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Introduction: Gastrointestinal stromal tumors (GIST) are rare, reported incidence is between 10 to 15 cases per million of habitants. They are usually located in the stomach (56%), small intestine (32%), colon-rectum (6%), and esophagus (<1%). Its symptoms include nausea, vomiting and abdominal fullness; 30% are asymptomatic. Incidental finding during abdominal surgery or imaging studies is common. Resection with negative margins is the standard treatment., Case Report: A 69-year-old female patient who debuted with massive digestive tract bleeding, requiring surgical treatment. A tumor was detected at jejunum compatible with a GIST., (Copyright: © 2024 Permanyer.)

Introduction: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception., Method: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period., Results: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically., Conclusion: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously., (Copyright © 2021 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis., (Copyright © 2021 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Aim: Graft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD., Materials and Methods: A retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard., Results: Twenty-one patients with GvHD (7 [33%] women; 37 ± 11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55 minutes (20-113) and the median small bowel transit time was 261 minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively., Conclusions: Capsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings., (Copyright © 2020 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Introduction: Intussusception is the insertion of a bowel loop segment into an adjacent segment. Unlike in children, where the condition is mainly idiopathic, intussusception in adults is more often associated with severe disease. The growing use of imaging studies to evaluate the abdomen has resulted in a higher rate of detection of cases of intussusception without underlying disease in which it is not possible to determine the cause. This study aimed to review the clinical presentation, evaluation, and treatment of patients in whom abdominal ultrasonography or computed tomography diagnosed intussusception., Method: We retrospectively reviewed radiology reports of abdominal ultrasound and computed tomography studies done at our hospital in a 10-year period., Results: In the 40 cases found, intussusception was an incidental finding in 10%. No underlying cause was identified in 68%, and posterior imaging studies showed spontaneous resolution in 75%. The most common symptom was abdominal pain, being present in 60%. Intussusception affected only the small bowel in 90% of cases (entero-enteric intussusception). Intussusception was attributed to malignancy in only 8% of cases. In 7 patients, intussusception was resolved surgically., Conclusion: The increased use of abdominal imaging has shown that a significant proportion of cases of intussusception are idiopathic and resolve spontaneously., (Copyright © 2021 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis., (Copyright © 2021 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: The purpose of the study was to evaluate the effect of oral administration of n-3 polyunsaturated fatty acids in experimental ischemic enteritis in rats., Methods: Forty Wistar rats were submitted to control narrowing of the superior mesenteric artery and were divided in two groups: N3 polyunsaturated fatty acids, which received a high-molecular polymer solution of artificial total enteral nutrition enriched with n-3 fatty acids and CONTROL which received a high-molecular polymer solution of artificial total enteral nutrition., Results: Reduction of the animals' body weight was observed in both groups, but there was no difference between the two groups. Regarding the level of cytokines interleukin (IL)-1b, IL-6, and tumor necrosis factor a (TNF-a) there was no statistically significant difference between the two groups. Ischemic lesions to the small bowel mucosa were observed in both groups. A statistically significant difference in the extent of intestinal lesions was observed between the two groups with the animals that received enteral nutrition enriched with n-3 fatty acid developing fewer lesions., Conclusion: Enteral nutrition enriched with n-3 polyunsaturated fatty acids reduces the mucosal lesions caused by mesenteric ischemia compared to standard enteral nutrition, by modifying the local, but not the systemic, immune, and inflammatory response.

Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis., (Copyright © 2020 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Aims: Capsule endoscopy has revolutionized the study of small bowel disorders. Its diagnostic yield, reasons for referral, and frequency of significant endoscopic findings at our institution are unknown. The aims of our study were to describe the reasons for referral, the frequency of significant endoscopic findings, and the diagnostic yield of capsule endoscopy in patients that underwent the procedure for the study of small bowel disorders., Material and Methods: A retrospective study was conducted that included all patients that underwent capsule endoscopy for small bowel disorder evaluation at our institution. The diagnostic yield for significant endoscopic findings, the frequency of significant endoscopic findings, and the reasons for referral for capsule endoscopy were determined., Results: A total of 134 patients were included in the study and 143 capsule endoscopies were performed. Women made up 48.5% of the sample and the mean patient age was 63 years (18.7 standard deviation). The main reasons for referral were suspicion of overt small bowel bleeding (55.9%) and suspicion of occult small bowel bleeding (28.6%). The overall diagnostic yield was 66.4%. The most common significant findings were small bowel angioectasias (52.6%) and small bowel ulcers (38.9%). There were two adverse events (1.3%): one capsule retention that required enteroscopic removal and one asymptomatic bronchoaspiration of the capsule that resolved spontaneously., Conclusions: The frequency of significant endoscopic findings with capsule endoscopy at our institution was different from that reported in other Mexican studies, but the reasons for referral and the diagnostic yield were similar., (Copyright © 2019 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Introduction and Aims: Double-balloon enteroscopy is a recently introduced endoscopic method that enables complete visualization of the small bowel, as well as biopsy sampling and therapeutic interventions in that part of the intestine. The aim of the present study was to describe the experience acquired at our hospital to determine the characteristics of the patients that underwent the procedure., Materials and Methods: A descriptive, cross-sectional study was conducted on all patients above 18 years of age admitted to the Hospital Universitario de la Fundación Santa Fe de Bogotá for double-balloon enteroscopy, within the time frame of January 2013 to December 2017., Results: The study sample included 93 procedures in 73 patients. Mean patient age was 57.91 years, with a similar number of men and women. There were no severe complications. The most frequent indication for the enteroscopy was gastrointestinal bleeding (overt or occult), presenting in 49.46% of the patients, followed by chronic diarrhea (16.13%). Video capsule endoscopy was the previous study most frequently performed (53.76%). Anterograde double-balloon enteroscopy was carried out in 49 patients and 44 patients underwent the retrograde procedure. A total of 86.02% of the enteroscopies were diagnostic procedures and 13.98% were therapeutic. Normal enteroscopy was the most frequent finding (59.68%), followed by the presence of ulcers (15.05%)., Conclusions: Our results were similar to those reported worldwide, with respect to indications, insertion route, and insertion depth, and there were no severe complications., (Copyright © 2019 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Introduction and Objective: The SB3 capsule endoscopy system has better image resolution and the capacity to increase the number of images from 2 to 6 frames per second. Small bowel bleeding is the most common indication. The aim To determine if the advances in capsule endoscopy technology increase diagnostic yield in cases of small bowel bleeding, according to the Saurin classification., Material and Methods: A retrospective, observational, analytic, cross-sectional study included 100 SB2 capsule endoscopies and 100 SB3 capsule endoscopies in patients that presented with small bowel bleeding. The findings obtained with both systems were evaluated. The lesions identified by the two capsules were categorized using the Saurin classification. The relation between the lesions identified with the SB3 and those found with the SB2 was identified through a logistic regression analysis., Results: In the SB2 capsule endoscopy group, 60% were women, patient age was 59 years (42.2, 73), and intestinal transit time was 271min (182, 353). In the SB3 group, 57% were women, patient age was 60 years (42.5, 73), and intestinal transit time was 277min (182, 352). There were no significant differences in the identification of P0 and P2 lesions between the two systems. The SB3 capsule endoscope identified more P1 lesions (p=0.020, OR: 2.35, 95% CI:1.12-4.90). There was no significant difference in relation to location of the lesions in the small bowel., Conclusions: A greater number of P1 lesions were detected through the technologic advances made in SB3 capsule endoscopy, but the diagnostic yield for P2 lesions was not modified., (Copyright © 2019 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Video capsule endoscopy (VCE) is a reliable noninvasive method for examination of small-bowel mucosa. However, it has some limitations. The aim of this article was to review the approach in patients with negative VCE. It is clear that a negative VCE should be interpreted based on the indication. In suspected small bowel bleeding (SSBB), patients with ongoing/recurrent overt bleeding, or occult