Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica / Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography

Antecedentes y objetivosLas principales guías de práctica clínica recomiendan un adecuado manejo periprocedimiento de los fármacos antitrombóticos en caso de realización de técnicas invasivas. El principal objetivo de este estudio fue evaluar si existe mayor riesgo de eventos tromboembólicos por la supresión o la disminución de la dosis de anticoagulantes o antiagregantes en pacientes sometidos a una colangiopancreatografía retrógrada endoscópica (CPRE). Pacientes y métodos: Se realizó un estudio observacional prospectivo que incluyó 644CPRE realizadas con intención terapéutica durante el año 2019 en el Hospital Universitario Reina Sofía con un seguimiento de 30días posprocedimiento. Resultados: Seis pacientes presentaron un evento tromboembólico, no hallando diferencias entre la incorrecta retirada/reintroducción del tratamiento antitrombótico y una mayor proporción de eventos tromboembólicos o hemorrágicos tras el procedimiento (p>0,05). La incidencia de eventos trombóticos fue significativamente mayor en pacientes en tratamiento con heparina o apixabán (p=0,001), así como con antecedente de fibrilación auricular (p=0,05), valvulopatía reumática (p=0,037) y tromboembolismo pulmonar recurrente (p=0,035), siendo este además un factor de riesgo independiente. Asimismo, la incidencia de hemorragia en los 30días postesfinterotomía fue significativamente menor en aquellos con implantación de prótesis biliar (p=0,04).Conclusiones: El inadecuado manejo periprocedimiento de la terapia antitrombótica no se asocia a un aumento significativo de la incidencia de eventos tromboembólicos en los 30días posteriores a la CPRE. No obstante, se aconseja seguir las recomendaciones para una adecuada suspensión/reintroducción de fármacos antitrombóticos, realizando una vigilancia y un seguimiento estrechos tras el procedimiento en pacientes con factores que aumenten el riesgo trombótico.(AU)

Background and objectives: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. Patients and methods: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. Results: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). Conclusions: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.(AU)

Risk of thromboembolic events in relation to the management of anticoagulant and antiagregant therapy in patients subjected to endoscopic retrograde cholangiopancreatography. / Riesgo de eventos tromboembólicos en función del manejo de la terapia anticoagulante y antiagregante en pacientes sometidos a colangiopancreatografía retrógrada endoscópica.

BACKGROUND AND OBJECTIVES: The main clinical practice guidelines recommend adequate periprocedural withdrawal and reintroduction of antithrombotic drugs in case of invasive techniques. The main objective of this study was to assess whether, in patients receiving anticoagulant or antiplatelet therapy, the suppression or reduction of the pharmacological dose for the performance of endoscopic retrograde cholangiopancreatography (ERCP) implies a greater risk of thromboembolic events. PATIENTS AND METHODS: A prospective observational study was carried out, which included 644ERCP performed with therapeutic intention during 2019 at the Reina Sofía University Hospital with follow-up during the 30days after the endoscopic intervention. RESULTS: Six patients presented a thromboembolic event, finding no differences between the incorrect withdrawal/reintroduction of antithrombotic treatment and a higher proportion of thromboembolic or hemorrhagic events after the procedure (P>.05). The incidence of thrombotic events was significantly higher in patients treated with heparin or apixaban (P=.001), as well as with a history of atrial fibrillation (P=.05), rheumatic valve disease (P=.037) and recurrent pulmonary embolism (P=.035), this being also an independent risk factor. Likewise, the incidence of hemorrhage in the 30days post-sphincterotomy was significantly lower in those with implantation of a biliary prosthesis (P=.04). CONCLUSIONS: Inadequate periprocedural management of antithrombotic therapy is not associated with a significant increase in the incidence of thromboembolic events in the 30days after ERCP. However, close follow-up and surveillance during the days after this is essential in those patients with a condition that significantly increases the risk of thrombosis.

