patients with premalignant gastric lesions have synchronous lesions with greater histological severity, which are detected when systematic endoscopy is conducted with indigo carmine dye added to acetic acid. Introducción Las lesiones premalignas gástricas constituyen un factor de riesgo para desarrollar cáncer gástrico. Objetivo Evaluar la utilidad de una endoscopia sistemática que incluye bicromoendoscopia para la detección de displasia en pacientes con lesiones premalignas gástricas. Pacientes y métodos Estudio longitudinal y prospectivo de pacientes consecutivos con diagnóstico de atrofia gástrica, metaplasia intestinal o displasia remitidos para nueva valoración por endoscopia antes de los 6 meses de la endoscopia inicial. La nueva endoscopia se realizó en 3 fases: revisión exhaustiva y sistemática de toda la mucosa con toma de fotos y biopsias de las lesiones sospechosas (fase 1), bicromoendoscopia con una mezcla de ácido acético 1,2% e índigo carmín 0,5% (fase 2) y mapeo topográfico con toma de biopsias aleatorias (fase 3). Resultados Cincuenta pacientes con diagnóstico de gastritis atrófica (n = 9, 18%), metaplasia intestinal (n = 38, 76%) y displasia de bajo grado (n = 3, 6%). La endoscopia sistemática con bicromoendoscopia identificó más pacientes con displasia (9 versus 3, p < 0,05) y se obtuvieron más biopsias con diagnóstico de displasia, tanto en lesiones visibles (6 vs. 0, p < 0,05) como no visibles (6 vs. 3, p = NS). En un paciente con displasia de bajo grado inicial, esta no volvió a detectarse en la endoscopia sistemática, siendo el rendimiento global de la endoscopia de seguimiento para detectar lesiones del 92%. Conclusiones Los pacientes con lesiones premalignas gástricas presentan lesiones sincrónicas de mayor severidad histológica que se ponen de manifiesto al realizar una endoscopia sistemática que incluye el uso de bicromoendoscopia.

Resumen Introduccion La calidad y tolerancia de la limpieza anterograda del colon son elementos clave para el exito del programa de cribado poblacional de cancer colorrectal (PPCCR). Objetivos Evaluar la calidad de la limpieza y la tolerancia segun la hora de administracion del polietilenglicol en individuos del PPCCR. Metodo Los participantes del PPCCR fueron aleatorizados en 2 grupos: a) grupo control (colonoscopia programada 09:00-12:00 h), preparacion con polietilenglicol la tarde antes; b) grupo a estudio (colonoscopia programada 12:00-15:00 h), preparacion con polietilenglicol la manana de la exploracion, con opcion de dosis partida. Se valoro la calidad de la limpieza con la escala de Boston y la tolerancia mediante un cuestionario. Resultados Se incluyeron 282 individuos: 134 se prepararon el dia anterior y 148 el mismo dia, 26 de los cuales realizaron dosis partida. El 95% de los individuos (n = 268) presentaron una limpieza adecuada. La calidad de la preparacion fue superior en el grupo a estudio (p = 0,045). El tiempo entre la finalizacion de la ingesta y el comienzo de la prueba se correlaciono inversamente con la puntuacion de la escala de Boston, (p = 0,036; r = −0,125). La tolerancia no se relaciono con el horario de la ingesta (p > 0,2). Los individuos del grupo a estudio presentaron peor aceptacion del horario que los del grupo control (26 vs. 10%, respectivamente; p = 0,001). Conclusiones Los pacientes que se preparan lo mas cerca posible de la hora de la exploracion presentan mejor calidad de la limpieza sin detrimento en la tolerancia, aunque esta pauta resulta mas incomoda.

