Prevention or cure in times of crisis: the case of screening for colorectal cancer.

Colorectal cancer is a serious health problem in which screening is capable of reducing both the mortality and the incidence of the disorder. Colonoscopy, the mainstay of this type of screening, allows to establish an early diagnosis and also to eliminate malignant precursor lesions. The screening test which is performed in Spanish programs is the determination of fecal occult blood using the immunochemical method which gives around 70% of positive values for colonoscopy for any type of neoplasia. As a result, in 2009 the National Health System set as an objective that these programs cover 50% of the population by 2015. It is well known that colon screening is highly cost effective with a ratio of around 2500€ per QALY, much lower than ratios of other programs. Only the direct costs of colon and rectal cancer in Spain can be estimated at more than one thousand million euros per year. Early diagnosis and the cancers avoided thanks to screening can reduce these costs by 40%. The impact that the introduction of this screening has on health services can be lessened if the indications for colonoscopy are followed adequately. In conclusion, there is no justification for not acting to prevent CRC and this is especially so in times of crisis as there is no better social cost invested than that which saves suffering, deathsand even money.

Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

PillCam colon capsule endoscopy (CCE) is an innovative noninvasive, and painless ingestible capsule technique that allows exploration of the colon without the need for sedation and gas insufflation. Although it is already available in European and other countries, the clinical indications for CCE as well as the reporting and work-up of detected findings have not yet been standardized. The aim of this evidence-based and consensus-based guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) is to furnish healthcare providers with a comprehensive framework for potential implementation of this technique in a clinical setting.

Short- and long-term changes in gastric morphology and histopathology following sleeve gastrectomy in diet-induced obese rats.

BACKGROUND: Sleeve gastrectomy (SG) has been used as a multipurpose surgical procedure for the treatment of morbid obesity. The aim of the study was to analyze gastric morphology and histology at two different time points after SG in rats. METHODS: Thirty-five male Wistar rats were fed ad libitum during 3 months on a high-fat diet to induce obesity. Subsequently, 25 diet-induced obese rats underwent either SG (n = 12) or a sham operation (n = 13). The remaining ten obese animals encompassed the nonoperated control group (Co). Four weeks postoperatively, 15 rats (n = 5 rats/experimental group) were sacrificed, while the remaining 20 rats were sacrificed after 16 weeks (animals/group; Co = 5, sham = 8, SG = 7) to compare the gastric morphological and histopathological changes over time. Body weight and food intake were regularly recorded. RESULTS: For both time periods, the Co groups exhibited the highest body weight, while the rats undergoing the SG showed the lowest weight gain (P < 0.05). Initially, significant differences (P < 0.005) in food intake relative to body weight were observed between the Co rats and animals undergoing surgery, which disappeared thereafter. The actual total stomach size after both experimental periods in the SG group was similar to that of non- and sham-operated rats mainly due to a forestomach enlargement, which was more pronounced after 16 weeks. Traits of gastritis cystica profunda characterized by gastric foveolae elongation with hyperplasia and cystic dilatation of the glands were observed in the residual stomachs of the sleeve-gastrectomized rats. These findings were mostly observed after 16 weeks of performing the SG, although they were also detected occasionally following 4 weeks postoperatively. No intestinal metaplasia was observed. CONCLUSION: After SG gastric macro- and microscopic changes with functional implications in both the short and long term take place.

Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal / Study of colorectal metachronous neoplastic lesions

