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Background and study aims Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. Patients and methods Patients with LST lesions ≥20 mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. Results We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR = 5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR = 1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. Conclusion This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.

Introduccion: la endoscopia tiene un papel fundamental en el manejo de los pacientes con colitis ulcerosa (CU), ya que permite la visualizacion y evaluacion de la gravedad de la enfermedad. No obstante, dicha evaluacion no es siempre algo objetivo, por lo que se han desarrollado diferentes escalas que pretenden homogeneizar los hallazgos. Objetico: el objetivo del estudio fue evaluar la variabilidad interobservador entre el Indice de Mayo Endoscopico (IME) y el Indice de Severidad Endoscopica de la Colitis Ulcerosa (UCEIS), al analizar la gravedad de las lesiones endoscopicas en pacientes con CU. El objetivo secundario fue analizar si la preparacion catartica afectaba al grado de concordancia entre los endoscopistas. Material y metodos: se trata de un estudio observacional comparativo de una unica cohorte a la cual se realiza una colonoscopia bajo guia de practica clinica habitual a pacientes con CU y se estadifica segun el IME y el UCEIS por tres endoscopistas expertos. Para valorar el grado de correlacion interobservador se utilizaron el indice de Kappa para el IME y el coeficiente de correlacion intraclase para el UCEIS. Se incluyeron 67 pacientes, con edad media de 51 anos (DE ± 16,7) e indice de Mayo clinico medio de 3,07 (DE ± 2,54). Resultados: el indice de Kappa ponderado entre los endoscopistas A y B para el IME fue de 0,8; entre el A y el C, de 0,52; y entre el B y el C, de 0,49. Para el UCEIS, el coeficiente de correlacion intraclase fue del 0,922 entre los tres endoscopistas (IC 95 %: 0,832-0,959). Se encontro una mejor correlacion interobservador cuando la preparacion catartica era ≥ 8 segun la escala de Boston. Conclusion: existe, por tanto, una superior correlacion entre los diferentes endoscopistas para el UCEIS que para el IME, por lo que deberia ser considerado como el mejor indice a utilizar en la practica clinica. Una buena preparacion catartica es importante para mejorar la correlacion interobservador.

[Background and Aims]: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models., [Methods]: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies., [Results]: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets., [Conclusions]: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT 03050333.), Research support for this study was received from “La Caixa/Caja Navarra” Foundation (ID 100010434;project PR15/11100006).

[Background] Besides dental erosion syndrome, other oral syndromes could benefit from the stimulation of sali-vary secretion, in patients with gastro-oesophageal reflux disease (GORD). Our aims is evaluate the improvement of oral extra-oesophageal manifestations in patients with GORD using xylitol–malic acid tablets to stimulate salivary secretion., [Material and Methods] The effectiveness of salivary stimulation using xylitol–malic acid tablets (as a supplement to omeprazole 40 mg/day) was assessed in a clinical trial (n = 14) lasting six months with patients with prior posi-tive pH-metry, through GORD extra-oesophageal clinical signs, GerdQ and RDQ questionnaires, odontological variables, basal salivary secretion, stimulated salivary secretion, pH and buffer capacity, mucosal erythema index and dental wear. Statistics: chi-square (Haberman post-hoc), ANOVA, and Mann-Whitney U; variables between visits were evaluated with McNemar’s Student’s t and Wilcoxon tests; p < 0.05., [Results] 100% of patients not taking xylitol–malic acid presented xerostomia, but only 14.3% of patients taking xylitol–malic acid (p < 0.01) did. The mean saliva-buffer capacity at the last visit for patients not taking xylitol–malic acid was 2.14 ± 0.38, versus 2.71 ± 0.49 for patients taking xylitol–malic acid (p < 0.05). Retro-sternal burn-ing (p < 0.05), heartburn (p < 0.05) and regurgitation (p < 0.05) were also reduced., [Conclusions] Xylitol–malic acid tablets improve quality of life among patients with GORD, by reducing dry mouth, increasing saliva buffering and reducing heartburn, retro-sternal burning and regurgitation., The study was funded by Dentaid S.A. (Vallés Technology Park, Barcelona, Spain).