Hallazgos endoscópicos no relacionados con hipertensión portal en pacientes con cirrosis hepática sometidos a un programa de cribado de varices / Endoscopic findings unrelated to portal hypertension in patients with liver cirrhosis undergoing a varicose vein screening programme

Objetivo: El consenso de Baveno VI para el cribado endoscópico de varices esofagogástricas recomienda evitar la endoscopia en algunos pacientes. Bajo esta estrategia, podrían pasar desapercibidas lesiones no relacionadas con hipertensión portal, algunas de ellas potencialmente graves. El objetivo de este estudio es determinar la prevalencia de dichas lesiones e identificar los factores clínicos asociados a las mismas. Pacientes y métodos: Estudio transversal unicéntrico sobre una cohorte consecutiva de pacientes cirróticos sometidos a endoscopia digestiva alta en el contexto de un programa de cribado de varices esofagogástricas entre noviembre del 2013 y noviembre del 2018. Se analizaron los factores de riesgo para la presencia de lesiones no relacionadas con hipertensión portal mediante regresión logística uni y multivariante. Resultados: Se incluyó a 379 pacientes. La etiología mayoritaria de la cirrosis fue etílica (n=229; 60,4%). La prevalencia de lesiones endoscópicas no relacionadas con hipertensión portal fue del 39,6% (n=150). Entre los 96 pacientes con enfermedad péptica (25,3%) se tomó test de ureasa en 54 (56,2%), siendo positiva en 24 (44,4%). La presencia de lesiones endoscópicas no relacionadas con hipertensión portal no estuvo influida por la edad (p=1), el género (p=0,28), la función hepática (MELD p=0,20, Child-Pugh p=0,77) o la presencia de datos ecográficos de hipertensión portal (p=0,14). Los pacientes fumadores presentaron tendencia a mayor prevalencia de lesiones endoscópicas no relacionadas con la hipertensión portal (43,2% vs. 34,6%; p=0,09), particularmente úlcera péptica (6,4% vs. 0,6%; p=0,05) y duodenitis péptica (17,3% vs. 6,3%; p=0,002). El tabaquismo activo fue el único factor predictivo independiente de ulcus o duodenitis péptica (odds ratio=2,56; intervalo de confianza del 95%: 1,18-5,56; p=0,017).(AU)

Aim: To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. Patients and methods: 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. Results: 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). Conclusion: 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.(AU)

Endoscopic findings unrelated to portal hypertension in patients with liver cirrhosis undergoing a varicose vein screening programme. / Hallazgos endoscópicos no relacionados con hipertensión portal en pacientes con cirrosis hepática sometidos a un programa de cribado de varices.

AIM: To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Cáncer colorrectal poscolonoscopia: características y factores predictivos / Post-colonoscopy colorectal cancer: Characteristics and predictive factors

Introducción y objetivos: La calidad de la colonoscopia es clave para asegurar la prevención del adenocarcinoma colorrectal (ACCR), aunque el riesgo de ACCR existe. Los objetivos del estudio fueron investigar la incidencia, las características y los factores predictores de ACCR poscolonoscopia (ACCRPC). Material y método: Estudio observacional retrospectivo y prospectivo sobre una población sometida a colonoscopia entre 1-01-1997 y 31-12-2014. Se analizaron variables demográficas, características de la colonoscopia diagnóstica de ACCR, de las previas y de las lesiones encontradas en ellas. Se aplicaron test de contraste de hipótesis para comparar el grupo de ACCRPC con el de ACCR sin colonoscopia previa y regresión logística múltiple para identificar factores independientes de ACCRPC (SPSS® 15), considerando significación estadística una p<0,05. Resultados: Se registraron 56.984 colonoscopias, 1.977 ACCR y 132 pacientes (edad media de 70,8 años y 56,8% varones) con al menos una colonoscopia en los 10 años previos (ACCRPC). El 70,5% de las colonoscopias previas fueron completas y el 63,7% tenían una preparación adecuada. Los factores de riesgo independientes relacionados con la aparición de ACCRPC fueron los antecedentes personales de pólipos colónicos (OR 35,01; IC 95% 11,1-110,8; p<0,001), antecedentes personales de ACCR (OR 176,64; IC 95% 51,5-606,1); p<0,001), antecedentes familiares de ACCR (OR 3,14; IC 95% 1,5-6,4); p=0,002) y la localización del ACCR en el colon derecho (OR 3,15; IC 95% 2,1-4,9; p<0,001). Conclusiones: La tasa de ACCRPC a 10 años fue del 6,7%. Realizar un adecuado seguimiento y una colonoscopia de calidad puede evitar la aparición del ACCRPC, especialmente en los pacientes con factores de riesgo (AU)