Fundamento. Analizar la frecuencia y las características delas lesiones neoplásicas metacrónicas, carcinomas y adenomas,tras la resección de un cáncer colo-rectal (CCR).Pacientes y métodos. Revisamos 382 CCR operados y seguidosmediante colonoscopias completas en dos hospitalesde nuestra comunidad. Analizamos las lesiones metacrónicasregistradas valorando su localización, momento deldiagnóstico, histología, número y tamaño. Estudiamos lafrecuencia de adenomas de aparición precoz (12 meses),comparando su tamaño con respecto al resto de lesiones.Resultados. La mediana de seguimiento fue de 48 meses (12-112), con 2,74±1,47 colonoscopias/caso. Diagnosticamos 7cánceres metacrónicos (1,8%), 4 de ellos en estadio I. La medianade tiempo hasta su diagnóstico fue de 24 meses (13-54).Registramos adenomas metacrónicos en 162 casos (42,4%),sin diferencias entre los dos hospitales: 42,1% vs. 43,8%(p=0,88). Un 6,3% de los pacientes presentaron adenomasavanzados. En 164 casos en que el primer control se efectuó alos 12 meses, la incidencia de adenomas fue del 24%. Los adenomasfueron mayoritariamente únicos (60,8%) y menores de5 mm (68,5%). En un 55,5% de los casos con pólipos, algunotenía una localización proximal. El diagnóstico se realizó enla 1ª exploración (56,2%), 2ª (27,8%) ó 3ª (9%). La mediana detiempo hasta el diagnóstico fue de 21 meses (12-112) para eladenoma simple y de 35 (12-112) para el avanzado.Conclusiones. Nuestro seguimiento permitió aplicar untratamiento teóricamente curativo en la mayoría de los carcinomasmetacrónicos diagnosticados. La alta incidenciade adenomas y su frecuente localización proximal hacennecesario un seguimiento con colonoscopias completas,que debería iniciarse al año de la operación y podría pasara ser menos estricto tras tres exploraciones consecutivassin pólipos(AU)

Background. To analyse the frequency and characteristicsof metachronous neoplastic lesions, carcinomas and adenomas,following resection of colorectal cancer.Patients and methods. We reviewed 382 patients subjectedto CCR operations and followed up through completecolonoscopies in two hospitals in our province. We analysedthe metachronous lesions registered, evaluating theirlocalisation, time of diagnosis, histology, number and size.We studied the frequency of early adenomas (12 months),comparing their size with the rest of the lesions.Results. The average follow-up was 48 months (12-112), with2.74±1.47 colonoscopies/case. We diagnosed 7 metachronouscancers (1.8%), 4 of them in stage I. The average time untiltheir diagnosis was 24 months (13-54). We registered metachronousadenomas in 162 cases (42.4%), without differencesbetween the two hospitals: 42.1% vs. 43.8% (p=0.88). Six pointthree percent of the patients presented advanced adenomas.In 164 cases where the control was carried out after 12 months,the incidence of adenomas was 24%. In the majority ofcases, the adenomas were sole (60.8%) and smaller than 5mm (68.5%). In 55.5% of the cases with polyps, some had aproximal localisation. Diagnosis was made on the 1st exploration(56.2%), the 2nd (27.8%) or the 3rd (9%). Average time untildiagnosis was 21 months (12-112) for simple adenoma and 35(12-112) for advanced adenoma.Conclusions. Our follow up made it possible to apply atheoretically curative treatment in the majority of the metachronouscarcinomas diagnosed. The high incidence ofadenomas and the frequent proximal localisation make afollow up with complete colonoscopies necessary, whichmust be started one year after the surgery and can becomeless strict following three consecutive explorations withoutpolyps(AU)

Recognition and management of hereditary colorectal cancer syndromes.

Over 1,900 colorectal tumors will arise in association with a hereditary colorectal cancer syndrome in Spain in 2009. The genetic defects responsible for the most common syndromes have been discovered in recent years. Genetic testing helps diagnose affected individuals and allows identification of individuals at-risk. Colonoscopy and prophylactic colectomy decrease colorectal cancer incidence and overall mortality in patients with hereditary colon cancer. Extracolonic tumors are frequent in these syndromes, so specific surveillance strategies should be offered.

Recognition and management of hereditary colorectal cancer syndromes

Over 1.900 colorectal tumors will arise in association with ahereditary colorectal cancer syndrome in Spain in 2009.The genetic defects responsible for the most common syndromeshave been discovered in recent years.Genetic testing helps diagnose affected individuals and allowsidentification of individuals at-risk.Colonoscopy and prophylactic colectomy decrease colorectalcancer incidence and overall mortality in patients with hereditarycolon cancer.Extracolonic tumors are frequent in these syndromes, so specificsurveillance strategies should be offered(AU)

[Study of colorectal metachronous neoplastic lesions]. / Estudio de las lesiones neoplásicas metacrónicas en el carcinoma colorrectal.

