Revista Espanola De Enfermedades Digestivas最新文献

Schistosoma japonicum, which has been endemic for a long time, associated colon abnormality has also been sporadically reported. The majority of patients with Schistosomiasis japonicum infected may mainly presented as acute manifestation or become chronic complication, known as schistosomiasis liver change, intestinal tract lesions and other system involved. Interestingly, both states could be observed in this patient. Acute infection presented as systemic hypersensitivity reaction, characterized by elevated eosinophils and intestinal symptom.

We present the Clinical Trial results of the first Spanish intragastric balloon manufactured: the Stella® balloon (SwanMedical, Barcelona). As a peculiarity, it has a double lumen in the introducer system. The first one is intended for the passage of a guidewire to insert the balloon quickly and safely, which also requires prior gastroscopy. The second lumen allows for regular filling. Therefore, Stella® accepts all current IGB indications, adding specific applicability for endoscopists in training and for some pharyngo-oesophageal anatomical alterations that could make the placement of another IGB model difficult or impossible. In conclusion, preliminary results suggest that Stella® could have efficacy and safety values comparable to those of the leading currently approved intragastric balloons. Final certification and market release of the device is expected by the end of 2024.

Celiac disease (CD) is an autoimmune disorder triggered by gluten in genetically predisposed individuals, often diagnosed by detecting anti-tTG2 antibodies. First-degree relatives of CD patients are at high risk and require careful evaluation. We conducted a prospective study to validate CeliacDetect, a rapid immunochromatographic test that detects anti-tTG2 IgA antibodies in capillary blood within 10 minutes. Involving 95 first-degree relatives, the study showed that CeliacDetect had 100% sensitivity, specificity, positive predictive value, and negative predictive value. These results suggest CeliacDetect is a highly accurate, non-invasive screening tool for early CD detection.

Introduction: incidental cystic pancreatic lesions are increasingly detected in the aging population, with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) being the most common. This study aimed to evaluate the benefits of implementing a surveillance program in patients diagnosed with presumed BD-IPMN at the age of 75 years or older.

Methods: a retrospective analysis was conducted using a prospective registry of patients diagnosed incidentally with presumed BD-IPMN at ≥ 75 years of age. Patients were categorized into two groups: group A, who underwent clinical and imaging follow-up, and group B, with no surveillance. Clinical records were reviewed to assess pancreatic cancer incidence, overall survival, and mortality.

Results: among 434 patients with BD-IPMN, 93 met inclusion criteria (42 in group A; 51 in group B). The mean age was 77 years in group A and 79.2 years in group B (p = 0.016). The mean cyst size was 15.6 mm in group A and 14.6 mm in group B (p = 0.56). No cases of pancreatic cancer were identified in group A, while one case occurred in group B (p = 1.0). Five patients died in each group (p = 1.0). Overall survival was comparable between groups (HR 0.8; 95 % CI: 0.22-2.94; p = 0.74).

Conclusions: presumed incidental BD-IPMNs diagnosed at ≥ 75 years of age rarely progress to pancreatic cancer. In patients with cysts < 2 cm and without high-risk features, surveillance does not appear to confer a survival benefit and may therefore be unnecessary.

Early diagnosis of abdominal actinomycosis is challenging due to its atypical presentation as an abdominal mass, which may mimic colon cancer. Initial clinical suspicion is crucial to guide treatment and prevent further complications.

Endoscopic fragmentation or removement of gastric bezoar is the simplest, most cost-effective approach, while the traditional endoscopic device include foreign body forceps, polypectomy snare, laser lithotripsy, and electrohydraulic lithotripsy. For bezoar < 3 cm, traditional snares are preferred. But for some giant or hard bezoars, traditional snares are too easily deformed to be used continuously and can be embedded in the bezoar causing direct damage to the stomach , Therefore, a handy and effective snare-like approach is needed, especially for elderly patients who have a high surgical risk. The lithotriptic device should be evaluated according to the size and texture of the gastroliths before lithotripsy. For some relatively hard gastroliths, which are easy to damage the endoscope, the use of transparent caps is a wise choice, which can protect the mirror body well. In this case, the bezoar was oversized (6 cm) and traditional snare was failed to capture the bezoar. Laser lithotripsy and electrohydraulic lithotripsy were lacking supplies and were not promptly available in our hospital. Therefore, we chose a yellow zebra guide wire to make this large snare for lithotripsy completely and removed with the assistance of gastric bezoar basket. The case highlights the importance of regular endoscopic instruments.

Obesity is a major global health challenge. Conventional lifestyle interventions or emerging anti-obesity medications often fail to achieve sustained long-term results. Metabolic and bariatric surgery (MBS) remains the gold-standard treatment for moderate-to-severe obesity and its comorbidities. However, concerns regarding operative risk, irreversibility, high cost, and patient refusing surgical option limit broader adoption. Endoscopic bariatric therapies (EBT) have emerged as a minimally invasive alternative bridging medical and surgical approaches. Endoscopic sleeve gastroplasty (ESG) has become the most widely adopted. First described in 2013, ESG has demonstrated feasibility, safety, and efficacy in obesity management. Large case series and meta-analyses report 15-20% total weight loss up to 24 months, emerging 5-year data, and 50-80% improvement in obesity-related comorbidities. Serious adverse events occur in less than 2.5% of cases. ESG is highly cost-effective compared with lifestyle intervention alone. Relative to laparoscopic sleeve gastrectomy, ESG offers lower procedural risk, faster recovery, and anatomical preservation, making it suitable for patients with mild-to-moderate obesity or elevated surgical risk. Emerging innovations in EBT include ESG technical improvements, robotic-assisted ESG, new suturing devices, combination therapy with GLP-1RAs, small-intestine metabolic interventions, and AI-assisted navigation. With ongoing advancements and expanding indications, ESG is poised to become a cornerstone of modern obesity management. This semi-systematic review summarizes recent global ESG evidence from 2020 to 2025, highlighting mechanisms and technical aspects, indications, efficacy in weight loss and metabolic improvement, special populations, safety, cost-effectiveness, and comparisons with diet alone, pharmacotherapy, and bariatric surgery.