Resumen Fundamento y objetivo La neoplasia solida seudopapilar (NSSP) es un tumor poco frecuente del pancreas exocrino que, aunque puede desarrollar metastasis, tiene un buen pronostico. El objetivo fue describir las caracteristicas de las NSSP tratadas en nuestro hospital. Pacientes y metodo Se incluyeron todas las NSSP de la base de datos del Servicio de Anatomia Patologica de 1981 a 2010. Se analizaron edad, sexo, forma de presentacion, tipo de cirugia, datos anatomopatologicos e inmunohistoquimicos, y evolutivos. Resultados Se identificaron 6 casos. La mediana de edad fue de 27,5 anos y todos eran mujeres. Una paciente presento hemoperitoneo, 2 dolor abdominal y 3 eran diagnosticadas incidentalmente. La localizacion mas frecuente fue en cola pancreatica (4) y la mediana de tamano de 7,7 cm. Cuatro eran benignos y 2 carcinomas, uno de estos presentaba metastasis hepaticas y ganglionares. El indice Ki-67 fue bajo (1-3%). Despues de una mediana de seguimiento de 33,5 meses, todas las pacientes estan vivas y sin recidiva. Conclusion La NSSP afecta a mujeres jovenes. El tratamiento quirurgico suele ser curativo. Un indice mitotico bajo le confiere un buen pronostico, con una larga supervivencia.

Resumen Fundamento y objetivo La neoplasia mucinosa papilar intraductal (NMPI) es una lesion pancreatica premaligna cuya historia natural no es bien conocida. Se han analizado las caracteristicas de las NMPI atendidas en nuestro hospital e identificado factores predictivos de malignidad. Pacientes y metodo Analisis retrospectivo de 88 pacientes con NMPI diagnosticados por tomografia computarizada (TC), colangio-pancreatografia por resonancia magnetica (CPRM) y/o ultrasonografia endoscopica (USE), de enero de 1997 a diciembre de 2008. Se evaluaron: edad, sexo, forma de presentacion, origen, localizacion, CA 19.9 serico, tamano del tumor y existencia de nodulos segun tecnicas de imagen, tipo de cirugia, malignidad y supervivencia. Se seleccionaron nueve variables prequirurgicas y se realizo un analisis uni y multivariante para identificar factores predictivos independientes de malignidad. Resultados La edad media de los pacientes fue de 64 anos y el 53% eran varones. El 39% fueron diagnosticados por un hallazgo casual. El 50% tenian su origen en el conducto de Wirsung, el 37% en ramas colaterales y un 13% eran mixtos. Fueron operados un 68%; de estos, el 42% fueron tumores malignos (32% carcinoma “in situ” y 68% invasivos). Fallecieron 12 pacientes (1 benigno, 1 “in situ” y 10 invasivos). Los analisis uni y multivariante identificaron como factores predictivos independientes de malignidad la presencia de sintomas y el tamano del tumor (≥ 22 mm [mediana de nuestra serie] y ≥ 30 mm [tamano aceptado en la literatura]). Conclusion Muchas NMPI son hallazgos casuales. La presencia de sintomas y el tamano del tumor son factores predictivos independientes de malignidad y deben tenerse en cuenta en el momento de decidir la actitud terapeutica.

Resumen El principal objetivo de la estadificacion en el cancer de pulmon de celulas no pequenas (CPCNP) es la evaluacion de la afectacion ganglionar mediastinica, y la TC toracica es la principal prueba no invasiva para la evaluacion. Sin embargo, dado que hasta un 15% de los pacientes sin afectacion ganglionar del mediastino en la TC tienen metastasis ganglionares en la cirugia, son necesarias otras exploraciones. La puncion aspirativa con aguja fina guiada por ultrasonografia endoscopica (USE-PAAF) ha demostrado ser capaz de detectar enfermedad avanzada (ganglios mediastinicos metastasicos, metastasis en la suprarrenal, invasion mediastinica por el tumor) en aproximadamente el 25% de los pacientes con TC que sugiere enfermedad no avanzada. Otra situacion en la que la TC tiene un valor muy limitado es en la evaluacion de la respuesta a la terapia de induccion, siendo su incapacidad intrinseca para distinguir entre tumor y necrosis el factor mas limitante. En este contexto la USE-PAAF ha demostrado tener un buen rendimiento con una sensibilidad, valor predictivo negativo y precision del 75, 67 y 83% respectivamente. En consecuencia, la USE-PAAF puede ser considerada una buena alternativa en la estadificacion preoperatoria de los pacientes con CPCNP con y sin ganglios mediastinicos patologicos en la TC y podria desempenar un papel importante en la reestadificacion mediastinica de estos pacientes mediante la identificacion de un subgrupo de pacientes que se beneficiarian de tratamiento quirurgico adicional.