BACKGROUND: To analyse the frequency and characteristics of metachronous neoplastic lesions, carcinomas and adenomas, following resection of colorectal cancer. PATIENTS AND METHODS: We reviewed 382 patients subjected to RCC operations and followed up through complete colonoscopies in two hospitals in our province. We analysed the metachronous lesions registered, evaluating their localisation, time of diagnosis, histology, number and size. We studied the frequency of early adenomas (12 months), comparing their size with the rest of the lesions. RESULTS: The average follow-up was 48 months (12-112), with 2.74+/-1.47 colonoscopies/case. We diagnosed 7 metachronous cancers (1.8%), 4 of them in stage I. The average time until their diagnosis was 24 months (13-54). We registered metachronous adenomas in 162 cases (42.4%), without differences between the two hospitals: 42.1% vs. 43.8% (p=0.88). Six point three percent of the patients presented advanced adenomas. In 164 cases where the control was carried out after 12 months, the incidence of adenomas was 24%. In the majority of cases, the adenomas were sole (60.8%) and smaller than 5 mm (68.5%). In 55.5% of the cases with polyps, some had a proximal localisation. Diagnosis was made on the 1st exploration (56.2%), the 2nd (27.8%) or the 3rd (9%). Average time until diagnosis was 21 months (12-112) for simple adenoma and 35 (12-112) for advanced adenoma. CONCLUSIONS: Our follow up made it possible to apply a theoretically curative treatment in the majority of the metachronous carcinomas diagnosed. The high incidence of adenomas and the frequent proximal localisation make a follow up with complete colonoscopies necessary, which must be started one year after the operation and can become less strict following three consecutive explorations without polyps.

Factores pronósticos del cáncer colorrectal / Prognosis factors in colorectal cancer

No disponible

Análisis de la posible influencia de las lesiones sincrónicas en el pronóstico del cáncer colorrectal resecado / Analysis of possible influence of synchronous neoplastic lesions on prognosis of resected colorectal cancer

Objetivo: Analizar la relación entre la presencia de lesiones sincrónicas en el cáncer colo-rectal y su pronóstico. Método: Revisamos 369 cánceres colo-rectales resecados. Comparamos el porcentaje de cirugía aparentemente curativa, la progresión y recidiva tumoral, aparición posterior de cáncer extra-colónico y mortalidad entre los cánceres sincrónicos y el resto. Analizamos los cánceres con adenomas sincrónicos frente al resto de casos. Repetimos el estudio estratificando los casos según su estadio pTNM: estadios 0-I-II versus III-IV. Resultados: Registramos un 7,6% de cánceres sincrónicos y un 54,7% de adenomas sincrónicos. El seguimiento entre los grupos con y sin cáncer sincrónico fue de 70,8 ± 22,9 vs 67,2 ± 24,5 meses (p = 0,55). Los cánceres sincrónicos mostraron mayor mortalidad: 35,7% vs. 14,4%:p = 0,006; OR = 3,31 (1,33-8,13), mayor progresión tumoral: 39,3 vs.19,1%: p = 0,011; OR = 2,75 (1,14-6,56) y mayor recidiva: 10,7 vs.3,5%: p = 0,096. Al estratificar según el estadio, los pacientes con estadio 0-I-II y cáncer sincrónico mantuvieron peor pronóstico: mortalidad =27,7 vs. 8,1% p = 0,019; OR = 4,45 (1,20-15,10), progresión tumoral =27,8 vs. 8,5% p = 0,02; OR = 4,12 (1,14-14,19), cáncer extra-colónico =16,7 vs. 6,4% p = 0,095. No encontramos diferencias entre los casos con y sin adenomas sincrónicos. Conclusiones: Los cánceres sincrónicos muestran peor pronóstico tras la resección, con mayor tasa de progresión tumoral y mortalidad. Esta diferencia se centra en los casos diagnosticados en estadios 0-I-II, perdiéndose en los estadios III-IV. En nuestra serie, la presencia de adenomas sincrónicos no influye en el pronóstico

Aim: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. Patients and methods: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters incolorectal cancer with and without synchronous adenomas. Finally, were peated the analysis after stratification of cancers in 2 groups accordingto pTNM staging: 0-I-II stage vs III-IV. Results: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 ± 22.9 and 67.2 ± 24.5 months (p= 0.55) respectivelly. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression: 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis:mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. Conclusions: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found inIII-IV. The presence of synchronous adenomas doesn’t influence prognosis

[Capsule endoscopy interpretation: the role of physician extenders]. / Interpretación de la cápsula endoscópica: el papel del personal no especializado.