Dysphagia is a debilitating consequence for patients with esophageal cancer. Recanalization of the obstruction with esophageal stents is one of the palliative measures that can most improve the quality of life in these patients. Among patients with dysphagia due to obstructing esophageal cancer, stent insertion has a high technical and clinical success with rapid relief of dysphagia. Interventional radiologists typically insert esophageal stents under fluoroscopic guidance only, whereas endoscopists insert them exclusively under endoscopic monitoring or by endoscopy and fluoroscopy. In this editorial we discuss the study by Relvas, which compares endoscopic-only insertion with fluoroscopy-guided insertion in obstructive esophageal tumors. The difficulties encountered by endoscopists in using proper radiological facilities is probably the main reason for not employing fluoroscopy in esophageal stenting. Proper placement of a guidewire beyond the esophageal stricture is often the first and most critical step in esophageal stenting. The undeployed stent is then slid over the guidewire. Fluoroscopy offers a high degree of certainty that the guidewire has successfully passed through the stenosis, but it is generally assumed that it is not necessary for esophageal stent placement if the stenosis can be passed through with an endoscope. When fluoroscopy is not available, several endoscopic methods can be used for the insertion of esophageal stents. The study by Relvas confirms that the results of endoscopic and fluoroscopic guided insertion are similar. However, ideally, endoscopists should have their own high-quality radiological facilities, such as those available to interventional cardiologists.

Background and aim: malnutrition, caused by malabsorption and maldigestion, affects nutrient intake and utilization. Early detection and interventions, such as oligomeric enteral formulas, are key to improving outcomes. This study explored healthcare professionals' experiences with oligomeric supplements in Spain's public healthcare system, focusing on clinical practices, patient adherence, tolerability, and benefits.

Methods: the S-QUEST study was an observational, multicenter, cross-sectional investigation conducted in real-world clinical settings. Healthcare providers, mainly physicians from various specialties, were surveyed electronically using an ad hoc questionnaire on nutritional screening practices for malnourished patients prescribed oligomeric supplements. Data were analyzed using SPSS® (version 25.0), with significance set at p < 0.05.

Results: a total of 259 healthcare providers from 41 Spanish hospitals completed the survey. Nutritional screening was reportedly performed by 75 % of respondents, with endocrinologists and gastroenterologists indicating more frequent use (p < 0.001) and a broader range of methods. Oligomeric formulas were prescribed by 67.6 % of participants, mainly in cases involving oncology, inflammatory bowel disease, and diarrhea-related malnutrition. A self-reported adherence rate of 85 % was noted, with higher compliance perceived by endocrinologists and gastroenterologists. Additionally, 95 % of participants perceived oligomeric formulas as beneficial, particularly in relation to weight, stool consistency, and albumin levels.

Conclusions: this study explored healthcare providers' perceptions of oligomeric formulas in malnutrition management. Respondents, particularly endocrinologists and gastroenterologists, reported frequent use and perceived patient benefits. High self-reported adherence suggests good acceptance. Further research is needed to objectively assess outcomes and guide clinical practice and training.

Background: Small bowel capsule endoscopy (SBCE) is widely recognized as a key diagnostic tool for Crohn's disease (CD). While several scores assess disease activity, a validated scoring system specifically designed for diagnosis was lacking. The Capsule Endoscopy Scoring System for Crohn's Disease (CESS-CD) was introduced in 2025 to address this gap in early CD diagnosis.

Methods: To externally validate the diagnostic performance and clinical utility of the CESS-CD in an independent, single-center cohort, clinical and SBCE data from 135 patients were retrospectively analyzed. The CESS-CD score was calculated based on age ≤30 years (3 points), presence of linear erosion (4 points), and circumferential alignment (4 points). Final diagnosis of CD was established by experienced gastroenterologists. Diagnostic performance was assessed via ROC curve analysis, with accuracy metrics calculated at the predefined cut-off of ≥7 points. Group differences were evaluated using the Mann-Whitney U test.

Results: The CESS-CD showed excellent diagnostic discrimination, with an AUC of 0.973 (vs. 0.925 in the original study). At the 7-point cut-off, sensitivity was 96.8% (vs. 83.3%), specificity 90.4% (vs. 80.0%), PPV 75.0% (vs. 83.3%), NPV 98.9% (vs. 80.0%), and overall accuracy 91.9%. CESS-CD scores were significantly higher in patients with CD compared to those without (p < 0.001).

Conclusion: This external validation confirms the CESS-CD as a highly accurate and robust diagnostic tool for early CD. Its strong sensitivity, NPV, and discriminative ability support its integration into clinical practice to enhance diagnostic precision and guide timely management.