Small bowel enteroscopy - A joint clinical guideline from the spanish and portuguese small bowel study groups

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 Português 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

100 años investigando el mar. El IEO en su centenario (1914-2014).

Se trata de un libro que pretende divulgar a la sociedad las principales investigaciones multidisciplinares llevadas a cabo por el Instituto Español de Oceanografía durante su primer siglo de vida, y dar a conocer la historia del organismo, de su Sede Central y de los nueve centros oceanográficos repartidos por los litorales mediterráneo y atlántico, en la península y archipiélagos.Kongsberg 20

Diagnosis and therapeutic endoscopic management of mid-gastrointestinal bleeding = Manejo endoscópico diagnóstico y terapéutico de la hemorragia digestiva media

La hemorragia digestiva media (HDM) constituye la principal indicación de la cápsula endoscópica (CE) y la enteroscopia de doble balón (EDB). Ambos procedimientos se han demostrado de gran utilidad en estos pacientes alcanzando un rendimiento diagnóstico similar aunque hay factores que han demostrado afectar a la concordancia entre ambas pruebas. Así mismo, se ha descrito que la CE debería de ser la primera línea en la mayoría de los pacientes. Sin embargo, hay muchas situaciones específicas de HDM en las que no hay consenso en el papel de estas técnicas como la HDM manifiesta masiva y los tumores malignos de intestino delgado (TMID). En la presente tesis doctoral se recogen tres artículos que analizan la base de datos de pacientes del Hospital Morales Meseguer entre los años 2004-2014 en los que se realizó una CE y/o EDB por HDM, con especial énfasis en esclarecer la concordancia diagnóstica entre estas técnicas por tipo de lesión y su papel concreto en las situaciones descritas previamente. Aunque el nivel de acuerdo diagnóstico es similar entre la CE y EDB de forma global, esta puede variar notablemente para cada tipo de lesión. La concordancia diagnóstica entre CE y EDB según el tipo de lesión es alta en pólipos, lesiones vasculares y tumores. El nivel de acuerdo entre ambas es bajo en la lesión de Dieulafoy y en el sangrado sin lesión identificada.La EDB puede modificar el curso evolutivo de pacientes con TMID hasta en un 25% de los casos evitando o retrasando la cirugía. Este procedimiento permite identificar la localización tumoral y sus características, proporcionando información adicional que influye en su manejo posterior. Las lesiones vasculares y en particular la lesión de Dieulafoy situada habitualmente en ID proximal constituyen una de las casas más frecuentes de HDM manifiesta severa recurrente.La EDB urgente es un procedimiento efectivo en la HDM masiva, encontrando lesiones sugestivas de tratamiento endoscópico en la mayoría de los casos. El procedimiento combinado con CE en tiempo real se ha demostrado eficaz como primera línea, siendo especialmente útil para determinar el nivel de la hemorragia y orientar el abordaje posterior con EDB. Mid-gastrointestinal bleeding (MGIB) is the first indication of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). Both procedures have demonstrated to be useful in these patients achieving a similar diagnostic yield. However, there are many factors that may influence the agreement between both procedures. In addition, CE should be administered as first-line in most of cases. However, there are many specific situations of MGIB in which there is no consensus about the role of these techniques, such as massive overt-MGIB and malignant small bowel tumors (MSBT). In the present thesis, three articles analyzed the Morales Meseguer Hospital database. Patients in whom a CE and/or DBE was carried out between 2004 and 2014 were considered, with focus on clarifying the diagnostic agreement by type of lesion of both techniques and its role in the previously described situations. Although the degree ofdiagnosticagreement is similarbetween the CE and DBE,thiscan vary significantlyforeach type of lesion.The diagnosis agreement between CE and DBE according to the type of lesion is high in polyps, vascular lesions and tumors. The degree of agreement between both is low for Dieulafoy’s lesion and bleeding without lesion identified.DBE may modify clinical outcome of patients with MSBT in up to 25% of cases by modifying or avoiding surgery. This procedure allows to identify the tumor location and characteristics, providing additional information that may influence further management. Vascular lesions and Dieulafoy’s lesion usually located in proximal small bowel are one of the most frequent causes of recurrent severe overt-MGIB.Emergency DBE is an effective procedure in massive MGIB, finding lesions amenable to endoscopic therapy in most of cases. Combined approach with real-time by CE has shown to be effective as fist-line, being especially useful to determine the level of the bleeding and guiding further DBE route

Enhancing the current evidence on endoscopist-directed propofol-based sedation.

During the last years, there is more and more scientific evidence about the safety and feasibility of non-anesthesiologist administration of propofol (NAAP) in gastrointestinal endoscopy, reducing sedation induction and recovery time as well as increasing patient and endoscopist satisfaction. Furthermore, a similar risk of adverse events compared with traditional agents or anesthesiologist administration of propofol (AAP) has been described. The present special issue of the Spanish Journal of Gastroenterology (Revista Española de Enfermedades Digestivas) focusses on NAAP in different settings, including complex endoscopic procedures

Endoscopic ultrasound-guided drainage with lumen-apposing metal stents: a good safety profile also in the long term?

Lumen-apposing metal stents (LAMSs) have been specifically designed for the endoscopic drainage of pancreatic fluid collections and walled-off necrosis. Lately, LAMS indications have expandedto other anastomoses, and these stents have proven to be effective in multiple situations. Safety data for this device are still limited, most studies to date being focused on intraoperative complications and not long-term issues. There are little data regarding the best timing for removal and the risks associated in leaving them in place for long duration. In addition, not all the procedure-related complications have the same clinical impact, and the settings in which LAMS have been used are heterogeneous, leading to different safety profiles and outcomes. A wide consensus on the definition of complications and a list of key performance measures for LAMS placement seems mandatory to allow for a robust assessment of their long-term outcomes

Angioectasias in the elderly: Interpreting the data

We read with great interest the recent study by Nennstiel et al.1 As reported by the authors, capsule endoscopy has a higher diagnostic yield in the elderly presenting with small bowel (SB) bleeding,2 where such patients are more likely to present with overt bleeding compared to young patients. The clinical relevance of vascular lesions in elderly patients may be more challenging to determine, particularly in those with the presence of other comorbidities and polypharmacy. [...