BACKGROUND AND AIMS: capsule endoscopy (CE) allows for a new era in small-bowel examination. Nevertheless, physicians time for CE-interpretation remains longer than desirable. Alternative strategies to physicians have not been widely investigated. The aim of this study was to evaluate the accuracy of physician extenders in CE-interpretation. MATERIAL AND METHODS: one CE-experienced gastroenterologist and two physician extenders reviewed independently 20 CE-procedures. Each reader was blinded to the findings of their colleagues. A consensus formed by the readers and a second CE-experienced gastroenterologist was used as gold standard. Number, type and location of images selected, character of CE-exams and their relationship with indications were recorded. Gastric emptying time (GEt), small-bowel transit time (SBTt) and time spent by readers were also noted. RESULTS: sensitivity and specificity for "overall" lesions was 79 and 99% for the gastroenterologist; 86 and 43% for the nurse; and 80 and 57% for the resident. All 34 "major" lesions considered by consensus were found by the readers. Agreement between consensus and readers for images classification and procedures interpretation was good to excellent (? from 0.55 to 1). No significant differences were found in the GEt and SBTt obtained by consensus and readers. The gastroenterologist was faster than physician extenders (mean time spent was 51.9 +/- 13.5 minutes versus 62.2 +/- 19 and 60.9 +/- 17.1 for nurse and resident, respectively; p < 0.05). CONCLUSIONS: physician extenders could be the perfect complement to gastroenterologists for CE-interpretation but gastroenterologists should supervise their findings. Future cost-efficacy analyses are required to assess the benefits of this alternative.

[Synchronous neoplastic lesions in colorectal cancer. An analysis of possible risk factors favouring presentation]. / Lesiones neoplásicas sincrónicas en el cáncer colorectal. Análisis de posibles factores que favorezcan su presentación.

AIM: few data have been published regarding the causes of synchronous lesions in patients with colorectal cancer. The aim of our study was to identify potential factors that might be implicated in the development of multicentric lesions, since this knowledge could be useful for tailored follow-up once initial synchronous lesions have been removed. METHODS: we retrospectively reviewed 382 colorectal cancer cases diagnosed by total colonoscopy and histological study of surgical specimens. We divided our population into 2 groups, based on whether they had synchronous lesions or otherwise. Several data related to personal and family history, habits, symptoms, and tumor characteristics were assessed. Univariate and multivariate statistical analyses were performed. RESULTS: 208 (54.5%) patients had synchronous adenomas and 28 (7.3%) had synchronous cancer. A multivariate analysis showed that the following parameters were consistently related to the presence of multicentric lesions--male gender: OR = 1.97; CI = 1.13-3.45; p = 0.017; age = 59 years: OR = 2.57; CI = 1.54-4.29; p < 0.001; personal history of colonic adenomas: OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors: OR = 0.48; CI = 0.27-0.85; p = 0.012. CONCLUSION: our results show that several parameters that are easy to measure could be considered risk factors for the development of multicentric lesions. These factors need to be confirmed with follow-up studies analyzing their role in patients with and without metachronic lesions once all synchronous lesions have been removed.

