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Background and Aims: Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. Methods: This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. Results: Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB (small bowel) transit time for the first indicative image of MD was 57% of the total SB transit time. Conclusions: Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.Estas recomendações baseadas na evidência detalham o uso da enteroscopia assistida por dispositivo no manejo clínico das doenças do intestino delgado. Um conjunto de Gastrenterologistas diferenciados em patologia do intestino delgado foi selecionado pelos grupos de estudos Espanhol e Portugués de intestino delgado para rever a evidência disponível sobre as principais indicações desta técnica, o seu papel nos algoritmos de manejo de cada indicação e sobre o seu rendimento diagnóstico e terapêutico. Foi gerado um conjunto de recomendações pelos autores.

Introduction: the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions. Methods: this is a systematic review and meta-analysis. A literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used. Results: the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding. Conclusions: patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding.

Device-assisted enteroscopy is currently lacking a validated training model, in contrast to the other major technique used for the study of the small bowel, namely capsule endoscopy. Training should be based on defining and achieving competency for the acquisition of the knowledge and skills required to perform enteroscopy in a safe and effective manner. The need for training is clear, since the technique is considered an advanced endoscopy form that requires maneuvers that differ from the usual ones that must be learned, in addition to specific equipment. Therefore, the ideal candidates for this training include professionals with accredited experience in therapeutic digestive endoscopy. Amongst the recommendations issued regarding device-assisted enteroscopy training, the estimation of small-bowel insertion depth and the choice of the examination route, whether oral or anal, should be highlighted. Learning curve descriptions have the limitation of being explorer-dependent with no consensus on the parameter that should be selected to establish a correct learning curve in enteroscopy. The most commonly used parameter is insertion depth. The few training models that have been proposed recommend using a highly useful tool, namely simulators and to start practicing under expert guidance. Based on the variability of published data, an experienced endoscopist may perform enteroscopy in a safe and effective manner after 5 to 35 training procedures. Although reaching the expert level requires prolonged clinical practice with exposure to the various disorders of the small bowel.

Introduccion: la lesion de Dieulafoy en intestino delgado es una causa infrecuente de hemorragia digestiva que recidiva frecuentemente tras su tratamiento endoscopico. Material y metodos: se presenta un estudio observacional, descriptivo, retrospectivo y unicentrico de 15 pacientes con hemorragia de intestino delgado, diagnosticados de lesion de Dieulafoy con capsula endoscopica o enteroscopia doble balon, en los que se realizo tratamiento endoscopico combinado. Resultados y conclusiones: durante una mediana de seguimiento de 33,5 meses (rango 2-145), recidivaron tres de los 12 casos que se pudieron seguir (25 %) y todos ocurrieron precozmente en las primeras 48 horas tras la terapeutica. Se retrataron con exito dos de ellos con una nueva enteroscopia.

Colorectal cancer (CRC) is one of the most relevant diseases worldwide because of its incidence, prevalence and mortalitye. It is the third most common tumor in men, after lung and prostate cancer, and the second most common tumor in women, after breast cancer. A recent systematic analysis showed global data referring to age-standardized incidence rates for CRC, which increased by 9.5% from 1990 to 2017, whereas mortality rates decreased by 13.5%. This might be due to the introduction of CRC prevention programs, which facilitate early identification and higher survival chances.

Background and Aim Intermediate-risk patients following a colorectal cancer screening program may have differential risk of advanced lesions depending on the findings of an index colonoscopy. The aim of the present study was to comparatively assess advanced colorectal neoplasia risk at the first follow-up colonoscopy among the different intermediate-risk subgroups with a focus on patients with three to four adenomas. Methods All patients recruited for a baseline screening colonoscopy between 2006 and 2011 were included. Number, size and histopathological characteristics of adenomas were collected. Main outcome was an advanced colorectal neoplasia detection rate (invasive carcinoma or advanced adenoma) at the first follow-up colonoscopy. Low- and high-risk patients were excluded. Results Five hundred and sixty-one intermediate-risk patients (63.3% men, mean age: 59.01 ± 6.16 years) underwent indexing and follow-up colonoscopy. By multivariate analysis, three to four adenomas (OR: 3.613 [95% CI: 1.661–7.859], P = 0.001) and adenoma size ≥10

Background: Angioectasias represents the most frequently found lesion in the small bowel by device-assisted enteroscopy for obscure gastrointestinal bleeding in Western countries. Recurrence of gastrointestinal bleeding after angioectasias therapy remains unclear and data regarding the efficacy of additional endoscopic therapeutic sessions to reduce the rebleeding rate is limited. Aim: To evaluate the rebleeding rate in small bowel angioectasias after a second endoscopic treatment with balloon-assisted enteroscopy after an initial bleed during the first endoscopic treatment. Methods: A retrospective double-center study of patients with small-bowel angioectasias undergoing a second enteroscopy treatment due to a first rebleeding episode. The endpoint was rebleeding, defined as the need for a blood transfusion, the presence of overt bleeding or a decrease in hemoglobin ≥ 2 g/dL. Results: Fifteen of 37 (40.5%) patients with small-bowel angioectasias that underwent a second endoscopic therapy after a first rebleeding episode (n = 15) experienced a second rebleeding episode. Kaplan-Meier curve analysis showed that most rebleeding episodes occurred within the first 12 months of follow-up, resulting in a rebleeding rate of 33.1% at 6 months, 39.1% at 12 months and 52.6% at 24 months. Conclusions: Despite the high absolute short-term rebleeding rate, further endoscopic treatments may be beneficial due to the effective reduction of rebleeding in a subset of patients.