Resumen Antecedentes Muchos pacientes con cirugia bariatrica desarrollan complicaciones postoperatorias gastrointestinales que pueden requerir la realizacion de una endoscopia digestiva alta. Objetivo Describir de forma prospectiva las complicaciones gastrointestinales diagnosticadas por endoscopia despues de la cirugia bariatrica. Pacientes y metodos Seguimiento de los pacientes sometidos a cirugia bariatrica laparoscopica entre enero de 1998 y diciembre de 2006. Fueron recogidos los siguientes datos: edad, sexo, indice de masa corporal, comorbilidad, tipo y duracion de la cirugia bariatrica, presentacion clinica de la complicacion, tiempo de la presentacion, tratamiento endoscopico y seguimiento. Resultados Fueron operados 474 pacientes (el 74% mujeres, el 26% hombres) con una edad media de 44 ± 11 anos (rango, 15-66) y un indice de masa corporal medio de 47 ± 7 (rango, 33-82). El procedimiento quirurgico mas frecuente fue la gastroenteroanastomosis en Y de Roux (90%). Identificamos 68 complicaciones (14%) que requirieron una endoscopia digestiva alta: estenosis de la anastomosis (21 casos, 5%), hemorragia digestiva alta (16 casos, 3,6%), epigastralgia (12 casos, 2,5%), vomitos (7 casos, 1,5%), pirosis (6 casos, 1,3%) y otros (6 casos, 1,3%). No encontramos ningun factor pronostico de presentacion de complicaciones que requiriera endoscopia despues de la cirugia. Conclusiones La estenosis de la anastomosis es la complicacion mas frecuente que requiere tratamiento endoscopico despues de cirugia bariatrica. La hemorragia digestiva alta en el postoperatorio inmediato y tardio puede ser tratada de forma adecuada y segura con tecnicas endoscopicas.

Background The diagnosis of pancreatic cystic lesions is still a challenge. Aim To prospectively investigate the usefulness and safety of EUS-guided cytology brushing (EUS BR) in the cellular diagnosis of pancreatic cysts. Methods Cysts >15 mm were sampled with a 19G needle. The fluid was aspirated and processed for cytology. The brush was introduced to scrub the cystic wall and processed as standard brushings. Antibiotic prophylaxis was administered. Complications were assessed in the first 24 h and 7 days after the procedure. Results 30 patients were included. In 8 patients the technique failed for technical reasons. EUS BR provided with a cellular diagnosis in 20/22 cases (91%). The EUS BR was superior to the aspirated fluid for detecting diagnostic cells (73% vs. 36%, p = 0.08) and mucinous cells (50% vs. 18%, p = 0.016). In the 8 patients operated on, the specimen was consistent with EUS BR diagnosis. Three patients (10%) had complications, one of them a subacute retroperitoneal haemorrhage in a patient on anticoagulation therapy who died for complications 1 month later. Conclusions EUS BR increases cellular diagnosis of pancreatic cystic lesions as compared with fluid analysis, mainly in mucinous lesions. Its use is not recommended in patients under anticoagulation therapy.

