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Resumen Objetivo El consenso de Baveno VI para el cribado endoscopico de varices esofagogastricas recomienda evitar la endoscopia en algunos pacientes. Bajo esta estrategia, podrian pasar desapercibidas lesiones no relacionadas con hipertension portal, algunas de ellas potencialmente graves. El objetivo de este estudio es determinar la prevalencia de dichas lesiones e identificar los factores clinicos asociados a las mismas. Pacientes y metodos Estudio transversal unicentrico sobre una cohorte consecutiva de pacientes cirroticos sometidos a endoscopia digestiva alta en el contexto de un programa de cribado de varices esofagogastricas entre noviembre del 2013 y noviembre del 2018. Se analizaron los factores de riesgo para la presencia de lesiones no relacionadas con hipertension portal mediante regresion logistica uni y multivariante. Resultados Se incluyo a 379 pacientes. La etiologia mayoritaria de la cirrosis fue etilica (n = 229; 60,4%). La prevalencia de lesiones endoscopicas no relacionadas con hipertension portal fue del 39,6% (n = 150). Entre los 96 pacientes con enfermedad peptica (25,3%) se tomo test de ureasa en 54 (56,2%), siendo positiva en 24 (44,4%). La presencia de lesiones endoscopicas no relacionadas con hipertension portal no estuvo influida por la edad (p = 1), el genero (p = 0,28), la funcion hepatica (MELD p = 0,20, Child-Pugh p = 0,77) o la presencia de datos ecograficos de hipertension portal (p = 0,14). Los pacientes fumadores presentaron tendencia a mayor prevalencia de lesiones endoscopicas no relacionadas con la hipertension portal (43,2% vs. 34,6%; p = 0,09), particularmente ulcera peptica (6,4% vs. 0,6%; p = 0,05) y duodenitis peptica (17,3% vs. 6,3%; p = 0,002). El tabaquismo activo fue el unico factor predictivo independiente de ulcus o duodenitis peptica (odds ratio = 2,56; intervalo de confianza del 95%: 1,18-5,56; p = 0,017). Conclusiones El tabaquismo activo aumenta el riesgo de lesiones endoscopicas no relacionadas con hipertension portal, lo cual deberia ser investigado en profundidad para redefinir el cribado endoscopico en pacientes fumadores con cirrosis hepatica.

To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis.Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression.A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017).Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.

Resumen Introduccion En los pacientes que han recibido resecciones gastricas parciales, las dificultades para realizar la colangiopancreatografia retrograda endoscopica (CPRE) se ven aumentadas debido a la alteracion anatomica regional. Objetivo Revisar la experiencia de la CPRE en pacientes con gastrectomia parcial y gastroenteroanastomosis (GE) tipo Billroth II o con otras GE (Billroth I e indeterminadas) en nuestro centro. Material y metodos Se incluyeron todos los pacientes con gastrectomia parcial y GE que recibieron CPRE en un periodo de 19 anos. Resultados Se incluyeron 233 pacientes (91% varones y 9% mujeres) desde 1993 a 2012. El 88,4% los pacientes presentaban gastrectomia con GE Billroth II y el 11,6% otras GE, siendo la tasa de exito de la CPRE del 51,9 y 55,6%, respectivamente. Las causas mas frecuentes de fracaso fueron en primer lugar la imposibilidad de canulacion (44%) y la no identificacion de la papila (39,6%). El 31,8% de los pacientes presento coledocolitiasis como diagnostico final. El numero medio de sesiones fue de 1,09. El porcentaje de complicaciones fue del 2,6%. Conclusiones El grado de dificultad tecnica influye en el exito de la CPRE, por este motivo, en nuestro centro, tuvo una tasa de exito algo superior al 50%, pero con un escaso numero de complicaciones.