Neuroendocrine tumors rarely occur in the esophagus because the neuroendocrine system is not well developed in the esophagus. The case of a neuroendocrine esophageal tumor developed in a patient with Barret's esophagus is presented. It was successfully trated by endoscopy.

espanolIntroduccion: en los ultimos anos, numerosos articulos relacionan el uso de los inhibidores de la bomba de protones (IBP) con posibles efectos adversos serios que han creado cierta alarma social. Objetivo: el objetivo de este trabajo es revisar la literatura de cara a elaborar un documento institucional de posicionamiento de la Sociedad Espanola de Patologia Digestiva (SEPD) sobre la seguridad de los IBP a largo plazo. Material y metodos: se ha realizado una revision exhaustiva de la literatura orientada a la presentacion de conclusiones tras una valoracion critica sobre los siguientes temas: a) indicaciones actuales de los IBP; b) deficit de vitamina B12 y alteraciones neurologicas; c) deficit de magnesio; d) fracturas oseas; e) infecciones entericas y neumonias; f) interaccion con los derivados de las tienopiridinas; y e) complicaciones en pacientes cirroticos. Resultados: las indicaciones actuales de los IBP no han variado en los ultimos anos y estan bien establecidas. No se recomienda la realizacion de un cribado generalizado de los niveles de vitamina B12 en todos los pacientes tratados de forma cronica con estos medicamentos; sin embargo, si parece necesario controlar los niveles de magnesio al inicio del tratamiento y monitorizarlos en pacientes con toma de otros farmacos que puedan inducir hipomagnesemia. Existe mayor riesgo de fracturas oseas, aunque no se puede concluir que esta asociacion sea causal. La asociacion IBP e infeccion por Clostridium difficile es debil o moderada y el riesgo de neumonia es bajo. En pacientes con riesgo cardiovascular y tratados con derivados de las tienopiridinas -dada la ausencia de evidencias definitivas en relacion a posibles interacciones medicamentosasparece que lo prudente sea sopesar adecuadamente los riesgos gastrointestinales y los riesgos cardiovasculares de cada paciente; cuando el riesgo gastrointestinal sea moderado/alto, debemos ejercer una accion terapeutica de prevencion efectiva utilizando un IBP. En cirroticos descompensados deben ser indicados con cautela. Conclusiones: los IBP son farmacos seguros y los beneficios de su empleo, tanto a corto como a largo plazo superan los posibles efectos secundarios, siempre que la indicacion, dosis y duracion sean las adecuadas. EnglishIntroduction: In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. Objective: The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Espanola de Patologia Digestiva (SEPD) regarding the safety of long-term PPI use. Material and methods: A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. Results: Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. Conclusions: PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.

[Background & Aims]: It is not clear whether closure of mucosal defects with clips after colonic endoscopic mucosal resection (EMR) prevents delayed bleeding, although it seems to have no protective effects when risk is low. We performed a randomized trial to evaluate the efficacy of complete clip closure of large (≥2 cm) nonpedunculated colorectal lesions after EMR in patients with an estimated average or high risk of delayed bleeding., [Methods]: We performed a single-blind trial at 11 hospitals in Spain from May 2016 through June 2018, including 235 consecutive patients who underwent EMR for large nonpedunculated colorectal lesions with an average or high risk of delayed bleeding (based on Spanish Endoscopy Society Endoscopic Resection Group score). Participants were randomly assigned to groups that received closure of the scar with 11-mm through-the-scope clips (treated, n = 119) or no clip (control, n = 116). The primary outcome was proportion of patients in each group with delayed bleeding, defined as evident hematochezia that required medical intervention within 15 days after colonoscopy., [Results]: In the clip group, complete closure was achieved in 68 (57%) cases, with partial closure in 33 (28%) cases and failure to close in 18 (15%) cases. Delayed bleeding occurred in 14 (12.1%) patients in the control group and in 6 (5%) patients in the clip group (absolute risk difference, reduction of 7% in the clip group; 95% confidence interval, –14.7% to 0.3%). After completion of the clip closure, there was only 1 (1.5%) case of delayed bleeding (absolute risk difference, reduction of 10.6%; 95% confidence interval, –4.3% to 17.9%)., [Conclusions]: In a randomized trial of patients with large nonpedunculated colorectal lesions undergoing EMR, we found that clip closure of mucosal defects in patients with a risk of bleeding can be a challenge, but also reduces delayed bleeding. Prevention of delayed bleeding required complete clip closure. ClinicalTrials.gov ID: NCT02765022., This work was supported by a grant from the Spanish Society of Digestive Endoscopy. Micro-Tech Endoscopy (Nanjing, China) contributed the clips needed for the study. The authors declare no conflicts of interest with this company or any other that relates to the topic addressed in this study. The first author received a grant from “La Caixa/Caja Navarra” Foundation (ID 100010434; Project PR15/11100006).