Resumen Introduccion Las neoplasias quisticas (NQ) del pancreas suponen el 10% de las lesiones quistica y el 1% de las neoplasias del pancreas. La neoplasia mucinosa quistica (NMQ), el cistoadenoma seroso (CS) y la neoplasia mucinosa papilar intraductal (NMPI) son algunos tipos de NQ y representan mas del 90% de este tipo de lesiones. Existen escasas series publicadas, especialmente en nuestro pais. Objetivo Evaluar la incidencia, caracteristicas y supervivencia de los pacientes con NQ atendidos en nuestro hospital en un periodo de 12 anos. Pacientes y metodo Se realizo un analisis retrospectivo de todos los pacientes diagnosticados en nuestro hospital de NQ por tomografia computadorizada abdominal, colangiopancreatografia por resonancia magnetica y/o ultrasonografia endoscopica, desde enero de 1997 a diciembre de 2008. Se evaluo el sexo, la edad, el ano de diagnostico, la forma de presentacion, la localizacion y el tamano del tumor, el tipo de cirugia, la anatomia patologica y la supervivencia. Resultados Fueron analizados 117 pacientes con una edad media de 63±14 anos, el 56% fueron mujeres. El diagnostico fue de 88 NMPI, 21 CS y 8 NMQ. El 59% fueron diagnosticados en los ultimos 4 anos. El 42,7% fueron un hallazgo casual y el 19% tenian el antecedente de pancreatitis aguda. La localizacion mas frecuente fue la cabeza pancreatica (53%). El tamano medio por tecnica de imagen fue de 32 mm. Fueron intervenidos quirurgicamente el 69,2%. El 23% eran malignos, 30% carcinoma «in situ» y 70% invasivos. Fallecieron 13% de los pacientes, 93,3% eran carcinomas invasivos. La supervivencia a los 5 anos de los CS fue del 94,7%, de las NMPI fue del 76% y de las NMQ del 60%. Conclusion Las NQ son mayoritariamente hallazgos casuales, aunque debe tenerse en cuenta como causa de pancreatitis aguda. El tumor mas frecuente en nuestro medio es la NMPI. El tratamiento quirurgico de las NMQ y NMPI, en el momento oportuno, puede evitar la evolucion hacia carcinoma pancreatico.

Background and aim The diagnosis of gastrointestinal stromal tumors (GISTs) has important prognostic and therapeutic implications. The specific diagnosis of GIST has to be based on immunocytochemistry. This study aimed to prospectively compare in a crossover manner the accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB) in the specific diagnosis of gastric GISTs. We hypothesized that EUS-TCB is superior to EUS-FNA in this respect. Patients and methods Forty patients with gastric subepithelial tumors suspected on the basis of EUS of being a GIST underwent both EUS-FNA and EUS-TCB. The sequence in which the techniques were employed was randomly assigned to avoid bias. Results Forty tumors were sampled (mean number of passes: 2.1 +/- 0.9 with EUS-TNB and 1.9 +/- 0.8 with EUS-FNA; P = not significant, NS). Final diagnoses were: GIST (n = 27), carcinoma (n = 2), leiomyoma (n = 1), schwannoma (n = 1), and no diagnosis possible (n = 9). Device failure occurred in 6 patients with EUS-TCB. A cytohistological diagnosis of mesenchymal tumor (n = 29) and carcinoma (n = 2) was made in 70 % of cases by EUS-FNA and in 60 % of cases by EUS-TCB ( P = NS). Among the samples that were adequate, immunohistochemistry could be performed in 74 % of EUS-FNA samples and in 91 % of EUS-TCB samples ( P = 0.025). When inadequate samples were included, the overall diagnostic accuracy of EUS-FNA was 52 % and that of EUS-TCB was 55 % ( P = NS). There were no complications. Conclusions EUS-TCB is not superior to EUS-FNA in GISTs because of the high rate of technical failure of trucut. However, when an adequate sample is obtained with EUS-TCB, immunohistochemical phenotyping is almost always possible. EUS-TCB can be safely performed in this set of patients.