Introduction and aims: A high quality colonoscopy is key in preventing colorectal cancer, but the risk of colorectal cancer (CRC) exists. The aims of the study were to investigate the incidence, characteristics and predictive factors of post-colonoscopy colorectal cancer (PCCRC). Material and method: A retrospective and prospective observational study was designed. A population undergoing colonoscopy between 1-01-1997 and 31-12-2014 was included. We analysed demographic variables, characteristics of the diagnostic colonoscopy of CRC, of the previous ones and the lesions found in them. To compare the PCCRC group versus the CRC group without previous colonoscopy, the Student's t-test and multiple logistic regression were used to determine predictive factors of PCCRC (SPSS® 15). The statistical significance was P<.05. Results: A total of 56,984 colonoscopies, 1,977 CRC and 132 patients (mean 70.8 years old, 56.8% male) with at least one colonoscopy in 10 years before were registered (PCCRC). Seventy and a half percent of the previous colonoscopies were completed and 63.7% had an adequate bowel preparation. Predictive factors of PCCRC were personal history of polyps (OR 35.01; 95% CI 11.1-110.8; P<.001), previous CRC (OR 176.64; 95% CI 51.5-606.1); P<.001), family history of CRC (OR 3.14; 95% CI 1.5-6.4); P=.002) and proximal CRC (OR 3.15; 95% CI 2.1-4.9; P<.001). Conclusions: PCCRC rate in 10 years was 6.7%. An adequate follow-up and a high-quality colonoscopy could prevent PCCRC, especially in patients with risk factors (AU)

Post-colonoscopy colorectal cancer: Characteristics and predictive factors. / Cáncer colorrectal poscolonoscopia: características y factores predictivos.

INTRODUCTION AND AIMS: A high quality colonoscopy is key in preventing colorectal cancer, but the risk of colorectal cancer (CRC) exists. The aims of the study were to investigate the incidence, characteristics and predictive factors of post-colonoscopy colorectal cancer (PCCRC). MATERIAL AND METHOD: A retrospective and prospective observational study was designed. A population undergoing colonoscopy between 1-01-1997 and 31-12-2014 was included. We analysed demographic variables, characteristics of the diagnostic colonoscopy of CRC, of the previous ones and the lesions found in them. To compare the PCCRC group versus the CRC group without previous colonoscopy, the Student's t-test and multiple logistic regression were used to determine predictive factors of PCCRC (SPSS® 15). The statistical significance was P<.05. RESULTS: A total of 56,984 colonoscopies, 1,977 CRC and 132 patients (mean 70.8 years old, 56.8% male) with at least one colonoscopy in 10 years before were registered (PCCRC). Seventy and a half percent of the previous colonoscopies were completed and 63.7% had an adequate bowel preparation. Predictive factors of PCCRC were personal history of polyps (OR 35.01; 95% CI 11.1-110.8; P<.001), previous CRC (OR 176.64; 95% CI 51.5-606.1); P<.001), family history of CRC (OR 3.14; 95% CI 1.5-6.4); P=.002) and proximal CRC (OR 3.15; 95% CI 2.1-4.9; P<.001). CONCLUSIONS: PCCRC rate in 10 years was 6.7%. An adequate follow-up and a high-quality colonoscopy could prevent PCCRC, especially in patients with risk factors.

[Endoscopic retrograde cholangiopancreatography in patients with anatomic abnormalities of the stomach due to surgery]. / Colangiopancreatografía retrógrada endoscópica en pacientes con alteraciones de la anatomía gástrica por cambios posquirúrgicos.

INTRODUCTION: In patients who have undergone partial gastric resections, the difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) is increased due to the resulting anatomic abnormality. AIM: To review our experience of ERCP in patients with Billroth II gastrectomy and other types of gastrectomy (Billroth I and indeterminate) in our center. MATERIAL AND METHODS: We included all patients with Billroth II gastrectomy or other types of gastrectomy undergoing ERCP in a 19-year period. RESULTS: 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%. CONCLUSIONS: 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.