RESUMEN Este documento resume el contenido de la Guía de resección mucosa endoscópica elaborada por el grupo de trabajo de la Sociedad Española de Endoscopia Digestiva (GSEED de Resección Endoscópica) y expone las recomendaciones sobre el manejo endoscópico de las lesiones neoplásicas colorrectales superficiales. ABSTRACT This document summarizes the contents of the Clinical Guidelines for the Endoscopic Mucosal Resection of Non-Pedunculated Colorectal Lesions that was developed by the working group of the Spanish Society of Digestive Endoscopy (GSEED of Endoscopic Resection). This document presents recommendations for the endoscopic management of superficial colorectal neoplastic lesions.

Resumen Este documento resume el contenido de la Guia de reseccion mucosa endoscopica elaborada por el grupo de trabajo de la Sociedad Espanola de Endoscopia Digestiva (GSEED de Reseccion Endoscopica) y expone las recomendaciones sobre el manejo endoscopico de las lesiones neoplasicas colorrectales superficiales.

The slow progression of chronic hepatitis C (CHC) infection requires long observation periods to detect clinical changes. We compare the incidence of clinical events, hepatocellular carcinoma (HCC), overall mortality, liver-related mortality, and fibrosis progression between patients with a sustained virological response (SVR) and nonresponders (NR) after a 13-year follow-up period.One hundred and eighty-two CHC patients, who received interferon and ribavirin treatment between 1996 and 2000, were included. Clinical events were evaluated during follow-up. At the end of follow-up, transient elastography was used to assess fibrosis progression.Of the 182 patients, 46.7% (n=85) achieved an SVR. Twenty-seven patients developed hepatic decompensation (one SVR) and 15 developed HCC (three SVR). Twenty-nine patients died (eight SVR). Twelve of the 29 deaths were liver related (two SVR). Independent factors associated with hepatic decompensation were NR to treatment [hazard ratio (HR)=23.35; 95% confidence interval (CI): 2.90-189.25; P=0.003], advanced fibrosis at baseline (HR=9.11; 95% CI: 4.13-20.09), and treatment delay after diagnosis (HR=1.02; 95% CI: 1.00-1.03; P=0.012). Only the latter two were associated with HCC development and liver-related mortality. An assessment of liver fibrosis was performed on 125 patients (66 SVR). Fibrosis values were significantly lower in SVR patients, showing less progression to advanced stages of fibrosis [SVR: 6.6 (2.8); 95% CI: 5.8-7.3] than NR [NR: 14.0 (11.1); 95% CI: 11.1-16.9; P0.001].In patients with CHC, SVR is durable and reduces clinical events. The risk of HCC development is lower, but not eliminated. Sustained responders showed fibrosis stabilization or improved fibrosis values.

