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Background & Aims Most fulfillment and benchmarking information for colonoscopy quality indicators has been obtained from studies of primary screening colonoscopies. We analyzed differences in the fulfillment of colonoscopy quality indicators based on the indication for endoscopy. Methods We performed an observational, multicenter, cross-sectional study of 14,867 patients who underwent endoscopy procedures for gastrointestinal symptoms (40.3%), a positive result from a fecal immunochemical test (36.0%), postpolypectomy surveillance (15.3%), or primary screening (8.4%), from February 2016 through December 2017 at 14 centers in Spain. We evaluated rates of adequate colon cleansing, cecal intubation, adenoma detection, and colorectal cancer detection, among others. We used findings from primary screening colonoscopies as the reference standard. Results Fewer than 90% of patients had adequate bowel preparation; 83.1% of patients with gastrointestinal symptoms had adequate bowel preparation (odds ratio [OR] compared with patients with primary screening colonoscopies, 0.62; 95% CI, 0.49–0.78) and 85.3% of patients receiving postpolypectomy surveillance had adequate bowel preparation (OR, 0.71; 95% CI, 0.55–0.91). The cecal intubation rate was also lower in patients with gastrointestinal symptoms (93.1%) (OR, 0.34; 95% CI, 0.22–0.52). The adenoma detection rate was higher in patients with a positive result from a fecal immunochemical test (46.4%) (OR, 2.01; 95% CI, 1.71–2.35) and in patients undergoing postpolypectomy surveillance (48.2%) (OR, 1.41; 95% CI, 1.20–1.67). The highest proportion of patients with colorectal cancer was in the gastrointestinal symptom group (5.1%) (OR, 5.24; 95% CI, 2.30–11.93) and the lowest was in patients undergoing surveillance (0.8%) (OR, 0.83; 95% CI, 0.32–2.14). Conclusions Fulfillment of colonoscopy performance measures varies substantially by indication. Policies addressing performance measures beyond colonoscopy screening procedures should be developed. Benchmarking recommendations could be adjusted according to colonoscopy indication.

Aim: to describe the management of acute calculous cholecystitis in a tertiary teaching hospital and the outcomes obtained. Material and methods: a retrospective single tertiary center cohort study. Results: medical records of 487 patients were analyzed. The mean follow-up was 44.5 ± 17.0 months. Treatment alternatives were cholecystectomy (64.3%), conservative treatment (23.0%), endoscopic retrograde cholangiopancreatography (17.4%), percutaneous cholecystostomy (10.7%) and endoscopic ultrasound-guided gallbladder drainage (0.8%). Most cholecystectomies were delayed (88.8%). Recurrences occurred in 38.2% of patients. Although cholecystectomy was the therapeutic approach with the lowest recurrence rate once performed, 44.6% of patients that underwent delayed surgery had pre-surgical recurrences. Conclusions: delayed cholecystectomy is still commonly performed, even though it is related with a high frequency of preoperative recurrences

Resumen Introduccion Los salicilatos son el tratamiento de eleccion en la fase de mantenimiento de la colitis ulcerosa. El primer salicilato fue la sulfasalazina, practicamente sustituida por la mesalazina por su supuesta mejor tolerancia. Estudios recientes indican que la mesalazina podria ser menos eficaz que la sulfasalazina. Nos planteamos si los pacientes mal controlados con mesalazina en fase de mantenimiento podrian responder a sulfasalazina antes de progresar a inmunosupresores o biologicos. Metodos De los pacientes con colitis ulcerosa de la consulta de Enfermedad Inflamatoria Intestinal del Hospital Ramon y Cajal, seleccionamos los tratados con mesalazina y en los que la sulfasalazina se habia utilizado como tratamiento de mantenimiento de rescate. Determinamos que porcentaje de pacientes insuficientemente controlados con mesalazina respondieron a sulfasalazina. Resultados De 415 pacientes con colitis ulcerosa, 49 habian tomado SSZ en algun momento. En 31, este tratamiento se indico como alternativa a la ineficacia de la mesalazina. El tiempo medio de tratamiento con mesalazina antes del cambio habia sido de 20,8 meses, siendo la dosis media utilizada de 3,35 g/dia. La dosis media de sulfasalazina empleada fue de 2,5 g/dia. En 21 de los 31 pacientes (67,7%) se consiguio mantener la remision con la sulfasalazina. Conclusion A pesar de las limitaciones de nuestro estudio, en el 67,7% de los pacientes con colitis ulcerosa mal controlados con mesalazina, el cambio a sulfasalazina resulto eficaz. Dado que se trata de pacientes en los que el siguiente paso seria el empleo de inmunosupresores o biologicos, creemos que esta opcion merece estudios controlados y que en todo caso la sulfasalazina no debe desterrarse en el manejo de pacientes con colitis ulcerosa.

Diagnosis of refractory celiac disease (CD) is based on exclusion of other disorders, persistence of malabsorptive symptoms and villous atrophy, despite a strict gluten-free diet for at least 6-12 months. Detection of alterations in the intraepithelial lymphocyte population is crucial for diagnosis. A subgroup of patients with refractory CD may develop severe complications such as enteropathy-associated T cell lymphoma (EATL). We present the case of a patient with longstanding silent CD who developed EALT, highlighting the challenge posed by the diagnosis and treatment of this entity.

Collagenous sprue is a rare disease of the small bowel characterized by mucosal atrophy and excessive subepithelial collagen deposition. The etiology remains unclear and the diagnosis is based upon patient's clinical picture and anatomopathological findings. Clinically, collagenous sprue is characterized by persistent diarrhoea, severe malabsorption, multiple nutrient deficiencies and progressive weight loss. Differential diagnosis includes celiac disease, which is mandatory to rule out because of their frequent association. Gluten-free diet is the first therapeutic step, but it usually is not effective. However, recent studies show high success rates with immunomodulators, mainly corticosteroids. We report the case of a patient presenting with chronic diarrhea and severe malabsorption who was diagnosed with collagenous sprue, with no response to gluten free diet, but with excellent response to budesonida.