bleeders who experience significant declines in hemoglobin after a negative VCE should proceed small bowel study; on the other hand, patients with occult SSBB and only mild-moderate anemia should be managed with supportive care. In inflammatory bowel disease, a normal VCE has a very high sensitivity and negative predictive value. In small bowel tumor suspicion there is a high risk of false negative results, so another imaging modality should be considered. In polyposis syndromes, if VCE is negative, patients should continue screening within 2-3 years., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Introduction and Aims: The growing elderly population and wide use of capsule endoscopy have led to a higher number of procedures in those patients. The aim of the present study was to assess the usefulness of capsule endoscopy in older patients., Materials and Methods: All consecutive patients undergoing capsule endoscopy at our center within the time frame of 2004-2016 were classified as older (≥75 years of age) and younger. Findings and diagnostic yield were comparatively assessed., Results: Of 2311 patients (mean age: 59.5 ± 19.23 years, 44.48% male), 648 were in the older group and 1663 in the younger group. Gastric transit time was shorter in the older patients (p=0.001), whereas small bowel transit time was shorter in the younger patients (p<0.001). Overall diagnostic yield in the elderly was higher (50.66% vs. 41.19%, p<0.001). Obscure gastrointestinal bleeding was the most frequent indication for capsule endoscopy in the elderly (90.4% vs. 53.77%, p<0.001), achieving a higher diagnostic yield than in the younger population (51.47% vs. 42.76%, p=0.002), whereas Crohn's disease, suspected or known neoplasms/polyps, malabsorption syndrome, and abdominal pain were the indications in the younger patient group. Such indications were rare in the older group. Vascular lesions and active bleeding were more frequently diagnosed in the older patients, whereas ulcers/erosions and mucosal atrophy were more common in the younger patients (p<0.001)., Conclusions: Capsule endoscopy achieved a higher overall diagnostic yield in the elderly patients. Obscure gastrointestinal bleeding indication for capsule endoscopy was much more frequent in the advanced-age group and had a higher diagnostic yield., (Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Introduction and Aims: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications., Materials and Methods: All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings., Results: The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma., Conclusions: Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield., (Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.)

Background: The gastrointestinal stromal tumours (GIST) are the most common soft tissue sarcomas of the digestive tract. They are usually found in the stomach (60-70%) and small intestine (25-30%) and, less commonly, in the oesophagus, mesentery, colon, or rectum. The symptoms present at diagnosis are, gastrointestinal bleeding, abdominal pain, abdominal mass, or intestinal obstruction. The type of symptomatology will depend on the location and size of the tumour. The definitive diagnosis is histopathological, with 95% of the tumours being positive for CD117., Clinical Cases: This is an observational and descriptive study of 5cases of small intestinal GIST that presented with gastrointestinal bleeding as the main symptom. The period from the initial symptom to the diagnosis varied from 1 to 84 months. The endoscopy was inconclusive in all of the patients, and the diagnosis was made using computed tomography and angiography. Treatment included resection in all patients. The histopathological results are also described., Conclusion: GIST can have multiple clinical pictures and unusual symptoms, such as obscure gastrointestinal bleeding. The use of computed tomography and angiography has shown to be an important tool in the diagnosis with patients with small intestine GISTs., (Copyright © 2016. Publicado por Masson Doyma México S.A.)

Introduction: Capsule endoscopy was approved by the FDA in 2001. Gastrointestinal bleeding and inflammatory bowel disease are the main indications. It has been available in our hospital since 2004., Methods: We retrospectively analysed data from patients who underwent small bowel capsule endoscopy in our hospital from October 2004 to April 2015. Indications were divided into: Obscure gastrointestinal bleeding (occult and overt), inflammatory bowel disease, and other indications. Findings were divided into: Vascular lesions, inflammatory lesions, other lesions, normal studies, and inconclusive studies., Results: A total of 1027 out of 1291 small bowel studies were included. Mean patient age was 56.45 years; 471 were men and 556 women. The most common lesion observed was angiectasia, as an isolated finding or associated with other lesions. Findings were significant in up to 80% of studies when the indication was gastrointestinal bleeding, but in only 50% of studies in inflammatory bowel disease. Diagnostic yield was low in the group «other indications». No major complications were reported., Discussion: Small bowel capsule endoscopy has high diagnostic yield in patients with gastrointestinal bleeding, but yield is lower in patients with inflammatory bowel disease., Conclusions: Our experience shows that capsule endoscopy is a safe and useful tool for the diagnosis of small bowel disease. The diagnostic yield of the technique in inflammatory bowel disease must be improved., (Copyright © 2016 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.)