espanolIntroduccion: el esofago de Barrett (EB) es una enfermedad adquirida definida por la presencia de metaplasia intestinal en el esofago distal. Su prevalencia se ha incrementado de forma alarmante en los ultimos anos. Objetivos: los objetivos primarios del presente trabajo fueron analizar el comportamiento del EB y del adenocarcinoma esofagico (ACE) en un area sanitaria espanola durante el seguimiento del periodo del estudio. Metodos: se analizaron caracteristicas sociodemograficas y el consumo de alcohol y tabaco. Tambien se valoro el comportamiento histologico asi como las causas de defuncion en cada uno de los grupos. Resultados: se incluyeron 430 pacientes, 338 con EB y 92 con ACE. La tasa de incidencia paso de 2,25 y 1,25 por 100.000 habitantes en 1996 a 6,5 y 4,75 en 2011, en EB y ACE, respectivamente. Hubo mas varones, mayor edad e ingesta etilica en el grupo adenocarcinoma respecto al grupo de Barrett. La supervivencia del ACE fue de 23 meses. Las principales causas de muerte en los pacientes con Barrett fueron el cancer no esofagico y la enfermedad cardiovascular. Conclusiones: existe una mayor incidencia y prevalencia tanto del EB como del ACE en los ultimos anos. Como factores de riesgo encontramos el sexo masculino, mayor edad y consumo de alcohol. El EB largo (> 3 cm) esta implicado en la progresion de la displasia. El diagnostico de ACE se hace, la mayor parte de las veces, con el debut de la enfermedad neoplasica y, en el menor de los casos, sobre un EB previo. La enfermedad cardiovascular y neoplasica no esofagica han sido las principales causas de mortalidad en los pacientes con EB. EnglishBackground: Barrett’s esophagus (BE) is an acquired disease defined by the presence of intestinal metaplasia with goblet cells in the distal esophagus. The prevalence of BE has increased dramatically over the last years. Aims: The primary aims of the study were to analyze the characteristics of BE and esophageal adenocarcinoma (EAC) in a Spanish health district during a follow-up period. Methodology: Sociodemographic factors, alcohol consumption and cigarette smoking were analyzed. We also studied the histological behavior and cause of death in each group. Results: In the present study 430 patients were included, 338 with BE and 92 with EAC. Incidence rates have risen from 2.25 and 1.25 per 100,000 inhabitants in 1996 to 6.5 and 4.75 per 100,000 in 2011, respectively. In the EAC group, male gender, age and alcohol consumption were higher in comparison to the BE group, and the overall survival was 23 months. In the BE group, the main causes of death were non-esophageal cancer and cardiovascular disease. Conclusions: The incidence and prevalence rates of AEC and BE have risen over the past years. Risk factors for these conditions were male gender, age and alcohol consumption. Long BE (> 3 cm) is involved in dysplasia progression. AEC diagnosis mainly occurs after neoplasia is detected and, in a few cases, due to a previous BE. Cardiovascular diseases and non-esophageal cancers have been found to be the main cause of death in BE patients.

The pathogenetic relationship underlying the high prevalence of gastroesophageal reflux disease (GERD) in patients with obstructive sleep apnea (OSA) remains unclear. Objective: 1.To investigate the GER in patients with severe OSA and to corroborate variations in the pH-metry register using auto-CPAP. 2.To test symptoms of GERD at baseline and after beginning treatment for OSA. METHOD: Prospective study with 22 severe OSA patients to study GERD by endoscopic placement of a record of continuous wireless pH monitoring(BravoTM capsule, up to 96 hours recording). After placing the capsule, nocturnal polysomnography study was done and then the auto-CPAP treatment began. Symptoms of GERD were assessed using specific questionnaires (GSRS and QOLARD),filled prior to placement of the capsule, at 96 hours and at a month. RESULTS: 77.2 % were man and obese (63.6%). The incidence of GERD was 65%. After starting auto-CPAP, we observed a significant improvement of parameters associated with the GER in 48 hours, with normalization of pH monitoring in 61.5 % of cases, although without reaching statistical significance. Significant symptomatic changes in the score of the questionnaires at baseline, at 96 hours and at a month after initiation of treatment with auto-CPAP were found. There were with a baseline score for GSRS>2.5 in 40.9% of cases and with the QOLARD CONCLUSIONS: We found a high prevalence of symptomatic GERD in patients with severe OSA. There are significant improvement in symptoms of GERD and tendency to normalization of pathological GER after initiation of treatment with CPAP. These findings could justify the active pursuit of GERD in patients with severe OSA.