Dilatación neumática en el tratamiento de pacientes con acalasia / Pneumatic dilation in the treatment of achalasia

INTRODUCCIÓN: La dilatación neumática y la miotomía quirúrgica son actualmente los tratamientos de elección de la acalasia sintomática. La selección de una u otra como primera opción depende de la experiencia de cada centro y de las preferencias del paciente. OBJETIVO: Revisar la experiencia en nuestro centro de la dilatación neumática en pacientes con acalasia. MATERIAL Y MÉTODOS: Se incluyeron todos los pacientes con diagnóstico clínico, endoscópico y manométrico compatible con acalasia a los que se les practicó una dilatación neumática en un periodo de 19 años. Todas las dilataciones se realizaron de forma sistemática con un balón Rigiflex(R), en la mayoría de los casos con presiones de 250, 250 y 300 mmHg en 3 tiempos de un minuto separados por un minuto de duración. Se evaluó el éxito de la dilatación en función de la sintomatología del paciente, número de sesiones requeridas y necesidad de cirugía, así 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 años (16-87), desde junio de 1993 hasta octubre de 2012. En 157 pacientes se utilizó un balón de 35mm, en 9 pacientes un balón de 30 mm y en 7 pacientes, uno de 40 mm. Del total de pacientes: 108 requirieron una sola sesión de dilatación, 56 dos sesiones con un tiempo medio entre la primera y la segunda sesión de 25,23 ± 43,25 meses (1-215) y 7 pacientes, 3 sesiones con un tiempo medio entre la segunda y la tercera sesión de 6,86 ± 5,33 meses (1-15). El 82% de los pacientes presentaron una buena evolución tras la dilatación, considerándose esta exitosa. De los 140 pacientes que presentaron respuesta, 121 tuvieron respuesta completa (desaparición total de los síntomas sin reaparición de los mismos) y 19 respuesta parcial (desaparición inicial de los síntomas con posterior reaparición). Un 15,8% de los pacientes requirieron cirugía (miotomía de Heller). En 4 de los 171 pacientes hubo complicación de la técnica, siendo todas ellas perforaciones que se resolvieron satisfactoriamente, 2 de ellas con tratamiento conservador y otras 2 de forma quirúrgica. No hubo ningún evento de mortalidad en relación con la técnica ni con las complicaciones de la misma. CONCLUSIONES: En nuestra serie, la dilatación neumática presentó una alta tasa de éxito, en la mayoría de los casos con una única sesión, y un escaso porcentaje de complicaciones, por lo que demuestra ser una técnica eficaz y segura para estos pacientes, evitando un gran número de intervenciones quirúrgicas

INTRODUCTION: 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. Background and aims: To review the experience of pneumatic dilation in patients with achalasia in our center. MATERIAL AND METHODS: 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(R) 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. RESULTS: 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. CONCLUSIONS: 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

[Pneumatic dilation in the treatment of achalasia]. / Dilatación neumática en el tratamiento de pacientes con acalasia.

INTRODUCTION: 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. BACKGROUND AND AIMS: To review the experience of pneumatic dilation in patients with achalasia in our center. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

[Adequate rate of response to hepatitis B virus vaccination in patients with inflammatory bowel disease]. / Eficacia de la vacuna contra el virus de la hepatitis B en pacientes con enfermedad inflamatoria intestinal.

BACKGROUND AND OBJECTIVE: Patients with Inflammatory Bowel Disease (IBD) may have an increased risk of developing hepatitis B virus (HB) infection. Invasive procedures such as colonoscopies and surgery might be some of the reasons for this. Moreover, the use of immunosuppressors may reactivate a latent infection. We assessed the immune status among IBD patients receiving HB vaccine and the circumstances that predicted its results. AIMS AND METHODS: Serological markers of B and C hepatitis virus in patients with IBD who were referred for consultation were assessed since 2006. The subsequent determination of antibodies against superficial antigen (HBsAb) could differentiate between responders and non responders to the vaccine and an adequate immunity to HB was defined as higher than 10mUI/ml. RESULTS: One hundred and twenty nine patients were included in our study. Fifty-six (43,4%) patients had received immunosuppressive medication before the first vaccine dose. Notably, 85 (65.9%) patients had inadequate levels of HBsAb: 36 had no detectable levels and 49 had less than 10mUI/ml. Younger patients had a better immunity response than older patients (30.91+/-14.8 vs 39.91+/-14.2) (p<0.001). CONCLUSION: More than half of the patients had a suboptimal serologic response after vaccination. Only the younger group showed a better rate of response. It was not demonstrated whether an additional fourth dose of vaccination or a complete revaccination improved the rate of responders.

