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Background An increased risk of lymphoma has been described in patients with Inflammatory Bowel Disease (IBD). The aims of our study were to determine the clinical presentation of lymphoma, previous exposure to immunosuppressive and biologic therapies, and the management and evolution of lymphomas in patients with IBD. Methods IBD patients with diagnosis of lymphoma from October 2006 to June 2021 were identified from the prospectively maintained ENEIDA registry of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU). Investigators at each participating centre provided additional information on lymphomas. Results We identified 52 patients with lymphoma in 18 centres following 21,740 patients with IBD (2.4 cases of lymphoma/1,000 patients with IBD; 95% CI 1.8-3.1). 35 were men (67%) and 27 (52%) had Ulcerative Colitis. Non-Hodgkin lymphoma was the most common lymphoma (65%). The median age at diagnosis of lymphoma was 59 years old (IQR 48-67). 31 patients (60%) received thiopurines, and 20 (38%) an anti-TNF drug (one of them had not received thiopurines) before lymphoma diagnosis. Age at diagnosis of lymphoma was lower in those patients treated with thiopurines (53 ± 17 years old) and anti-TNF drugs (47 ± 17 years old) than in those patients not treated with thiopurines nor anti-TNF drugs before the diagnosis of lymphoma (63 ± 12 years old; p Conclusion Most IBD patients with lymphoma had been treated with thiopurines and/or anti-TNF agents before lymphoma diagnosis, and these patients were younger at diagnosis of lymphoma than those not treated with these drugs. IBD treatment was usually changed after a diagnosis of lymphoma. Relapse and mortality of lymphoma were not related to the use and duration of thiopurines or biologic therapies.

Introduction: gastric varices hemorrhage is a severe complication of portal hypertension, with high mortality rates and few management alternatives, especially when there is a contraindication to transjugular intrahepatic portosystemic shunts (TIPS). The usual therapeutic options are the injection of cyanoacrylate, the insertion of coils or both. Hydrocoils are special coils coated with different types of expandable hydrogel polymers conventionally used in neurovascular interventionism. They allow rapid occlusion of vessel, forming a mesh that favors the local formation of thrombus and the development of a neointima on the gel cover. We consider the use of endoscopic ultrasound (EUS) guided hydrocoil insertion in gastric varices, without using cyanoacrylate. Objective: this study aimed to evaluate the safety and effectivity of the application of EUS-guided hydrocoils in patients with gastric varices hemorrhage with TIPS contraindication. Material and methods: this was a retrospective case series of four patients with TIPS contraindication after interventional radiologist evaluation. Linear echoendoscopes, fluoroscopy, 19G needles and hydrocoils (Azur®, Terumo) and Progreat® 3 Fr microcatheters were used. An interventional radiologist expert advised the procedures and endoscopic ultrasound confirmed the varix obliteration. Results: technical and clinical success occurred in all patients involved in this study. There were no adverse effects related to the procedure or endoscopic equipment damage. Conclusions: the application of EUS-guided hydrocoils can be a safe and effective method in the short term for gastric varices bleeding in patients who are not candidates for TIPS. Besides, a complete obliteration of the vascular lumen could occur and thus, dispense with the use of cyanoacrylate. Further studies are needed to corroborate these preliminary results.

Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C, including transplant recipients with an advanced fibrosis stage. Our aim in this study was to assess the clinical and functional benefits and improvement in liver fibrosis after treatment with DAAs in liver transplant recipients with chronic hepatitis C virus who achieved sustained virologic response (SVR).We retrospectively analyzed 42 patients who underwent liver transplantation (LT) at our institution and were treated with DAAs from June 2014 to December 2015. Two patients died, so we ultimately included 40 transplant patients with chronic hepatitis C who received DAAs and achieved SVR. We assessed liver function, fibrosis stage, and clinical features at the start of the treatment, and then at 6 and 12 months after SVR. The indication for LT was hepatocellular carcinoma in 8 patients (20%) and Child-Pugh score B/C in 32 patients (80%).The DAAs regimens were sofosbuvir plus daclatasvir (45.0%), simeprevir plus sofosbuvir (42.5%), sofosbuvir plus ledipasvir (7.5%), and ombitasvir/paritaprevir/ritonavir (5%). The mean Modified End-stage Liver Disease (MELD) score pretreatment was 10.78, and was 8.46 at 1 year after treatment (P .05). In addition, fibrosis stage decreased significantly from 14.81 kPa to 9.07 kPa (FibroScan) at 12 months after SVR. Clinically, there was a significant improvement, including control of ascites and chronic hepatic encephalopathy.DAAs were used successfully in the treatment of hepatitis C after orthotopic liver transplantation and resulted in significant improvement in liver function as measured by MELD score, fibrosis level, and cirrhotic clinical condition, even in patients with very advanced disease.

Introduccion: La Entero-Anastomosis Endoscopica (EAE) es un procedimiento novel realizado en modelos animales y excepcionalmente en pacientes. Puede utilizarse para lograr acceso a la via biliar (ABV) en anatomia postquirurgica o restablecer el transito en casos de obstruccion al vaciamiento gastrico (OVG). Objetivo: Identificar las EAE realizadas en un hospital terciario y estudiar los aspectos tecnicos y resultados. Material y Metodo: identificamos retrospectivamente de una base prospectiva recogida del 01/01/12 al 30/06/15, los pacientes con EAE. En todos los casos se utilizo una protesis metalicas de aposicion luminal (PMAL) 15 × 10 mm, insertado con Ecoendoscopia sectorial, bajo sedacion con Propofol. Resultados: 16 pacientes con edad media de 71,1 anos (SD 11,01). Un paciente fue excluido del analisis por falta de ventana endoscopica. En 10 pacientes con anatomia postquirurgica se realizo para AVB (2 pacientes oncologicos), mediante Gastro-Yeyunostomia (50%), Yeyuno-Yeyunostomia (20%) y Yeyunostomia percutanea (20%). Exito tecnico 80% y exito clinico 60% (entendido como posibilidad de AVB); con un 20% de complicaciones (perforacion) y una migracion de PMAL con el paso del Duodenoscopio. En 5 pacientes (100% oncologicos), se realizo EAE por OVG, con fracaso previo de los tratamientos endoscopicos convencionales. El 80% mediante Gastro-Yeyunostomia, el 20% Gastro-Duodenostomia. Exito tecnico 60%, exito clinico 40% (posibilidad de ingesta oral tras la exploracion). Tasa de complicaciones del 20% con perforacion, peritonitis y posterior fallecimiento. No se produjo migracion de PMAL al realizar endoscopia trans-stent con un gastroscopio pediatrico o convencional. Conclusiones: La EAE parece un procedimiento seguro y efectivo para facilitar el AVB en pacientes con anatomia postquirurgica, igual que para solucionar la OVG en casos de obstruccion neoplasica en pacientes paliativos, desestimados para cirugia. Serian necesarios estudios mas amplios y prospectivos para confirmar los resultados obtenidos.