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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).

Chronic abdominal pain is highly prevalent in school-aged children and is one of the most frequent disorders in our environment. The aim of the present study was to evaluate the usefulness of capsule endoscopy (CE) in patients with chronic abdominal pain. Sixteen patients (nine boys and seven girls), aged between 5 and 16 years old, with chronic abdominal pain for at least 12 months were studied. In all patients the results of hemograms, biochemical investigations, urine sediment test, Helicobacter pylori breath test and celiac serology were normal. In all children, gastroscopy, small bowel follow-through, abdominal ultrasound and colonoscopy were normal. All patients received CE by mouth. In 43.75 % of the patients studied (7/16), the capsule showed evidence of nodular lymphoid hyperplasia, mainly located in the ileum. In one girl, oxyuriasis was observed in the cecum and in another girl aphthous lesions were observed in the ileum. These lesions suggested small bowel Crohn's disease. CE mainly showed images compatible with nodular lymphoid hyperplasia, with unknown clinical significance. Consequently, we conclude that CE does not provide useful information in patients with abdominal pain without other symptoms.

to compare the efficacy of three endoscopic therapies for achalasia and to identify predictors of response.prospective, single-blinded study at short and medium term.22 patients (9M/13 F; mean age: 47.45 +/- 21.01 years) with confirmed clinical and manometric achalasia were randomised in three groups: intrasphincteric injections of botulinum toxin (group 1: 10 patients ), injections of 1% polidocanol (group 2:6 patients), and a combined therapy with both of them (group 3: 6 patients). Clinical response was evaluated by a score (0-5) of tested symptoms (dysphagia, regurgitation and chest pain) at 1 and 24 weeks post-treatment.at 24 weeks post-treatment group 2 had the best complete response (CR) rate (33.33%), whereas CR in both the botulinum toxin and combined therapy groups was 10 and 0%, respectively. Groups 1 and 2 got an overall improvement in clinical score at 1 (p= 0.02) and 24 weeks (p= 0.04). Five patients (50%) in group 1, two patients (33.33%) in group 2, and three patients (50%) in group 3 needed other therapies (dilation or surgery) because of treatment failure. Separately, neither age nor sex, time from diagnosis or type of therapy could distinguish responders from non-responders in these three groups. However, absence of response within the first week, and an initial clinical score above 7 were predictive factors of poor response at six months.short- and medium-term clinical response to these endoscopic therapies was limited. The absence of response at seven days and a severe initial clinical score were predictive factors of poor medium-term response.

The recent emergence of capsule endoscopy has entailed a relevant diagnostic imaging advance for gastrointestinal conditions, especially those involving the small bowel. Gastrointestinal haemorrhage of obscure origin is probably the most widely accepted indication for this new technique, and promising results have been reported from series extant to date. In view of data available on this new modality, and looking forward to having wide, well designed studies fr corroboration, this paper suggests a tentative algorithm for the management of this patient group.

Early results with the use of endoscopic techniques in the treatment of gastro-oesophageal reflux disease (GERD) have been recently reported. Methods used are an injection of biocompatible substances within the lower oesophageal sphincter (LES), LES ablation using radio-frequency, and suture of folds in the area distal to the Z-line. The latter--endoscopic gastroplasty--is most difficult, but this technique has been most widely accepted by gastroenterologists to this date. Effectiveness of these endoscopic management systems in the long-term control of GERD has never been compared to a control group. This fact, together with the proven efficacy of anti-secretory drugs and the refinement of laparoscopic surgery during the past few years, has led physicians to be more demanding regarding early results. This review will discuss each method available, and issues answered by reported studies to this day are approached.

Chronic Pancreatitis is a recurrent disease, frequently alcohol intake related and tend to occur in the third and the fourth decades. Stenoses and lithiasis in the main pancreatic duct causes obstruction and subsequently pain. Therefore endoscopic or surgical decompression of main pancreatic duct results in pain relief.Review our experience in the endoscopic management in patients suffering from chronic pancreatitis. 42 patients underwent ERCP for management of their chronic pancreatitis. Therapeutic options were sphincterotomy alone, prostheses and "do nothing". Follow-up was made by phone call and outpatient office visits. Mean follow-up was 47.8 (27.2) months.22 patients underwent therapeutic ERCP. In 8 patients we performed sphincterotomy and in 14 patients, a sphincterotomy and prostheses intubation. 8 patients are asymptomatic after a mean follow-up of 10.8 (11.6) months. 2 of them, underwent sphincterotomy and six of them, underwent sphincterotomy and prostheses intubation.Therapeutic ERCP is a tool that relieves pain in a fifth of patients suffering from chronic pancreatitis.