Eficacia de la vacuna contra el virus de la hepatitis B en pacientes con enfermedad inflamatoria intestinal / Adequate rate of response to hepatitis B virus vaccination in patients with inflammatory bowel disease

Fundamento y objetivo: Aunque parece que no hay un aumento en la prevalencia de infección por el virus de la hepatitis B (VHB) en pacientes con enfermedad inflamatoria intestinal (EII), se especula que la necesidad de exploraciones invasivas e intervenciones quirúrgicas sitúa a estos pacientes dentro de un grupo de riesgo para contraer esta infección. Además, el uso cada vez más frecuente de inmunomoduladores puede conducir a una reactivación vírica latente. El objetivo de este trabajo fue evaluar la eficacia de la vacuna contra el VHB en pacientes con EII y las circunstancias que pueden influir en su resultado. Pacientes y métodos: Desde el año 2006, se determinaron los marcadores serológicos de los virus B y C de la hepatitis en los pacientes con EII atendidos en esta consulta médica de forma consecutiva. La posterior determinación de los anticuerpos contra el antígeno de superficie del VHB (anti-HBs) diferenció entre reactivos o no a la vacuna, y se consideró como respuesta valores iguales o superiores a≥10mUI/ml. Resultados: Se incluyó en el estudio a 129 pacientes. Cincuenta y seis pacientes (43,4%) habían recibido algún tratamiento inmunomodulador previo a la vacuna. En 85 pacientes (65,9%) la vacuna no indujo una respuesta adecuada: 36 pacientes no crearon anti-HBs y en 49 pacientes se desarrollaron títulos inferiores a 10mUI/ml. El único factor implicado en la respuesta de la vacuna fue la edad, de forma que en los pacientes más jóvenes la eficacia de la vacuna fue mayor (media de 30,91 [14,8] frente a 39,91 [14,2] años, p<0,001). Conclusiones: En más de la mitad de los pacientes con EII no se desarrolló una respuesta adecuada a la vacuna del VHB. El único factor relacionado con una mejor eficacia fue la edad más joven. Queda por demostrar si una cuarta dosis o si la revacunación completa aumentarían esta tasa de respuesta (AU)

Background and objective: Patients with Inflammatory Bowel Disease (IBD) may have an increased risk of developing hepatitis B virus (HB) infection. Invasive procedures such as colonoscopies and surgery might be some of the reasons for this. Moreover, the use of immunosuppressors may reactivate a latent infection. We assessed the immune status among IBD patients receiving HB vaccine and the circumstances that predicted its results. Aims and methods: Serological markers of B and C hepatitis virus in patients with IBD who were referred for consultation were assessed since 2006. The subsequent determination of antibodies against superficial antigen (HBsAb) could differentiate between responders and non responders to the vaccine and an adequate immunity to HB was defined as higher than 10mUI/ml. Results: One hundred and twenty nine patients were included in our study. Fifty-six (43,4%) patients had received immunosuppressive medication before the first vaccine dose. Notably, 85 (65.9%) patients had inadequate levels of HBsAb: 36 had no detectable levels and 49 had less than 10mUI/ml. Younger patients had a better immunity response than older patients (30.91±14.8 vs 39.91±14.2) (p<0.001). Conclusion: More than half of the patients had a suboptimal serologic response after vaccination. Only the younger group showed a better rate of response. It was not demonstrated whether an additional fourth dose of vaccination or a complete revaccination improved the rate of responders (AU)

Utilidad de la endoscopia ultrafina transnasal en la aplicación de sondas de nutrición enteral / Usefulness of ultrathin transnasal endoscopy for the placement of nasoenteric feeding tubes

INTRODUCCIÓN: La colocación de sondas de nutrición enteral puede requerir apoyo endoscópico.OBJETIVO: Analizar la utilidad de la endoscopia ultrafinatransnasal en este aspecto.PACIENTES Y MÉTODOS: Estudio ambispectivo de todos lospacientes a los que se les ha realizado esta técnica (4,9 mm) en 2007.RESULTADOS: Se realizaron exploraciones en 26 pacientescon una edad de 69,3 ± 13 años. Se utilizó anestesia tópica nasal en 23 (88,4%) pacientes, midazolam en 8 exploraciones (30,8%) y ninguna en 4 (15,3%). Las indicaciones fueron las siguientes: lesiones estenosantes esofágicas (42,3%), colocación distal a una afección (46,1%) e imposibilidad de colocación de forma habitual (11,5%). Se colocaron 13 (50%) nasoduodenales, 7 (29,6%) nasogástricas y 6 (23,1%) nasoyeyunales. Se obtuvo un 100% de resultados positivos. El calibre de sonda más empleado fue de 12 F. No se apreciaroncomplicaciones.CONCLUSIONES: La endoscopia ultrafina se ha utilizado en la aplicación de sonda nasoenteral de forma exitosa, segura y con relativa facilidad en este tipo de pacientes