Resumen Fundamento y objetivo La valoracion del paciente con hemorragia digestiva (HD) aguda requiere de una evaluacion clinica y analitica precoz. El objetivo de este estudio es valorar la concordancia de la determinacion de hemoglobina (Hb) y hematocrito (HTC) precozmente mediante gasometria venosa (GSV) y de forma convencional por el Laboratorio (LAB) de Urgencias. Pacientes y metodo Estudio observacional y prospectivo de pacientes ingresados en la Unidad de Hemorragias Digestivas por HD aguda alta y baja. Se recogieron variables demograficas, clinicas y muestras de sangre venosa simultaneas para la determinacion de Hb y HTC por GSV y LAB. Se analizo la concordancia de ambos metodos mediante el coeficiente de correlacion intraclase (CCI) y el analisis de Bland-Altman. Resultados Se incluyeron 132 pacientes. Un total de 87 (65,9%) eran varones y la edad media fue de 66,8 anos. La GSV sobreestimo la Hb en 0,49 g/dl (intervalo de confianza del 95% 0,21-0,76) respecto al LAB. La concordancia fue muy buena en la Hb (CCI 0,931) y buena en el HTC (CCI 0,899), mostrando las graficas de Bland-Altman tanto la concordancia como la sobreestimacion de la determinacion de la Hb por GSV. En 19 pacientes (14,39%) la Hb por GSV supero en mas de 1 g/dl la determinacion final obtenida por LAB. Conclusiones La determinacion precoz de Hb y HTC en pacientes con HD aguda mediante GSV resulta fiable en la valoracion inicial de la anemia. La GSV sobreestima sistematicamente el valor de Hb en al menos 0,5 g/dl, por lo que la evaluacion clinica y hemodinamica del sangrante debe prevalecer sobre el resultado analitico.

Resumen Introduccion La dilatacion neumatica y la miotomia quirurgica son actualmente los tratamientos de eleccion de la acalasia sintomatica. La seleccion de una u otra como primera opcion depende de la experiencia de cada centro y de las preferencias del paciente. Objetivo Revisar la experiencia en nuestro centro de la dilatacion neumatica en pacientes con acalasia. Material y metodos Se incluyeron todos los pacientes con diagnostico clinico, endoscopico y manometrico compatible con acalasia a los que se les practico una dilatacion neumatica en un periodo de 19 anos. Todas las dilataciones se realizaron de forma sistematica con un balon Rigiflex ® , en la mayoria de los casos con presiones de 250, 250 y 300 mmHg en 3 tiempos de un minuto separados por un minuto de duracion. Se evaluo el exito de la dilatacion en funcion de la sintomatologia del paciente, numero de sesiones requeridas y necesidad de cirugia, asi como la presencia de complicaciones. Resultados Se incluyeron 171 pacientes, 53,2% varones y 46,8% mujeres, con una edad media de 51,53 ± 17,78 anos (16-87), desde junio de 1993 hasta octubre de 2012. En 157 pacientes se utilizo un balon de 35 mm, en 9 pacientes un balon de 30 mm y en 7 pacientes, uno de 40 mm. Del total de pacientes: 108 requirieron una sola sesion de dilatacion, 56 dos sesiones con un tiempo medio entre la primera y la segunda sesion de 25,23 ± 43,25 meses (1-215) y 7 pacientes, 3 sesiones con un tiempo medio entre la segunda y la tercera sesion de 6,86 ± 5,33 meses (1-15). El 82% de los pacientes presentaron una buena evolucion tras la dilatacion, considerandose esta exitosa. De los 140 pacientes que presentaron respuesta, 121 tuvieron respuesta completa (desaparicion total de los sintomas sin reaparicion de los mismos) y 19 respuesta parcial (desaparicion inicial de los sintomas con posterior reaparicion). Un 15,8% de los pacientes requirieron cirugia (miotomia de Heller). En 4 de los 171 pacientes hubo complicacion de la tecnica, siendo todas ellas perforaciones que se resolvieron satisfactoriamente, 2 de ellas con tratamiento conservador y otras 2 de forma quirurgica. No hubo ningun evento de mortalidad en relacion con la tecnica ni con las complicaciones de la misma. Conclusiones En nuestra serie, la dilatacion neumatica presento una alta tasa de exito, en la mayoria de los casos con una unica sesion, y un escaso porcentaje de complicaciones, por lo que demuestra ser una tecnica eficaz y segura para estos pacientes, evitando un gran numero de intervenciones quirurgicas.

Eosinophilic esophagitis is an underdiagnosed disease that should be suspected in all patients with dysphagia and food impaction. Although these are the leading symptoms, the clinical and endoscopic spectrum is highly varied. Clinicians should be aware of the risk of endoscopy-related complications in this disorder. Precautions should be maximized in endoscopic examinations to avoid iatrogenic damage. We describe the case of a young patient with esophageal stricture and dysphagia who suffered a perforation following a biopsy.

Ischemic gastropathy is highly infrequent in daily medical practice. In the last few years, the number of reported cases has increased. Although the guiding symptom is usually abdominal pain, the clinical spectrum of the disease is highly variable. Early diagnosis and treatment are essential to change the natural history of the disease. We present the case of a 75-year-old man with chronic abdominal pain who developed a fulminant form of necrotizing gastric ischemia and died within less than 24 h.