El dolor abdominal crónico afecta a un alto porcentaje de niños en edad escolar, lo que la convierte en una de las patologías más frecuentes en nuestro medio. El objetivo es valorar si la cápsula endoscópica (CE) permite identificar lesiones intestinales en estos pacientes. Se han incluido 16 pacientes (9 niños y 7 niñas) con edades comprendidas entre los 5 y 16 años con dolor abdominal crónico de más de 12 meses de evolución. Todos tenían realizados hemograma, bioquímica, sedimento de orina, test de aliento para Helicobacter pylori y serología para enfermedad celíaca, que eran negativos. A todos se les había realizado una gastroscopia, y una colonoscopia que resultaron negativas, así como un tránsito gastrointestinal y una ecografía abdominal, sin hallazgos de interés. En el 43,75 % de los pacientes estudiados (7/16) la CE mostró imágenes compatibles con hiperplasia folicular linfoide localizadas en el íleon. En una niña se observaron oxiuros en ciego y en otra, lesiones aftosas ileales compatibles con enfermedad de Crohn.La CE muestra en la mayoría de los casos imágenes compatibles con hiperplasia nodular linfoide intestinal, con dudosa significación clínica, por lo que podemos concluir que la CE no aporta nada específico en niños con dolor abdominal crónico. : 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.

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.

La cápsula endoscópica es un nuevo método de diagnóstico no invasivo que permite visualizar de forma nítida posibles lesiones en el intestino delgado. Su tamaño es pequeño y porta una batería y una videocámara que permite tomar dos fotos por segundo del interior del tubo digestivo. Está indicada en casos de hemorragia digestiva de causa no clara y en el diagnóstico de enfermedad inflamatoria intestinal, entre otros. Hasta la fecha se ha utilizado principalmente en adultos.Creemos que en la edad pediátrica puede tener un papel muy importante, por tratarse de una prueba no invasiva, porque permite el diagnóstico de procesos intestinales, y así evitar la realización de numerosas pruebas diagnósticas inútiles. Aportamos el caso de una paciente en edad pediátrica con alta sospecha de enfermedad de Crohn no confirmada mediante las técnicas endoscópicas habituales. La cápsula muestra lesiones intestinales compatibles con esta enfermedad. Tras tratamiento corticoideo la paciente mejora clínicamente y con una evolución favorable de su proceso. : Wireless endoscopy is a new noninvasive diagnostic method that is able to visualize small bowel lesions. The instrument is small and carries a battery and microcamera that takes two photographs per second. It is indicated in cases of bleeding of unknown origin and for the diagnosis of inflammatory bowel disease, among other disorders.To date, it has mainly been used in adults. We believe that this instrument could play an important role in the pediatric age group since it is noninvasive and can be used to diagnose small bowel lesions, thus avoiding unnecessary diagnostic tests. We report the case of a girl with suspicion of Crohn's disease that was unconfirmed by conventional endoscopic techniques. The capsule showed small bowel lesions compatible with Crohn's disease. Corticosteroid treatment was initiated and the patient is now in clinical remission.

Rectally localized colitis cystica profunda can simulate mucosecretory carcinoma. PURPOSE AND METHODS: Because endoscopic examination and barium enema do not clarify the diagnosis, other diagnostic imaging methods such as transrectal ultrasonography, computerized tomography, or magnetic resonance imaging are needed. RESULTS: Transrectal ultrasonography identifies multiple cysts in the rectal submucosa, with areas of echorefringent fibrosis between cysts, and confirms the absence of lymph node involvement or invasion of the muscular layer. Findings with computerized tomography and magnetic resonance imaging have not previously been described for colitis cystica profunda. With computerized tomography, the lesion appears as a noninfiltrating entity in the submucosa, with loss of perirectal layers of fatty tissue and thickening of the levator ani muscle. With nuclear magnetic imaging, nodulations produce intense signals that increase in T2, illustrating the mucoprotein content of the cysts. The presence in surgical biopsy material of large, whole cysts confirms the diagnosis. CONCLUSION: Reeducation of bowel habits aimed at avoiding straining and a high-fiber diet together with bulk laxatives can lead to complete remission of lesions in 6 to 18 months.