Helicobacter pylori (Hp) infection is characterized by an intense inflammatory infiltrate in the gastric mucosa, which is chemoattracted by different cytokines. Interleukin-8 (IL-8) seems to play an important role in the recruitment of circulating neutrophils, and modulation of IL-8 secretion seems to be a strain marker. This study was designed to examine IL-8 concentrations in the gastric mucosa and their relationship with H. pylori phenotype and histologic findings.Gastric biopsies were obtained from the antrum and corpus in 106 patients (69 Hp-positive and 37 Hp-negative). IL-8 levels in the gastric mucosa were analyzed by ELISA and Hp phenotype was determined with a western blot test.75% of H. pylori strains were CagA+ and 54.2% were VacA+. The Houston classification was used for histologic findings. No association between gastric atrophy or intestinal metaplasia and Hp phenotype was found. The highest IL-8 levels were found in CagA+ infected gastric mucosa, but the difference with respect to infection by a VacA+ strain was not statistically significant. IL-8 levels were highest when neutrophils were the predominant cell in the gastric inflammatory infiltrate (p0.05). IL-8 levels were higher in patients with atrophic gastritis than in patients with nonatrophic gastritis (p0.05).In patients with H. pylori infection, IL-8 levels are higher than in Hp-negative patients regardless of Hp phenotype. There is an association between IL-8 and a neutrophilic infiltrate. Perpetuation of a chronic infiltrate could lead to more severe lesions such as atrophic gastritis or intestinal metaplasia, as deduced from the IL-8 levels found in these types of lesion.

to evaluate the possible relationship between the various grades of endoscopic esophagitis and the different patterns of reflux determined by 24-hour ambulatory pH-metry.we selected 80 patients with symptoms of gastroesophageal reflux disease in whom upper digestive tract endoscopy revealed some degree of mucosal lesion. These patients subsequently underwent 24-hour ambulatory pH-metry. The lesions of the mucosa were classified into 4 grades according to the criteria of Savary and Miller. The patterns of reflux were determined by 24-hour pH-metry and classified according to the severity of reflux (slight, moderate or severe, using DeMeester's table) and the type of reflux (in bipedestation, supine or mixed) according to the percentage of time at pH4 in bipedestation, in decubitus or in both positions.patients with grades I and II esophagitis showed variable patterns of reflux, although the most frequent seemed to be slight in bipedestation, which we observed in 34% of the patients. Most (76. 2%) of the patients with grades III or IV (p0.05) showed a clearly defined pattern of severe type in the supine position or in both positions.the presence of a reflux pattern of predominantly supine or mixed type in 24-hour pH-metry may help to identify patients at higher risk for developing severe esophagitis or other complications.

The aim of this study was to obtain pathologic diagnosis by aspiration punction (AP) by real time lineal echoendoscopy in different lesions suspected to be malignant. AP was performed in 6 cases with a Pentax-Hitachi FG 32UA lineal echoendoscopy. Four pancreatic neoplasms, one plastic linitis and one adenopathy of the celiac trunk were observed. Malignancy was confirmed by clinical evolution or surgery. The sensitivity of malignancy diagnosis was 67%, specificity 100% and diagnostic certainly 87%. No complications were observed. In the authors' preliminary experience, aspiration punction with real time lineal echoendoscopy allowed pathological diagnosis to be performed safely and effectively with relative simplicity.

The AA. of the present paper recall the clinical and functional results of this therapy in a group of 70 patients complaining of vertigo. The Gingko biloba extract (4 ml/12 h per mouth) has been continued during 6 months. Neck and vertebrobasilar insufficiency were predominant causes. Six months later statistically significant changes regarding the decrease of intensity of tinnitus and vertigo crises were confirmed. Besides favorable alterations in the peripherical symptomatology as a relative hearing improvement turned up.

We report a case of a 5-aminosalicylate-induced pancreatitis in a patient with Crohn's disease. These findings suggest that some side effects, traditionally thought to be related to sulphafapyridine, are really due to 5-aminosalicylate. The good prognosis of this rare complication depends on the early withdrawal of the drug. Therefore the degree of the clinical suspicion plays a essential role in the appropriate diagnosis, but a challenge with mesalazine must be carried out in those patients in which other causes of pancreatitis could not be excluded.