Salvador Navarro a, , Eva Vaquero , Joan Maurel , Josep Antoni Bombi , Carmen De Juan , Jaime Feliu , Laureano Fernandez Cruz , Angels Gines , Enrique Girela , Ricardo Rodriguez j y Luis Sabater , en representacion del Grupo Espanol de Consenso en Cancer de Pancreas, el Club Espanol Biliopancreatico (CEBP), Grupo Espanol Multidisciplinar de Cancer Digestivo (GEMCAD), Sociedad Espanola de Diagnostico por Imagen del Abdomen (SEDIA), Sociedad Espanola de Endoscopia Digestiva (SEED) y la Sociedad Espanola de Anatomia Patologica (SEAP) a Servicio de Gastroenterologia, CIBERehd, IDIBAPS, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana b Servicio de Gastroenterologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana c Servicio de Oncologia Medica y Radioterapica, CIBERehd, IDIBAPS, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana d Servicio de Anatomia Patologica, IDIBAPS, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana e Servicio de Radiologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana f Servicio de Oncologia Medica y Radioterapica, Hospital La Paz, Madrid, Espana g Servicio de Cirugia, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana h Seccion de Endoscopia Digestiva, Hospital Clinic, Universitat de Barcelona, Barcelona, Espana i Servicio de Radiologia, Hospital Morales Meseguer, Murcia, Espana j Servicio de Radiologia, Hospital Clinico, Madrid, Espana k Servicio de Cirugia, Hospital Clinico, Valencia, Espana

Background: To analyze the feasibility of capecitabine with weekly irinotecan and concurrent radiotherapy followed by laparoscopic-total mesorectal excision (LTME) in rectal cancer patients. Methods: Eligible criteria included adenocarcinoma of the rectum staged by endoscopic ultrasonography (u), spiral abdominal and pelvic CT and chest X-ray. Patients received weekly irinotecan 50 mg/m2 (days 1, 8, 15, 22, 29) and capecitabine (days 1 through 5 for 5 weeks); dose level; (DL) I 250 mg/m2/bid; DL II 375 mg/m2/bid; DL III 500 mg/m2/bid, according to phase I methodology. External beam radiotherapy was delivered up to a total dose of 45 Gy in daily fractions of 1.8 Gy, 5 days a week. LTME was planned 5–7 weeks after CRT. Results: From February 2003 to February 2006, 22 patients were included. Median age was 62 (range 48 to 78). Seven pts were uT3N0 and 15 pts uT3N1. Seven patients were treated at DL I, six at DL II and nine at DL III. Grade 3 adverse events were observed in all levels. The maximum tolerated dose was reached at 375 mg/m2 (DL II). Conversion rate to open surgery was 5%. Median hospital stay was 6.6 days. One month post-surgical complications were noted in five patients (23%). Median excised nodes were 11 (range 4–21). Pathological complete response was observed in two patients (9%). Conclusions: LTME after preoperative CRT with CAPIRI is feasible but severe adverse events were found in all levels despite the use of lower dose of capecitabine than previously published.

Background & Aims: It is essential to optimize standard colonoscopy technique to be able to increase polyp detection. We sought to compare the performance of colonoscopy using a high-definition, wide-angle endoscope (HDE) versus a standard colonoscope (SC) for the detection of colorectal neoplasia. Patients and Methods: All consecutive consenting adult patients referred from primary care centers were included and randomly assigned at a 1:1 ratio to undergo HDE or SC. Times to reach and withdraw from the cecum were measured. Morphology, size, location, and pathologic diagnosis of each polyp were recorded. Sample size calculation resulted in a total of 682 patients needed. Results: A total of 693 consecutive patients fulfilled all inclusion criteria (73 excluded owing to insufficient bowel preparation). Each arm included 310 patients with no baseline characteristic differences. Time to reach the cecum was slightly superior for SC (8.9 ± 4.8 minutes vs 8.2 ± 4.5 minutes; P = .055). Pathology examination was feasible in 418 lesions (272 adenomas, 109 hyperplastic polyps, and 37 inflammatory lesions). Both techniques detected a similar number and type of lesions, and there were no differences in the distribution along the colon, in the degree of dysplasia, or morphology of adenomas. The per-patient basis analyses demonstrated that there were no differences between the 2 arms of the study in the detection rates of polyps (SC, 0.84 ± 1.59; HDE, 0.83 ± 1.30), adenomas (0.45 ± 1.07 vs 0.43 ± 0.87), small adenomas (0.22 ± 0.71 vs 0.28 ± 0.78), flat adenomas (0.30 ± 0.91 vs 0.21 ± 0.63), or hyperplastic polyps (0.16 ± 0.50 vs 0.18 ± 0.54). Conclusion: HDE did not detect significantly more colorectal neoplasia than SC.

