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Barrett's esophagus is an area of great interest in Gastroenterology, with an increasing number of research studies being published in recent years and decades. Due to the fast growing evidence regarding this disease, it has become extremely difficult to keep updated on this subject. The present review article aims to summarize and update what is known regarding diagnosis and therapy in Barrett's esophagus. A critical and detailed review is made and the role of surveillance for this condition, techniques available for diagnosis (standard white light endoscopy, virtual chromoendoscopy, magnification...) and treatment (mucosectomy, ablation...) are presented. New and emerging technologies are described in detail and existing evidence is presented.

Lung cancer is one of the most frequent neoplasms in our environment, and represents the first cause of cancer related death in western countries. Diagnostic and therapeutic approach to these patients may be complicated, with endoscopic ultrasound guided fine needle aspiration (EUS-FNA), classically performed by gastroenterologists, playing a very important role. As this disease is not closely related to the "digestive tract", gastroenterologists have been forced to update their knowledge on this field o adequately diagnose this significant group of patients. The recent advent of modern and promising techniques like endobronchial ultrasound guided fine needle aspiration (EBUS-FNA) have prompted new approaches for diagnosis and staging of this type of patients. In this clinical guideline, the "Sociedad Española de Endoscopia Digestiva" (SEED), "Sociedad Española de Patología Digestiva" (SEPD) and the "Asociación Española de Gastroenterología", have jointed efforts to update the existing knowledge on the field and provide their members with evidence based recommendations.

Background: endoscopic ultrasonography (EUS) and magnetic resonance cholangiography (MRC) are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC). Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRC and EUS were compared, and so their impact in the management of these patients. Results: seventy six patients were evaluated (lithiasis in 30% of them). Sensitivity and diagnostic accuracy of EUS (100%, 92%) were significantly higher than MRC values (0%, 70%) (p < 0.05). EUS findings (suspicion of choledocholithiasis) favored a significant change in therapeutic attitude (therapeutic ERCP was performed) in 38% of the patients (in which MRC had ruled out the presence of choledocholithiasis, and so, ERCP had not been performed) (p < 0.05). Conclusions: EUS allows the diagnosis of lithiasis in approximately 1/3 of patients with intermediate suspicion of choledocholithiasis and normal MRC. EUS findings involve a significant change in the management of these patients; this supports the use of EUS in clinical practice.Antecedentes: la ultrasonografía endoscópica (USE) y la colangiografía por resonancia magnética nuclear (CRM) son las técnicas de elección para el diagnóstico de litiasis en la vía biliar. Aunque la CRM es mejor aceptada por los pacientes, la sensibilidad de esta para detectar litiasis de pequeño tamaño podría ser insuficiente. Objetivo: estudiar de forma prospectiva la precisión diagnóstica y el impacto terapéutico de la USE en los pacientes con sospecha intermedia de coledocolitiasis y CRM normal. Material y métodos: se incluyeron prospectivamente durante 24 meses todos los pacientes con sospecha clínica intermedia de coledocolitiasis y CRM negativa. Se compar�� la sensibilidad, especificidad, precisión diagnóstica, valor predictivo positivo y negativo de CRM y USE, así como su impacto en el tratamiento. Resultados: se evaluaron 76 pacientes (litiasis en el 30%). La sensibilidad y precisión diagnóstica de USE (100%, 92%) eran significativamente superiores a las alcanzadas por la CRM (0%, 70%) (p < 0,05). Los hallazgos de la USE (sospecha de coledocolitiasis) propiciaron un cambio significativo en la actitud terapéutica (realización de CPRE terapéutica) en el 38% de los pacientes (CRM había descartado coledocolitiasis y contraindicado la CPRE) (p < 0,05). Conclusiones: en pacientes con sospecha intermedia de coledocolitiasis y CRM normal, la USE permite diagnosticar litiasis en aproximadamente una tercera parte de ellos. Los hallazgos endosonográficos permiten modificar significativamente la actitud terapéutica en estos pacientes, lo que apoya su utilización en la práctica clínica diaria.