BACKGROUND: Placement of nasoenteral feeding tubes canrequire endoscopic support.AIM: To analyze the usefulness of transnasal ultrathin endoscopy in the placement of nasoenteral feeding tubes.PATIENTS AND METHODS: We performed an ambispectivestudy of all patients who underwent nasoenteral feeding (4.9 mm) in 2007.RESULTS: Twenty-six procedures were performed. The meanage of the patients was 69.3 ± 13 years. Nasal anesthesia was used in 23 patients (88.4%), and midazolam in 8 (30.8%). No anesthesia was used in 4 patients (15.3%). Indications: stenotic esophageal lesions (42.3%), distal placement to thepathological alteration (46.1%), and failure of placement through the normal route (11.5%). We placed 13 (50%) nasoduodenal, 7 (29.6%) nasogastric and 6 (23.1%) nasojejunal tubes. The success rate was 100%. The most frequently used calibre was 12 F. There were no complications.CONCLUSIONS: The use of transnasal ultrathin endoscopy inthe placement of nasoenteral feeding tubes in our patients was safe, effective and relatively easy

[Endoscopic retrograde cholangiopancreatography in patients aged less than 18 years old: our experience]. / Colangiopancreatografía retrógrada endoscópica en pacientes menores de 18 años: nuestra experiencia.

BACKGROUND: There is scant information on the use of endoscopic retrograde cholangiopancreatography (ERCP) in patients under 18. OBJECTIVE: To analyze our experience in all patients under 18 who underwent ERCP. PATIENTS AND METHODS: We performed a retrospective study of all ERCP conducted in patients under 18 between 1993 and 2006. We analyzed indications, endoscopic and radiologic findings, diagnostic and therapeutic success, and complications. RESULTS: We included 31 patients who underwent 36 ERCP in total. The mean age was 9.89 +/- 5 years old. We used general anesthesia in 58.3% (21 patients), with a mean age of 8 +/- 5 years. The most frequent indications were complications after liver transplantation in 33.3% (12 patients), suspicion of biliary obstruction in 27.7% (10 patients), and pancreatitis in 22.2% (8 patients). We achieved cannulation and repletion in the selected duct in 94.4%. The most frequent pathologic findings were changes in the biliary tract after liver transplantation in 25% (9 patients). The results of ERCP were normal in 10 patients (27.7%). Therapeutic maneuvers were indicated in 17 out of the 34 (50%) examinations considered, achieving therapeutic success in 76.47% (13/17). Complications consisted of hemorrhage after simple sphincterotomy in one patient (2.8%) and mild pancreatitis in two patients (5.6%). CONCLUSIONS: We found ERCP to be a safe procedure with a high diagnostic and therapeutic success rate, and a low rate of early complications.

Colangiopancreatografía retrógrada endoscópica en pacientes menores de 18 años: nuestra experiencia / Endoscopic retrograde cholangiopancreatography in patients aged less than 18 years old: our experience

ANTECEDENTES: Hay una escasa información sobre el empleode la colangiopancreatografía retrógrada endoscópica(CPRE) en pacientes menores de 18 años.OBJETIVO: Analizar nuestra experiencia en todos los pacientesmenores de 18 años sometidos a CPRE.PACIENTES Y MÉTODOS: Estudio retrospectivo de todas lasCPRE realizadas a pacientes menores de 18 años entre 1993y 2006. Se analizaron las indicaciones, hallazgos endoscópicosy radiológicos, el éxito diagnóstico y terapéutico, y lascomplicaciones.RESULTADOS: Se incluyeron 31 pacientes a los que se realizaron36 exploraciones en total. La edad media fue de 9,89 ± 5años. Se utilizó la anestesia general en un 58,3% de los pacientes(n = 21), con una edad de 8 ± 5 años. Las indicacionesmás frecuentes fueron, por este orden, las complicacionespostrasplante hepático (12 casos; 33,3%), la sospecha de obstrucciónbiliar (10 casos; 27,77%) y la evaluación de pancreatitis(8 casos; 22,2%). Se logró la canulación y la replecióndel conducto deseado en un 94,4% de los casos. Los hallazgospatológicos más frecuentes fueron las alteraciones en la víabiliar postrasplante hepático (9 casos; 25%). La exploraciónfue compatible con la normalidad en 10 casos (27,7%). Se indicaronmaniobras terapéuticas en 17 de las 34 exploracionesconsideradas como éxito diagnóstico (50%), lográndose eléxito terapéutico en 13 de ellas (76,4%). Las complicacionesregistradas fueron un caso de hemorragia leve postesfinterotomía(2,8%) y 2 pancreatitis leves (5,6%).CONCLUSIONES: La realización de CPRE en nuestra serie hasido segura, con un alto índice de éxito diagnóstico y terapéutico,y pocas complicaciones precoces

