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BACKGROUND AND AIMS Small bowel capsule endoscopy (SBCE) does not reach the cecum within the battery lifetime in approximately 15-35% of patients. Incomplete examinations result in diagnostic delays and increase the economic burden. To date, risk factors for incomplete examinations have been described with contradictory results. The aims of this study were to analyze rate and identify risk factors for incomplete examinations, excluding capsule retentions, in a large cohort of patients. METHODS Data from 1894 consecutive SBCE examinations performed from January 2009 to December 2015 were analyzed. Variables recorded included demographics, past medical and surgical history, biochemical parameters and procedure characteristics. The rate of incomplete examinations, excluding capsule retentions, was calculated and a multivariate analysis using a logistic regression model was performed in order to evaluate predictive factors. RESULTS The incidence of incomplete examinations, excluding capsule retentions, was 10.1% (187 incomplete procedures). The multivariate analysis showed that age >65 years, gastric transit time >41 minutes and SB transit time >286 minutes are predictive factors for incomplete examinations, increasing the probability of this event by 199% (OR:1.99; CI95%:1.34-2.95), 260% (OR:2.60; CI95%:1.72-3.93) and 352% (OR:3.52; CI95%:2.26-5.48), respectively. CONCLUSIONS Age >65 years, gastric transit time >41 minutes and SB transit time >286 minutes are predicting factors for incomplete examinations excluding capsule retentions. Both age and gastric transit time events are known before procedure ending. Therefore, pharmacologic or endoscopic measures may be taken into account to avoid incomplete examinations.

Background Capsule endoscopy (SBCE) has developed a relevant role in different indications in patients with established Crohn’s Disease (CD). However, evaluation of its impact in clinical management in CD specific modification strategies has been scarce. The purpose of our study was to question therapeutic impact of SBCE in an 11-year real-life cohort of established CD patients. Methods Retrospective single center study including all consecutive patients with CD submitted to SBCE from January 2008 to December 2019. Small bowel patency was evaluated with patency capsule in selected patients. A conclusive procedure was defined as the one that allowed clinical decision-making. Mucosal inflammation was graded as mild (few aphtoid ulcers), moderate (multiple aphtoid ulcers/isolated deep ulcers) or severe (multiple deep ulcers/stenosis). Therapeutic impact was defined as a change in CD related treatment including escalation, de-escalation, dose adjustment or referral to surgery recommended based on SBCE results within the next 3 months after the SBCE. Patients were assigned to four groups regarding CE indication: staging, flare, post-op and remission (fig 1). Results From the 432 CE performed, 378 (87.5%) were conclusive and allowed clinical decision-making. SBCE results guided changes in 51.3% of patients: 199 (46.1%) with escalation and 23 (5.3%) with de-escalation of treatment. Active disease was present in 310 (71.8%) patients; 131 (30.3%) presented mild, 126 (29.2%) moderate and 53 (12.3%) severe activity. Disease activity demonstrated by SBCE correlated with therapeutic changes. With mild activity 24.1% increased therapy, whereas 77.8% and 84.9% increased therapy with moderate or severe disease, respectively (p Conclusion SBCE is a safe and useful tool when approaching established CD patients guiding therapeutic management in a real-life setting. Its positive impact does not limit to treatment escalation but also helps to de-escalate in patients who can benefit from it.

Background: Nowadays, capsule endoscopy is the first-line procedure to assess the small bowel. During small bowel procedures, other segments of the gastrointestinal tract may be visualized. The aim of the current study was to evaluate the incidence of colonic abnormalities in patients undergoing small bowel capsule and its impact on patient management. Patients and methods: This study is a retrospective analysis of data from 526 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between 2008 and 2011. Patients with incomplete procedures were excluded from the analysis. Patient baseline characteristics, colonic lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was performed. Results: Four hundred and sixty four patients were finally included in the analysis. Two hundred and ninety three patients were male (57.3%) and the mean age was 61.3 ± 20.03 years (18-86). Obscure gastrointestinal bleeding (59%) and inflammatory bowel disease (19%) were the main indications for the procedure. Colonic abnormalities were detected by capsule endoscopy in 47 (9%) of 464 patients. The most common types of missed lesions were vascular lesions (34%) and colonic ulcers (32%). This information had a clinical or diagnostic impact of 7.55% and a therapeutic impact of 6.03%. Conclusion: All images of the colon should be evaluated during small bowel capsule endoscopy as they may provide relevant information that may result in changes in patient management.

Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule en-doscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. Howe-ver, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST.

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica. Obscure gastrointestinal bleeding accounts for approximately 5-10% of patients presenting with gastrointestinal haemorrhage. The majority of lesions responsible were found to be located in the small bowel. Currently, capsule endoscopy is the first-line tool to investigate the small bowel as it is a non-invasive, feasible and simple procedure. However, capsule endoscopy sometimes identifies the source of bleeding outside the small bowel and within the reach of conventional endoscopy. We present the case of a 46 year-old man with few prior negative endoscopic procedures and iron-deficiency anaemia due to gastric GIST.

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica.