Background: Among the rarest types of cancer found are the small intestine malignancies, representing only 2% of all gastrointestinal cancer and 0.1-0.3% of all malignancies. The most common subtype of this tumour is the adenocarcinoma, which is located mainly in the duodenum, jejunum and, rarely, in ileum., Clinical Case: A 75 year-old male, with no any surgical history, who in the previous three months, referred to two clinical episodes of partial bowel obstruction and unquantified weight loss. When admitted into the surgical service, the patient referred to a partial bowel obstruction of more than one week onset. A laparotomy was performed, finding 3 stenosis rings at the ileum end portion, carrying out an intestinal resection and enteral-enteral anastomosis. On the seventh day there was dehiscence of the anastomosis and abdominal sepsis. New surgery was performed with the resection of the intestinal anastomosis and an ileostomy. The pathologist report indicated a small bowel adenocarcinoma moderately differentiated, ulcerated, and multifocal. It was classified as stage III or T3N1M0. The patient progress was satisfactorily, managed as outpatient with postoperative chemotherapy with 5 fluorouracil and cisplatin. The patient died a year later due to liver metastases., Conclusions: Due to the extreme rarity of the case, is very likely that general surgeons may find one or two cases of adenocarcinoma of the ileum in their professional career. Thus, they must suspect this pathology when faced with an episode of intestinal obstruction in the adult., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Introduction: Obscure gastrointestinal bleeding (OGIB) is defined as bleeding from the gastrointestinal tract with no obvious cause after assessment with upper and lower gastrointestinal endoscopy. In these cases, the source is suspected to be in the small bowel. Obscure bleeding can be occult or overt. The aim of this study was to analyze the clinical and analytical characteristics and findings on capsule endoscopy in patients with OGIB and to determine the factors related to the detection of lesions in both forms of presentation., Methods: We performed a retrospective study of capsule endoscopies carried out between November 2009 and November 2012 for OGIB., Results: We analyzed 284 capsule endoscopies in 272 patients. Initially, 12 procedures could not be evaluated and were repeated. A total of 272 procedures were finally included in the analysis. The results of 114 (41.9%) capsule endoscopies were normal. Compared with patients with occult OGIB, those with overt OGIB were significantly older (70.2 vs. 67.5 years; p = 0.04), consumed more NSAID (24.2% vs. 11.9%; p = 0.01), had higher hemoglobin levels (9.3 vs. 10.4; p < 0,001) and more frequently required transfusion (64.5% vs 32.2%; p < 0.001). No differences were found between the two forms of presentation in the detection of canker sores-ulcers and polyps-masses. Vascular lesions were more frequently detected in overt than in occult OGIB (40.3% vs. 25.7%, respectively), (p < 0.05). When the total number of diagnoses carried out by capsule endoscopy was analyzed, no differences were found in diagnostic yield between overt OGIB (57%) and occult OGIB (54%), (p = 0.6). In overt OGIB, multivariate analysis showed that the variables that significantly predicted the detection of lesions on capsule endoscopy were consumption of medication NSAID (OR 2.75; p = 0.01), antiplatelets and anticoagulants (OR 2.64; p = 0.03) and analytical data hemoglobin (OR 3.23; p < 0.001) and INR (OR 1.8; p = 0.02). In occult OGIB, multivariate analysis showed that the factors significantly related to the detection of lesions on endoscopy were age (OR 1.9; p = 0.04) and NSAID consumption (OR 2.1; p = 0.01)., Conclusions: Capsule endoscopy is essential in the assessment of OGIB. Although the diagnostic yield was similar in both forms of presentation, vascular lesions were more frequently detected in overt OGIB. The diagnostic yield of capsule endoscopy could be optimized by taking into account the form of presentation (overt vs. occult) and certain clinical and analytic data (age, drug consumption, hemoglobin)., (Copyright © 2014 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.)

Radiology with oral contrast, or enteroclysis, have traditionally been the techniques of choice in the examination of the small intestine, due to the excellent visualisation of the mucosal pattern. However, the absence of extra-luminal information and the use of ionising radiation have replaced these examinations with sectional techniques which enable the abdominal cavity to be viewed with good resolution. Magnetic resonance enterography is a simple technique, with no ionising radiation, provided quality images, distends the intestinal lumen well by the administration of non-reabsorbable oral substances, minimises peristalsis, and establishes a protocol which includes sequences with intravenous contrast. These properties can be used in patients with Crohn's disease, achieving good diagnostic precision in the assessment of activity and monitoring of treatment, in intestinal obstruction, in the suspicion of small intestine tumours, and in paediatric patients due to it being harmless., (Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.)