BACKGROUND AND STUDY AIM Acute pancreatitis as a complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is rarely observed. However, there is little information on the incidence of hyperamylasemia after EUS-FNA of the pancreas and its clinical significance. This study aimed to supply this lack of information. PATIENTS AND METHODS Patients who underwent EUS-FNA of a pancreatic lesion between October 2004 and October 2005 were studied prospectively. Exclusion criteria were: (i) platelet count under 50,000/mm (3) and/or prothrombin time < 50 %; (ii) performance of surgery, endoscopic retrograde cholangiopancreatography (ERCP), a percutaneous biopsy attempt, or another invasive procedure within 7 days before EUS-FNA; (iii) lack of informed consent. Serum amylase levels were determined before and 8 and 24 h after the procedure. Hyperamylasemia was defined by amylase levels above 104 UI/L (and higher than baseline levels) 8 h after the procedure. Acute pancreatitis was defined by upper abdominal pain (with or without nausea and/or vomiting) accompanied by elevation of serum amylase or lipase to at least twice baseline levels. RESULTS A total of 100 patients underwent EUS-FNA of a pancreatic lesion (58 men, 42 women; mean age 60 +/- 13 years). Eleven patients (11 %) showed hyperamylasemia 8 h after the puncture (298 +/- 293 UI/L, range 105 - 1044 UI/L), but only two of them developed acute mild pancreatitis after EUS-FNA. Hyperamylasemia was not related either to the type of lesion (cystic or solid) or to its location, the duration of the procedure, or the number of passes performed. CONCLUSIONS Pancreatitis after pancreatic EUS-FNA occurs in 2 % of patients, with some more cases of silent hyperamylasemia. This complication may have to be included in the information given to patients for their informed consent.

Fundamento y objetivo Hasta un 50% de las indicaciones de endoscopia digestiva se realizan en la asistencia extrahospitalaria. Dado que los recursos de que se dispone son limitados, es imprescindible una correcta indicacion de las exploraciones. El objetivo de este estudio fue valorar de forma prospectiva la adecuacion de las endoscopias digestivas solicitadas desde centros de asistencia extrahospitalaria de acuerdo con los criterios del European Panel on the Appropriatness of Gastrointestinal Endoscopy (EPAGE). Pacientes y metodo Entre mayo y junio de 2005 se incluyeron todas las endoscopias solicitadas desde la asistencia extrahospitalaria (478 colonoscopias y 264 gastroscopias). La adecuacion de las indicaciones se evaluo de acuerdo con los criterios del EPAGE. Para poder evaluar el rendimiento diagnostico de una indicacion adecuada se registraron los hallazgos relevantes de las exploraciones. Resultados En 146 (20%) pacientes la indicacion no figuraba en el listado de la guia del EPAGE o los datos estaban incompletos y se los excluyo del analisis. En los restantes 596 pacientes, la indicacion de la exploracion se considero adecuada en 401 (67%) pacientes (253 [69%] colonoscopias y 148 [65%] gastroscopias). El rendimiento diagnostico fue superior en las endoscopias consideradas adecuadas (el 30 frente al 7%; p Conclusiones El rendimiento diagnostico de las endoscopias procedentes de la asistencia extrahospitalaria aumenta cuando las indicaciones son adecuadas segun las recomendaciones del EPAGE. Debido a que en una proporcion considerable estas endoscopias son inadecuadas, la implementacion de guias validadas para su correcto uso podria mejorar esta situacion.