Resumen Objetivo Estudiar en el cancer colorrectal (CCR) la posibilidad de un desplazamiento hacia segmentos mas proximales de los adenomas metacronicos tras la extirpacion del tumor y sus lesiones sincronicas. Material y metodos Revisamos 382 CCR resecados, diagnosticados y controlados evolutivamente mediante colonoscopias completas. Comparamos la localizacion de los adenomas metacronicos con respecto a los sincronicos globalmente y segun el sexo, el tamano y el numero de las lesiones sincronicas. Analizamos la frecuencia de localizacion exclusivamente proximal en los adenomas metacronicos de primera, segunda y tercera generacion y la comparamos con la de los adenomas sincronicos. Resultados Un 54,5% de los pacientes con CCR presento adenomas sincronicos. Tras una mediana de seguimiento de 48 meses, con 2,74±1,47 colonoscopias/caso, el 42,4% desarrollo adenomas metacronicos, el 16,8% desarrollo adenomas de segunda generacion y el 7,3% desarrollo adenomas de tercera generacion. Registramos un desplazamiento proximal de los adenomas metacronicos en ambos sexos, independientemente del tamano y del numero de las lesiones iniciales. La frecuencia de localizacion exclusivamente proximal de los adenomas fue sincronico=21,2%; primera generacion de metacronicos=39,5% (p=0,0001; OR=2,46 [1,50–3,95]); segunda generacion=42,6% (p=0,0008; OR=2,77 [1,44–5,31]) y tercera generacion=39,3% (p=0,0003; OR=2,41 [0,97–5,93]). Conclusiones Registramos una elevada incidencia de adenomas sincronicos y metacronicos. Observamos un «giro proximal» de los adenomas metacronicos, independientemente del sexo y del tamano y el numero de las lesiones sincronicas. Esta tendencia se mantiene en las sucesivas generaciones de adenomas metacronicos, lo que obliga a efectuar colonoscopias completas durante todo el seguimiento postoperatorio.

To study the possibility of shift toward more proximal sites in colorectal cancer (CRC) after resection of tumors and synchronous lesions.We reviewed 382 resected CRC diagnosed and followed-up with complete colonoscopies. The localization of metachronous adenomas was compared with that of synchronous lesions overall and by sex, tumoral size and the number of synchronous lesions. The frequency of exclusively proximal localization in first-, second- and third-generation metachronous adenomas was compared with that of synchronous adenomas.A total of 54.5% of patients with CRC had synchronous adenomas. After a median follow-up of 48 months, with 2.74+/-1.47 colonoscopies/case, 42.4% developed metachronous adenomas, 16.8% second-generation adenomas and 7.3% third-generation lesions. Proximal shift was found in metachronous adenomas in both sexes, independently of tumoral size and the number of initial lesions. The frequency of exclusively proximal localization in adenomas was 21.2% in synchronous lesions, 39.5% in first-generation metachronous adenomas (p=0.0001; OR=2.46 [1.50-3.95]), 42.6% in second-generation metachronous adenomas (p=0.0008; OR=2.77 [1.44-5.31]) and 39.3% in third-generation metachronous lesions (p=0.0003; OR=2.41 [0.97-5.93]).We found a high incidence of synchronous and metachronous adenomas. Metachronous adenomas showed a proximal shift, independently of sex, tumoral size and the number of synchronous lesions. This tendency was maintained in successive generations of metachronous adenomas, thus demonstrating the need to perform complete colonoscopies throughout the postoperative follow-up period.

To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value.We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV.We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 +/- 22.9 and 67.2 +/- 24.5 months (p = 0.55) respectively. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas.Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn't influence prognosis.

Objetivo: Analizar la relación entre la presencia de lesiones sincrónicas en el cáncer colo-rectal y su pronóstico. Método: Revisamos 369 cánceres colo-rectales resecados. Comparamos el porcentaje de cirugía aparentemente curativa, la progresión y recidiva tumoral, aparición posterior de cáncer extra-colónico y mortalidad entre los cánceres sincrónicos y el resto. Analizamos los cánceres con adenomas sincrónicos frente al resto de casos. Repetimos el estudio estratificando los casos según su estadio pTNM: estadios 0-I-II versus III-IV. Resultados: Registramos un 7,6% de cánceres sincrónicos y un 54,7% de adenomas sincrónicos. El seguimiento entre los grupos con y sin cáncer sincrónico fue de 70,8 ± 22,9 vs 67,2 ± 24,5 meses (p = 0,55). Los cánceres sincrónicos mostraron mayor mortalidad: 35,7% vs. 14,4%: p = 0,006; OR = 3,31 (1,33-8,13), mayor progresión tumoral: 39,3 vs. 19,1%: p = 0,011; OR = 2,75 (1,14-6,56) y mayor recidiva: 10,7 vs. 3,5%: p = 0,096. Al estratificar según el estadio, los pacientes con estadio 0-I-II y cáncer sincrónico mantuvieron peor pronóstico: mortalidad = 27,7 vs. 8,1% p = 0,019; OR = 4,45 (1,20-15,10), progresión tumoral = 27,8 vs. 8,5% p = 0,02; OR = 4,12 (1,14-14,19), cáncer extra-colónico = 16,7 vs. 6,4% p = 0,095. No encontramos diferencias entre los casos con y sin adenomas sincrónicos. Conclusiones: Los cánceres sincrónicos muestran peor pronóstico tras la resección, con mayor tasa de progresión tumoral y mortalidad. Esta diferencia se centra en los casos diagnosticados en estadios 0-I-II, perdiéndose en los estadios III-IV. En nuestra serie, la presencia de adenomas sincrónicos no influye en el pronóstico. Aim: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. Patients and methods: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV. Results: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 ± 22.9 and 67.2 ± 24.5 months (p = 0.55) respectivelly. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. Conclusions: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn't influence prognosis.

Aim: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. Patients and methods: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV. Results: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 ± 22.9 and 67.2 ± 24.5 months (p = 0.55) respectivelly. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. Conclusions: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn’t influence prognosis.