Interpretación de la cápsula endoscópica: el papel del personal no especializado / No disponible

Introducción y objetivos: la cápsula endoscópica (CE) hasupuesto una nueva era en el estudio del intestino delgado. Noobstante, el tiempo empleado por el gastroenterólogo en esteprocedimiento es mayor del deseable y no se han evaluado completamentealternativas al personal especializado. El objetivo deeste estudio es evaluar la precisión de personal no especializadoen la interpretación de la CE.Material y métodos: un gastroenterólogo con experienciaen CE y personal no especializado revisaron independientemente20 procedimientos. Los hallazgos de cada participante eran desconocidospor el resto. Un consenso formado por los participantesy un segundo gastroenterólogo fue empleado como gold standard.Se analizaron número, tipo y localización de las imágenesseleccionadas y tiempo de evacuación gástrica (tEG), tiempo detránsito en intestino delgado (tTID) y tiempo empleado por losparticipantes.Resultados: la sensibilidad y la especificidad global fueron del79 y 99% para el gastroenterólogo; del 86 y 43% para la enfermera;y del 80 y 57% para el residente. Las 34 lesiones “mayores”consideradas por consenso fueron detectadas por los tresparticipantes. El acuerdo entre consenso y participantes para clasificare interpretar las imágenes fue de buena a excelente (k de0,55 a 1). No se encontraron diferencias estadísticamente significativasen el tEG y tTID obtenido por consenso y participantes. Elgastroenterólogo fue el más rápido en revisar los procedimientos(51,9 ± 13,5 minutos versus 62,2 ± 19 y 60,9 ± 17,1 para enfermeray residente, respectivamente; p < 0,05).Conclusiones: el personal no especializado podría ser elcomplemento perfecto al gastroenterólogo en la interpretación dela CE, aunque este debería supervisar sus hallazgos. Los beneficiosde esta alternativa deberían ser contrastados en el futuro poranálisis coste-efectividad

Background and aims: capsule endoscopy (CE) allows for anew era in small-bowel examination. Nevertheless, physicians’time for CE-interpretation remains longer than desirable. Alternativestrategies to physicians have not been widely investigated.The aim of this study was to evaluate the accuracy of physicianextenders in CE-interpretation.Material and methods: one CE-experienced gastroenterologistand two physician extenders reviewed independently 20 CEprocedures.Each reader was blinded to the findings of their colleagues.A consensus formed by the readers and a secondCE-experienced gastroenterologist was used as gold standard.Number, type and location of images selected, character of CEexamsand their relationship with indications were recorded. Gastricemptying time (GEt), small-bowel transit time (SBTt) and timespent by readers were also noted.Results: sensitivity and specificity for “overall” lesions was 79and 99% for the gastroenterologist; 86 and 43% for the nurse;and 80 and 57% for the resident. All 34 “major” lesions consideredby consensus were found by the readers. Agreement betweenconsensus and readers for images classification and proceduresinterpretation was good to excellent (k from 0.55 to 1). Nosignificant differences were found in the GEt and SBTt obtainedby consensus and readers. The gastroenterologist was faster thanphysician extenders (mean time spent was 51.9 ± 13.5 minutesversus 62.2 ± 19 and 60.9 ± 17.1 for nurse and resident, respectively;p < 0.05).Conclusions: physician extenders could be the perfect complementto gastroenterologists for CE-interpretation but gastroenterologistsshould supervise their findings. Future cost-efficacyanalyses are required to assess the benefits of this alternative

Lesiones neoplásicas sincrónicas en el cáncer colorrectal. Análisis de posibles factores que favorezcan su presentación / No disponible

Objetivo: en el cáncer colorrectal son poco conocidas las causasdel frecuente desarrollo de lesiones neoplásicas sincrónicas.Pretendemos identificar posibles factores que pudieran influir enla multicentricidad lesional. Su conocimiento sería útil para, tras eltratamiento de las lesiones iniciales, optimizar el seguimiento enlos pacientes que los presentaran.Pacientes y métodos: estudiamos retrospectivamente 382cánceres colorrectales diagnosticados mediante colonoscopiacompleta y estudio de la pieza quirúrgica. Comparamos una seriede parámetros referentes a los antecedentes personales y familiares,hábitos, datos clínicos y del tumor entre los grupos con y sinlesiones neoplásicas sincrónicas, mediante análisis estadístico univariabley multivariable.Resultados: doscientos ocho (54,5%) pacientes presentaronadenomas sincrónicos y 28 (7,3%) carcinoma sincrónico. En el análisismultivariable el sexo masculino: OR = 1,97; IC = 1,13-3,45,p = 0,017; la edad superior a 59 años: OR = 2,57; IC = 1,54-4,29,p < 0,001; el antecedente personal de pólipo colónico: OR = 3,04,IC = 1,04-8,85, p = 0,042 y el carácter obstructivo del cáncer:OR = 0,48; IC = 0,27-0,85, p = 0,012 se asocian significativamentecon la multicentricidad lesional.Conclusión: en los enfermos con cáncer colorrectal, nuestroestudio muestra una serie de parámetros, de fácil determinación,que podrían comportarse como factores de riesgo para el desarrollode multicentricidad lesional. Estos factores deberán confirmarsemediante un estudio de seguimiento, analizando su comportamientoentre los pacientes que presenten o no lesionesmetacrónicas tras la limpieza quirúrgico-endoscópica inicial