Aims To evaluate a) new diagnoses by endoscopic ultrasound guided real-time fine-needle aspiration (EUS-FNA) compared with EUS alone; b) the predictive factors for an accurate EUS-FNA diagnosis, and c) the cost-effectiveness of the presence of an on-site cytopathologist. Patients and methods Demographic data, ultrasonographic characteristics, technical information on EUS-FNA and cytological results were prospectively collected in 213 patients. The gold standard used was pathological examination or clinical follow-up. Operating characteristics of EUS-FNA, multivariate analysis, and a cost-minimization study of onsite evaluation were performed with these variables. Results Samples were obtained from a total of 262 lesions: extramural masses (n = 115), lymph nodes (n = 96), cysts (n = 40) and intramural lesions (n = 11). The overall accuracy of EUS-FNA was 89% (234/262 lesions). The accuracy of EUS in discriminating between malignant and benign disease was 92% but 105 lesions (40% of the total) were classified as indeterminate. The addition of FNA to EUS allowed almost all lesions (89%) to be diagnosed with an accuracy of 90%. The only variable independently associated with an incorrect diagnosis was intramural location of the target lesion. The effectiveness of EUS-FNA in the complete series progressively increased, reaching a plateau in the fourth pass. The presence of an attendant cytopathologist was cost-effective. Conclusions EUS-FNA allows diagnosis of most lesions classified as indeterminate by EUS alone. The only factor independently associated with low accuracy is intramural location of the lesion. The availability of an on-site cytopathologist is cost-effective.

OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe and effective technique for the diagnosis of focal pancreatic lesions and enlarged abdominal lymph nodes. The aim of this study was to assess the usefulness of EUS-FNA in the diagnosis of mediastinal lesions. PATIENTS AND METHODS: A retrospective review was performed of all consecutive cases in which EUS-FNA was used for the diagnosis of a mediastinal lesion between January 2001 and September 2003. We used a radial echoendoscope to assess the characteristics of the lesion and a linear-array echoendoscope to perform transesophageal needle aspiration with a 22-gauge needle. Histopathology of the resected specimen was considered as the gold standard in surgically treated patients whereas cytology obtained by EUS-FNA was the gold standard when surgery was not indicated. RESULTS: EUS-FNA was performed in 59 patients with a total of 89 lesions with mean (SD) dimensions of 2.4 (2.0) cm · 1.6 (1.4) cm. Malignant lesions were larger than benign ones (short axis, 2.7 [1.4] as compared with 1.0 [0.9] cm; P

Objetivo: La puncion aspirativa con aguja fina guiada por ultrasonografia endoscopica (USE-PAAF) es una tecnica eficaz y segura en el diagnostico de las lesiones focales del pancreas y las adenopatias intraabdominales. El objetivo de este estudio es describir su utilidad en el diagnostico de las lesiones mediastinicas. Pacientes y metodos: Se han revisado todos los casos consecutivos a los que se realizo una USE-PAAF para estudio de una lesion mediastinica desde enero de 2001 hasta septiembre de 2003. Las exploraciones se efectuaron con un ecoendoscopio radial para estudio de las caracteristicas de la lesion y un ecoendoscopio sectorial para realizar la puncion transesofagica usando una aguja de 22 G. Se utilizo como referencia la cirugia en los pacientes operados y el resultado de la citologia obtenida con la USE-PAAF en los casos en que el tratamiento quirurgico no estaba indicado. Resultados: Se realizo USE-PAAF a 59 pacientes con un total de 89 lesiones, con diametro medio ± desviacion estandar de 2,4 ± 2 × 1,6 ± 1,4 cm. El tamano de las lesiones malignas fue mayor que el de las benignas (diametro corto: 2,7 ± 1,4 frente a 1 ± 0,9 cm, respectivamente; p < 0,001). El material obtenido permitio el diagnostico en 53 pacientes (90%) y en 81 lesiones (91%), y el numero de pases fue de 2 ± 1 por lesion. La sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la precision para el diagnostico fueron del 81, el 100, el 100, el 75 y el 88%, respectivamente (el 88, el 100, el 100, el 80 y el 92% al analizarlos por paciente). Conclusiones: La USE-PAAF es una tecnica eficaz en el estudio de la patologia mediastinica. La probabilidad de malignidad es mayor cuanto mayor es el tamano de la lesion.