Background and aims MELD allocation system has changed the clinical consequences on waiting list (WL) for LT, but its impact on mortality has been seldom studied. We aimed to assess the ability of MELD and other prognostic scores to predict mortality after LT. Methods 301 consecutive patients enlisted for LT were included, and prioritized within WL by using the MELD-score according to: hepatic insufficiency (HI), refractory ascites (RA) and hepatocellular carcinoma (HCC). The analysis was performed to predict early mortality after LT (8 weeks). Results Patients were enlisted as HI (44.9%), RA (19.3%) and HCC (35.9%). The major aetiologies of liver disease were HCV (45.5%). Ninety-four patients (31.3%) were excluded from WL, with no differences among the three groups (p = 0.23). The remaining 207 patients (68.7%) underwent LT, being HI the most frequent indication (42.5%). HI patients had the shortest length within WL (113.6 days vs 215.8 and 308.9 respectively; p

In patients who have undergone partial gastric resections, the difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) is increased due to the resulting anatomic abnormality.To review our experience of ERCP in patients with Billroth II gastrectomy and other types of gastrectomy (Billroth I and indeterminate) in our center.We included all patients with Billroth II gastrectomy or other types of gastrectomy undergoing ERCP in a 19-year period.We included 233 patients (91% men and 9% women) from 1993 to 2012. A total of 88.4% of the patients had undergone Billroth II and 11.6% had undergone other types of gastrectomy, with an ERCP success rate of 51.9% and 55.6%, respectively. The most common causes of failure were inability to cannulate (44%) and failure to identify the papilla (39.6%). The final diagnosis was choledocholithiasis in 31.8%. The mean number of sessions was 1.09. The complications rate was 2.6%.The success of ERCP is influenced by the technical difficulty. For this reason, the success rate in our center was slightly over 50%, but with few complications.

Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences.To review the experience of pneumatic dilation in patients with achalasia in our center.We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex(®) balloon, usually at pressures of 250, 250 and 300mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications.A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53±17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23±43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86±5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications.In our series, pneumatic dilation had a high success rate. In most patients, a single session was required and the complications rate was low. These results show that this technique is safe and effective in these patients, avoiding a large number of surgical interventions.

Evaluation of patients with acute gastrointestinal bleeding (AGB) requires early clinical evaluation and analysis. The aim of this study is to evaluate early concordance of hemoglobin (Hb) and hematocrit (HTC) levels determined by conventional venous blood gas analysis (VBG) and by conventional Laboratory in Emergencies (LAB).Observational and prospective study of patients admitted in the Gastrointestinal Haemorrhage Unit with both high and low AGB. Demographic and clinical variables and simultaneous venous blood samples were obtained to determine Hb and HTC by VBG and LAB. Concordance in both methods was analysed by intra-class correlation coefficient (ICC) and Bland-Altman analysis.One hundred and thirty-two patients were included: 87 (65.9%) males, average age 66.8 years. VBG overestimated Hb in 0.49 g/dl (95% confidence interval: 0.21-0.76) with respect to LAB. Concordance was very high in Hb (ICC 0.931) and high in HTC (0.899), with the Bland-Altman graphs showing both concordance and overestimation of Hb levels determined by VBG. In 19 patients (14.39%), Hb by VBG exceeded in more than 1g/dL the final determination obtained by LAB.Early determination of Hb and HTC in patients with AGB by VBG provides reliable results in the initial evaluation of anaemia. VBG systematically overestimates Hb values by less than 0.5 g/dl, and therefore clinical and hemodynamic evaluation of the bleeding patient should prevail over analytical results.

Eosinophilic esophagitis is an underdiagnosed disease that should be suspected in all patients with dysphagia and food impaction. Although these are the leading symptoms, the clinical and endoscopic spectrum is highly varied. Clinicians should be aware of the risk of endoscopy-related complications in this disorder. Precautions should be maximized in endoscopic examinations to avoid iatrogenic damage. We describe the case of a young patient with esophageal stricture and dysphagia who suffered a perforation following a biopsy.

Ischemic gastropathy is highly infrequent in daily medical practice. In the last few years, the number of reported cases has increased. Although the guiding symptom is usually abdominal pain, the clinical spectrum of the disease is highly variable. Early diagnosis and treatment are essential to change the natural history of the disease. We present the case of a 75-year-old man with chronic abdominal pain who developed a fulminant form of necrotizing gastric ischemia and died within less than 24h.