Aim: few data have been published regarding the causes ofsynchronous lesions in patients with colorectal cancer. The aim ofour study was to identify potential factors that might be implicatedin the development of multicentric lesions, since this knowledgecould be useful for tailored follow-up once initial synchronous lesionshave been removed.Methods: we retrospectively reviewed 382 colorectal cancercases diagnosed by total colonoscopy and histological study ofsurgical specimens. We divided our population into 2 groups,based on whether they had synchronous lesions or otherwise.Several data related to personal and family history, habits, symptoms,and tumor characteristics were assessed. Univariate andmultivariate statistical analyses were performed.Results: 208 (54.5%) patients had synchronous adenomasand 28 (7.3%) had synchronous cancer. A multivariate analysisshowed that the following parameters were consistently relatedto the presence of multicentric lesions –male gender: OR = 1.97;CI = 1.13-3.45; p = 0.017; age >= 59 years: OR = 2.57;CI = 1.54-4.29; p < 0.001; personal history of colonic adenomas:OR = 3.04; CI = 1.04-8.85; p = 0.042; and obstructive tumors:OR = 0.48; CI = 0.27-0.85; p = 0.012 .Conclusion: our results show that several parameters that areeasy to measure could be considered risk factors for the developmentof multicentric lesions. These factors need to be confirmedwith follow-up studies analyzing their role in patients with andwithout metachronic lesions once all synchronous lesions havebeen removed

[Analysis of possible influence of synchronous neoplastic lesions on prognosis of resected colorectal cancer]. / Análisis de la posible influencia de las lesiones sincrónicas en el pronóstico del cáncer colorrectal resecado.

AIM: To analyze the relationship between synchronous lesions in patients with colorectal cancer and their prognostic value. PATIENTS AND METHODS: We have retrospectively reviewed 369 patients with resected colorectal cancer. We compared the rate of apparently curative surgery, progression and tumoral relapse, development of extracolonic cancer and mortality between patients with and without synchronous cancer. Afterwards, we analyzed the same parameters in colorectal cancer with and without synchronous adenomas. Finally, we repeated the analysis after stratification of cancers in 2 groups according to pTNM staging: 0-I-II stage vs III-IV. RESULTS: We found synchronous adenomas in 54.7% of our patients and synchronous cancers in 7.6%. Follow-up period of groups with and without synchronous lesions were: 70.8 +/- 22.9 and 67.2 +/- 24.5 months (p = 0.55) respectively. Synchronous cancers showed higher mortality: 35.7 vs. 14.4%: p = 0.006; OR = 3.31 (1.33-8.13), higher tumoral progression : 39.3 vs. 19.1%: p = 0.011; OR = 2.75 (1.14-6.56) and higher relapse rate: 10.7 vs. 3.5%: p = 0.096. Stratifying according to stage, patients with stage 0-I-II and synchronous cancer showed worse prognosis: mortality = 27.7 vs. 8.1%, p = 0.019; OR = 4.45 (1.2-15.1), tumoral progression = 27.8 vs. 8.5%, p = 0.02; OR = 4.12 (1.14-14.19), and extracolonic cancer = 16.7 vs. 6.4% p = 0.095. There were no statistical differences between cases with and without synchronous adenomas. CONCLUSIONS: Synchronous cancers showed worse prognosis after resection, with higher rate of tumoral progression and mortality. This difference is focused on the cases diagnosed in stage 0-I-II, not being found in III-IV. The presence of synchronous adenomas doesn't influence prognosis.

