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Nowadays, capsule endoscopy is the first-line procedure for the visualization of the small bowel. Although it was primarily designed with this goal, it may also identify other segments of the gastrointestinal tract. The aim of the current study is to evaluate the incidence of esophageal abnormalities detected in patients undergoing small bowel capsule endoscopy and its impact on patient management.This study is a retrospective analysis of data from 2217 consecutive capsule endoscopy procedures performed at a single tertiary-care centre between January 2008 and February 2016. Patient baseline characteristics, esophageal lesions, diagnosis and management before and after capsule endoscopy were recorded and a descriptive analysis was then performed.2217 patients were finally included in the analysis. 1070 were male (48.2%) and the mean age was 56.1 ± 19.5 years (12-93). Obscure gastrointestinal bleeding (52.3%) and inflammatory bowel disease (18.3%) were the main procedure indications. Esophageal abnormalities were detected in 105 out of 2217 patients (4.7%). The most common lesions detected were peptic esophagitis (58.1%) and esophageal varices (17.1%). This information had a clinical/diagnostic impact of 3.3% and a therapeutic impact of 3.2%.Capsule endoscopy detects not only small bowel lesions, but also significant esophageal lesions that may be overlooked during initial gastroscopy. Therefore, all images of the esophagus should be read during small bowel capsule endoscopy, since it could provide relevant information that may result in changes on patient´s management.

La hemorragia digestiva de origen oscuro constituye el 5-10% del total de hemorragias digestivas, siendo el intestino delgado la localización más frecuente. Por su sencillez y fiabilidad la enteroscopia con cápsula es la técnica de elección tras un primer estudio endoscópico negativo (gastroscopia e ileo-colonoscopia). Sin embargo, en ocasiones, el origen del sangrado no se identifica en el interior de éste, sino fuera y al alcance de la endoscopia convencional (esófago, estómago o colon). Presentamos el caso de un paciente de 46 años con anemia ferropénica y varios estudios endoscópicos previos negativos a quien se detectó un tumor gástrico (GIST) durante una enteroscopia con cápsula. El diagnóstico definitivo se obtuvo tras el estudio histológico de la pieza quirúrgica.

Fundamento. El hepatocarcinoma asienta generalmente sobre una cirrosis hepática. El cribado pretende mejorar la supervivencia. Los objetivos de nuestro trabajo son conocer las características del hepatocarcinoma, su evolución y la influencia del cribado en su supervivencia, en la práctica clínica en Navarra. Material y Métodos. Estudio prospectivo y retrospectivo de 111 pacientes diagnosticados de hepatocarcinoma en hospitales públicos navarros, entre enero de 2009 y enero de 2015. Se analizaron características epidemiológicas, clínicas, analíticas, radiológicas, estadio tumoral, tratamiento y evolución, y el efecto del cribado. Resultados. El 84,7% de los pacientes eran varones. La edad media fue 67 años. El 85,6% tenían cirrosis. La etiología más frecuente fue la enólica (40,7%). El 62,2% se diagnosticó en estadios tempranos, el 15,3% en intermedio y el 22,5% en avanzado o terminal. El 4,5% se trató mediante trasplante, el 21,6% con resección, el 23,4% mediante ablación, el 10,8% con quimioembolización, el 5,4% con radiembolización, el 2,7% con embolización, el 13,5% con sorafenib y el 18% de modo sintomático. Solamente 32 pacientes (28,8%) realizaban cribado. No se han encontrado diferencias significativas en la supervivencia según la realización de cribado (mediana de 32 y 34 meses; p = 0,971). Conclusiones. En Navarra, el hepatocarcinoma se desarrolla generalmente sobre una cirrosis, cuya etiología más frecuente es el consumo de alcohol. El hepatocarcinoma se ha diagnosticado con más frecuencia en estadios iniciales, fuera de cribado. El cribado no ha mejorado la supervivencia. Background. Hepatocellular carcinoma generally arises in a cirrhotic liver. The aim of screening is to improve survival. The aims of our study are to determine the characteristics and evolution of hepatocellular carcinoma and the effect of screening on survival, in clinical practice in Navarre. Methods. Prospective and retrospective study of 111 patients diagnosed with hepatocellular carcinoma in public hospitals in Navarre between January 2009 and January 2015. Epidemiological, clinical, analytical, radiological characteristics, tumour staging, treatment and evolution were analyzed. Survival was compared between patients subjected to screening and those not. Results. Mean age was 67 years. The patients (84.7%) were mainly male and 85.6% had cirrhosis. The most frequent aetiology was alcohol consumption (40.7%). 62.2% were diagnosed in early stages, 15.3% in intermediate and 22.5 % in advanced or terminal stages. 4.5% received transplants, 21.6% received surgical resection, 23.4% were treated with ablation techniques, 10.8 % with chemoembolization, 5.4% with radiembolization, 2.7% with embolization, 13.5 % with sorafenib and 18% symptomatically. Only 32 patients (28.8%) were subjected to screening. No statistical differences were found in survival depending on surveillance (32 month versus 34; p = 0.971). Conclusions. In Navarre, hepatocellular carcinoma generally appears against a background of cirrhosis, and alcohol is the most frequent aetiology. Hepatocellular carcinoma is diagnosed most frequently in early stages and out of screening practices. Screening was not associated to better survival.

The choledochocele is a cystic dilatation of the intraduodenal portion of the bile duct and corresponds to the type III biliary cysts in the Todani ´s classification. Eventhough the majority of patients remain asymptomatic they can be an atypical cause of abdominal pain or relapsing acute pancreatitis events. The risk of malignancy is lower than other choledochal cyst (2,5%). The treatment is based on surgical or new endoscopic techniques of resection. In some of the cases an endoscopic sphincterotomy is the first approach.