Background and objective: the prevalence of gastric polyps in esophagogastroduodenoscopies (EGDs) ranges between 0.33 and 6.35%. The relative frequency of histological subspecies varies widely among published series. The objective is to describe the endoscopic and histological characteristics of the polypoid lesions, and to study possible associations. Material and methods: we retrospectively revised the EGDs done in our center in 2009. Demographic, endoscopic and histological data were gathered. We proceeded to a descriptive analysis and studied possible associations. Results: gastric polypoid lesions were found in 269 of the 6,307 (4.2%) reviewed EGDs, 61% were found in women. Mean age was 64.93 years (SD: ±15.23). A single polyp was found in 186 patients (69.1%), over 10 lesions appeared in 31 (11.5%). An estimated size of ≤ 3 mm was found in 108 lesions (37.2%) and greater than 10 mm in 52 cases (17.9%). Most lesions were sessile (90.8%). The location of 34.8% was the gastric antrum, 39.3% were found in the gastric body and 25.9% were in the fundus. Chronic gastritis was confirmed in 53.5% of the patients and 46.5% had received PPIs. Histopathological diagnosis was: hyperplastic polyps 50.9%, fundic gland polyps 7.4%, adenomas 3%, adenocarcinomas 1.9% and normal mucosa 29.7%. We found no significant association between the histopathological type of lesions and the use of proton pump inhibitor. Conclusions: we found polypoid lesions in 4.2% of the EGDs. The most frequent histopathological findings were hyperplastic polyps (50.9%), followed by fundic gland polyps (7.4%), adenomas (3%), and adenocarcinomas (1.9%).Antecedentes y objetivo: la prevalencia de pólipos gástricos en la endoscopia digestiva alta (EDA) oscila entre el 0,33 y el 6,35%. La frecuencia de los subtipos histológicos varía ampliamente entre las series publicadas. El objetivo de nuestro estudio es describir las características endoscópicas e histológicas de los pólipos hallados en las EDA y valorar posibles asociaciones. Material y métodos: revisamos retrospectivamente las EDA realizadas en nuestro centro en 2009. Se recogieron variables demográficas, endoscópicas e histológicas. Se realizó un análisis descriptivo y se estudiaron posibles asociaciones. Resultados: se analizaron 6.307 EDA identificándose lesiones polipoideas en 269 (4,2%), el 61% en mujeres. La edad media fue de 64,93 años (DE: ±15.23). En 186 pacientes (69,1%) se objetivó un solo pólipo y en 31 (11,5%), más de 10. Se estimó un tamaño ≤ 3 mm en 108 lesiones (37,2%), y mayor de 10 mm en 52 casos (17,9%). La mayoría de los pólipos eran sésiles (90,8%). El 34,8% se ubicaban en antro, el 39,3% en cuerpo y el 25,9% en fundus. El 53,5% de los pacientes presentaba gastritis crónica y el 46,5% había recibido inhibidores de la bomba de protones (IBP). Los hallazgos histológicos principales fueron: pólipos hiperplásicos 50,9%, pólipos de glándulas fúndicas 7,4%, adenomatosos 3% y adenocarcinomas 1,9%. En el 29,7% la biopsia mostró una mucosa normal. No se objetivó asociación entre el tipo histológico y el consumo de IBP. Conclusiones: encontramos lesiones polipoideas en el 4,2% de las EDA. La histología relevante más frecuente fueron pólipos hiperplásicos (50,9%), de glándulas fúndicas (7,4%), adenomas (3%) y adenocarcinomas (1,9%).

Interventional endoscopy is a field that continues to grow rapidly. A novel prototype forward-viewing echoendoscope (FV-EUS) has been recently developed in an attempt to overcome some of the limitations of conventional curved linear-array echoendoscopes (OV-EUS). We present a case of a successful endoscopic ultrasound-guided drainage of a pancreatic pseudocyst using a forward-viewing echoendoscope. Although the use of this newly developed echoendoscope has not yet become widespread, its unique characteristics can help to easily perform routine therapeutic procedures and contribute to the expansion of interventional endoscopic ultrasound.