Nuevas aplicaciones de la cápsula endoscópica: PILLCAM (TM) ESO / New applications of Capsule Endoscopy: PILLCAMTM ESO

La enteroscopia con cápsula abre una nueva era en el estudio de las enfermedades del intestino delgado. En estos momentos sus indicaciones están bien definidas y este procedimiento se ha convertido en una herramienta de primera línea en el estudio del intestino delgado. La esofagoscopia con cápsula se ha mostrado como una alternativa eficaz y segura en pacientes con sospecha de patología esofágica y en aquellos pacientes que no desean ser sometidos a una esofagoscopia convencional. No obstante y a pesar de que los resultados obtenidos hasta la fecha en pacientes cirróticos o con reflujo gastroesofágico son positivos, existen diferencias, en términos de rendimiento, entre algunos de los estudios publicados (fundamentalmente en pacientes con reflujo gastroesofágico). Estas diferencias pueden deberse al diseño de algunos estudios, a la ausencia de una adecuada experiencia con este nuevo procedimiento y finalmente, al protocolo de ingestión de la cápsula. Por todo ello, parecen necesarios nuevos estudios que incluyan series más amplias y cambios en el protocolo de ingestión de la cápsula, con el fin de confirmar los resultados obtenidos hasta la fecha

Capsule endoscopy has opened a new era in small bowel examination. Its indications are now welldefined and currently, wireless capsule endoscopy is considered as the first-line imaging tool for the diagnosis of small bowel diseases. ECE has been shown to be feasible, safe and a good alternative technique in patients refusing conventional endoscopy. Although results reported in both GERD and cirrhotic patients are encouraging, great differences in terms of accuracy (particularly in GERD patients) have been found in published studies. These differences have been attributed to study designs, the lack of adequate experience and inconvenience of ingestion protocols. In summary, more large-scale studies evaluating the new 14-fps capsule, adequate ECE-experience and new modified ingestion protocols are still needed

[New applications of capsule endoscopy: PILLCAMTM ESO]. / Nuevas aplicaciones de la cápsula endoscópica: PILLCAM ESO.

Capsule endoscopy has opened a new era in small bowel examination. Its indications are now well-defined and currently, wireless capsule endoscopy is considered as the first-line imaging tool for the diagnosis of small bowel diseases. ECE has been shown to be feasible, safe and a good alternative technique in patients refusing conventional endoscopy. Although results reported in both GERD and cirrhotic patients are encouraging, great differences in terms of accuracy (particularly in GERD patients) have been found in published studies. These differences have been attributed to study designs, the lack of adequate experience and inconvenience of ingestion protocols. In summary, more large-scale studies evaluating the new 14-fps capsule, adequate ECE-experience and new modified ingestion protocols are still needed.

Use of sedation for routine diagnostic upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy Survey of National Endoscopy Society Members.

BACKGROUND/AIMS: Sedation rates may vary among countries, depending on patients' and endoscopists' preferences. The aim of this survey was to investigate the rate of using premedication for routine diagnostic upper gastrointestinal (UGI) endoscopy in endoscopy societies, members of the European Society of Gastrointestinal Endoscopy (ESGE). METHODS: We evaluated a multiple-choice questionnaire which was e-mailed to representatives of national endoscopy societies, which are members of the ESGE. The questionnaire had 14 items referring to endoscopy practices in each country and the representatives' endoscopy units. RESULTS: The response rate was 76% (34/45). In 47% of the countries, less than 25% of patients undergo routine diagnostic UGI endoscopy with conscious sedation. In 62% of the responders' endoscopy units, patients are not asked their preference for sedation and do not sign a consent form (59%). Common sedatives in use are midazolam (82%), diazepam (38%) or propofol (47%). Monitoring equipment is not available 'in most of the endoscopy units' in 46% (13/28) of the countries. Though they were available in 91% of the national representatives' endoscopy units, they are rarely (21%) used to monitor unsedated routine diagnostic UGI endoscopy. CONCLUSIONS: In about 50% of ESGE-related countries, less than 25% of patients are sedated for routine diagnostic UGI endoscopy. Major issues to improve include availability of monitoring equipment and the use of a consent form.