BACKGROUND: There is scant information on the use of endoscopicretrograde cholangiopancreatography (ERCP) inpatients under 18.OBJECTIVE: To analyze our experience in all patients under18 who underwent ERCP.PATIENTS AND METHODS: We performed a retrospective studyof all ERCP conducted in patients under 18 between 1993and 2006. We analyzed indications, endoscopic and radiologicfindings, diagnostic and therapeutic success, and complications.RESULTS: We included 31 patients who underwent 36 ERCPin total. The mean age was 9.89 ± 5 years old. We used generalanesthesia in 58.3% (21 patients), with a mean age of 8 ±5 years. The most frequent indications were complicationsafter liver transplantation in 33.3% (12 patients), suspicionof biliary obstruction in 27.7% (10 patients), and pancreatitisin 22.2% (8 patients). We achieved cannulation and repletionin the selected duct in 94.4%. The most frequent pathologicfindings were changes in the biliary tract after livertransplantation in 25% (9 patients). The results of ERCPwere normal in 10 patients (27.7%). Therapeutic maneuverswere indicated in 17 out of the 34 (50%) examinations considered,achieving therapeutic success in 76.47% (13/17).Complications consisted of hemorrhage after simple sphincterotomyin one patient (2.8%) and mild pancreatitis in twopatients (5.6%).CONCLUSIONS: We found ERCP to be a safe procedure witha high diagnostic and therapeutic success rate, and a lowrate of early complications

[Usefulness of ultrathin transnasal endoscopy for the placement of nasoenteric feeding tubes]. / Utilidad de la endoscopia ultrafina transnasal en la aplicación de sondas de nutrición enteral.

BACKGROUND: Placement of nasoenteral feeding tubes can require endoscopic support. AIM: To analyze the usefulness of transnasal ultrathin endoscopy in the placement of nasoenteral feeding tubes. PATIENTS AND METHODS: We performed an ambispective study of all patients who underwent nasoenteral feeding (4.9 mm) in 2007. RESULTS: Twenty-six procedures were performed. The mean age of the patients was 69.3+/-13 years. Nasal anesthesia was used in 23 patients (88.4%), and midazolam in 8 (30.8%). No anesthesia was used in 4 patients (15.3%). INDICATIONS: stenotic esophageal lesions (42.3%), distal placement to the pathological alteration (46.1%), and failure of placement through the normal route (11.5%). We placed 13 (50%) nasoduodenal, 7 (29.6%) nasogastric and 6 (23.1%) nasojejunal tubes. The success rate was 100%. The most frequently used calibre was 12 F. There were no complications. CONCLUSIONS: The use of transnasal ultrathin endoscopy in the placement of nasoenteral feeding tubes in our patients was safe, effective and relatively easy.

[Diagnostic value of fecal calprotectin in predicting an abnormal colonoscopy]. / Precisión diagnóstica de la calprotectina fecal para predecir una colonoscopia patológica.

BACKGROUND AND OBJECTIVE: Abdominal pain and diarrhoea are common symptoms in the general population. The colonoscopy is the gold standard method of detecting an organic pathology in the colon. However, it is invasive; it can not be repeated frecuently; it is expensive; and the system is overloaded. Fecal calprotectin (FCP) is a marker that may detect organic pathologies of the colon. The aims of this study were to analyze the usefulness of FCP to predict an abnormal colonoscopy and to correlate the levels of FCP with the degree of activity in inflammatory bowel disease (IBD). PATIENTS AND METHOD: 190 people were included in the study. All of them underwent a colonoscopy and a stool sample. People were divided in: normal colonoscopy: 117 people, and 28 colon adenomas, 20 colorectal cancer (CRC) and 25 IBD. RESULTS: The mean (SD) FCP concentration was 2,171.1 (2,133.6) mg/kgin patients with IBD and 726.6 mg/kg (533) in CRC. Both results were significantly elevated compared with those of healthy controls [114 (113)] mg/kg In patients with IBD, their levels correlated directly with the activity of the inflammation. 217 mg/kg was the best cut-off for discriminating patients with organic colon disorders. The sensibility was 85% and NPV was 93%. NSAIDs use was a clinical variable which was connected with a high FCP concentration in patients with normal colonoscopy. CONCLUSIONS: The higher levels of FCP were found in people with IBD and CRC. The measurement of FCP is a non-invasive, inexpensive, reliable and easily measured test. Among people with abdominal pain and diarrhoea, testing for FCP allows us to select those who must undergo a colonoscopy. NSAIDs can raise the levels of FCP in people with normal colonoscopies.