Ectopic pancreas (EP) is defined as pancreatic tissue found outside its usual anatomical position, with no ductal or vascular communication with the native pancreas.We report the case of a 59-year-old woman with a mesenteric jejunal EP initially suspected on computed tomography and confirmed by secretin-enhanced magnetic resonance cholangiopancreatography.Mesenteric EP is a very rare finding with nonspecific clinical presentation, so that, classic radiological findings have not been well described previously.

Background and Aim There are few data concerning emergency double-balloon enteroscopy (DBE) and its usefulness in the management of severe acute obscure gastrointestinal bleeding (OGIB). The aim of this retrospective study was to evaluate emergency DBE and capsule endoscopy (CE) in patients with overt OGIB, analyzing the feasibility of this combined approach. Methods Emergency DBE in patients with overt OGIB was defined as performance within 24 h of symptom onset. We reported 27 patients (16 men, mean age: 64.6 ± 17.9 years) with overt severe bleeding who underwent 29 emergency DBE (22 anterograde, 7 retrograde). Of 27 patients, 16 (59.3%) underwent CE with real time (RT) viewing. Results Patients were diagnosed with the following: Dieulafoy's lesion (DL; n = 11, 40.7%), angioectasia (n = 7, 25.9%), tumors (n = 4, 14.8%), diverticulum (n = 3, 11.1%), ulcers (n = 2, 7.4%). We diagnosed 23 lesions amenable to endoscopic hemostasis and successfully treated 21 of them (77.8%). DL detection rate was statistically higher in the emergency DBE group than in OGIB patients with DBE done 24 h after symptom onset (40.7% vs 0.9%, respectively, P

espanolIntroduccion y objetivo: la capsula endoscopica y la enteroscopia de doble balon son tecnicas de reconocido valor en el estudio de la hemorragia digestiva media, habiendo numerosos factores que pueden afectar a su rendimiento diagnostico. El objetivo del presente estudio es el de caracterizar y definir los niveles de concordancia entre ambas focalizando en el tipo de lesion, en una gran cohorte de pacientes de un centro de referencia. Material y metodo: entre los anos 2004-2014 se administraron 1.209 capsulas en 1.078 pacientes y se realizaron 381 enteroscopias en 361 pacientes con hemorragia digestiva media. Resultados: en 332 pacientes (edad media: 65,22 ± 15,41, 183 hombres) se realizaron ambos procedimientos. Ambas tecnicas tuvieron un rendimiento diagnostico similar (70,5% vs. 69,6%, p = 0,9). El rendimiento diagnostico global de la enteroscopia fue superior en pacientes con una capsula previa positiva (79,3% vs. 27,9%, p 0,55-0,77]), tumores (0,66 [95% IC: 0,55-0,76]) y moderada para ulceras (0.56 [95% IC: 0,46-0,67]). Los diverticulos (0,39 [95% IC: 0,29-0,5] tuvieron una concordancia razonable. Los resultados entre ambos procedimientos difirieron en 73 pacientes (22%). Conclusiones: el presente estudio evidencia que aunque el rendimiento de la capsula endoscopica y la enteroscopia de doble balon de forma global sean similares, hay numerosos factores que pueden modificar estos valores, siendo el principal el tipo de lesion. EnglishBackground and aim: Capsule endoscopy and doubleballoon enteroscopy are well-recognized procedures in obscure gastrointestinal bleeding, with many factors that may influence their diagnosis yield. The aim of the present study was to characterize the degree of agreement between both techniques with focus on the type of lesion in a large cohort of patients at a referral center. Material and method: One thousand two hundred and nine capsules were administered in 1,078 patients and 381 enteroscopies were performed in 361 patients with obscure-gastrointestinal bleeding from 2004 to 2014. Results: Both procedures were carried out in 332 patients (mean age: 65.22 ± 15.41, 183 men) and they have a similar diagnosis yield (70.5% vs. 69.6%, p = 0.9). Overall enteroscopy diagnosis yield was higher within patients with a previous positive capsule endoscopy (79.3% vs. 27.9%, p 0.46-0.67]). Diverticula (0.39 [95% CI: 0.29-0.5]) achieved a fair agreement. The results of CE and DBE differed in 73 patients (22%). Conclusions: The present study confirms that although overall diagnostic yield by capsule endoscopy and double-balloon enteroscopy is similar, there are many factors which can modify these values, mainly the type of lesion.