Precisión diagnóstica de la calprotectina fecal para predecir una colonoscopia patológica / Diagnostic value of fecal calprotectin in predicting an abnormal colonoscopy

Fundamento y objetivo: El dolor abdominal y la diarrea son síntomas comunes en la población general que no permiten discriminar enfermedad intestinal orgánica. La colonoscopia es la prueba de referencia, pero es cara, invasiva, no puede repetirse frecuentemente y supone una gran carga asistencial. La calprotectina fecal (CPF) es un marcador fácil y rápido de medir, no invasivo y barato, que podría detectar la enfermedad orgánica en la zona del colon. El objetivo de nuestro estudio es valorar la utilidad de este marcador para predecir una colonoscopia patológica y correlacionar sus valores con el grado de actividad en la enfermedad inflamatoria intestinal (EII). Pacientes y método: Se determinó la calprotectina en muestras fecales (mediante enzimoinmunoanálisis) en 190 personas sometidas a una colonoscopia. Los diagnósticos endoscópicos fueron: 117 normales, 28 pólipos colónicos, 20 cáncer colorrectal (CCR) y 25 EII. El análisis de los datos se realizó con el programa SPSS 11.0. Resultados: La media (DE) de CPF estaba aumentada en CCR (726,6 [533] mg/kg) y EII (2.171,1 [2.133,6] mg/kg). No hubo diferencias en pacientes con pólipos (158,3 [15,8] mg/kg). En pacientes con EII, los valores se correlacionaron con el grado de actividad de la enfermedad. El valor de corte fue 217 mg/kg, y se obtuvo una sensibilidad de la CPF del 85% y un valor predictivo negativo del 93%. En el grupo control, la única variable que se relacionó con un aumento de CPF fue la medicación previa con ácido acetilsalicílico (AAS) y/o antiinflamatorios no esteroideos (AINE). Conclusiones: La CPF es una prueba no invasiva, barata y sensible para detectar enfermedad orgánica en la zona del colon, que puede ser útil para seleccionar a pacientes que deben someterse a una colonoscopia. Se correlaciona con el grado de actividad en la EII. La toma de AAS y/o AINE podría aumentar la tasa de falsos positivos

Background and objective: Abdominal pain and diarrhoea are common symptoms in the general population. The colonoscopy is the gold standard method of detecting an organic pathology in the colon. However, it is invasive; it can not be repeated frecuently; it is expensive; and the system is overloaded. Fecal calprotectin (FCP) is a marker that may detect organic pathologies of the colon. The aims of this study were to analyze the usefulness of FCP to predict an abnormal colonoscopy and to correlate the levels of FCP with the degree of activity in inflammatory bowel disease (IBD). Patients and method: 190 people were included in the study. All of them underwent a colonoscopy and a stool sample. People were divided in: normal colonoscopy: 117 people, and 28 colon adenomas, 20 colorectal cancer (CRC) and 25 IBD. Results: The mean (SD) FCP concentration was 2,171.1 (2,133.6) mg/kgin patients with IBD and 726.6 mg/kg (533) in CRC. Both results were significantly elevated compared with those of healthy controls [114 (113)] mg/kg In patients with IBD, their levels correlated directly with the activity of the inflammation. 217 mg/kg was the best cut-off for discriminating patients with organic colon disorders. The sensibility was 85% and NPV was 93%. NSAIDs use was a clinical variable which was connected with a high FCP concentration in patients with normal colonoscopy. Conclusions: The higher levels of FCP were found in people with IBD and CRC. The measurement of FCP is a non-invasive, inexpensive, reliable and easily measured test. Among people with abdominal pain and diarrhoea, testing for FCP allows us to select those who must undergo a colonoscopy. NSAIDs can raise the levels of FCP in people with normal colonoscopies