Objective To report the results of endoscopic ultrasound‐guided injection of coils with cyanoacrylate (CYA) using a less‐expensive coil with an emphasis on the roles of Doppler and endosonographic varicealography (EV) in identifying the feeder vessel in gastric varix treatment. Methods An observational, descriptive study with prospectively collected data. Patients with gastric varices (GV) were included and were treated by endoscopic ultrasound‐guided injection of CYA and a less‐expensive coil. Technical success, complete and immediate variceal obliteration, rebleeding, complication and survival rates were evaluated. Results Thirty patients with GV with a mean age of 62 years (range: 44–76 years) were treated. Median number of coils used was 2 (range: 1–3), and median volume of CYA was 1.8 mL (1.2–2.4 mL). Technical success rate was 100%. EV technical success was observed in 26/30 patients. Complete variceal obliteration was observed in 96.6% of patients, and immediate disappearance of the varix was observed in 24 (80%) patients. The complication rate was 6.7%. Conclusions Endoscopic‐ultrasound guidance for gastric varix treatment with the addition of EV and the use of a less‐expensive coil is a safe and effective technique that results in the immediate disappearance of GV after targeting the feeding vessel.

Background and aims Irritable bowel syndrome (IBS) is considered to be a functional disease, but recent data indicate measurable organic alterations. We aimed to determine the presence of colorectal mucosa microinflammation in vivo via probe-confocal laser endomicroscopy (pCLE) and histological evaluation in IBS patients. Methods This was a prospective, controlled, nonrandomized single-blind diagnostic trial performed in a tertiary institution. pCLE images and targeted biopsy of each colon segment obtained during colonoscopies of IBS patients and controls were analyzed for inflammatory changes. Biopsies were classified using the Geboes scale, and the odds ratio and overall diagnostic accuracy were calculated. Results During the 15-month study period, 37 patients were allocated to each group. The mean age was 53.1 ± 14.3 years; 64.9 % were female. Signs of colonic mucosa inflammation were evident on 65.8 % of pCLE images from IBS patients compared to 23.4 % of images from controls (OR 6.28; 4.14–9.52; P < 0.001). In total, 20/37 patients had microinflammation via pCLE in ≥ 3 colon segments in the IBS group, compared to 1/37 in the control group. A Geboes score > 0 was attributed to 60.8 % of biopsies from patients in the IBS group compared to 27.5 % of biopsies from the control group. The sensitivity, specificity, positive and negative predictive values, observed and interrater agreement of pCLE-detected inflammatory changes in IBS using histology as gold standard were 76 %, 91 %, 76 %, 91 %, 86.5 %, and 66.8 %, respectively. Conclusions Patients with IBS have a six-fold higher prevalence of colorectal mucosa microinflammation than healthy controls. pCLE might be a reliable method to detect colorectal mucosa microinflammation in IBS patients.

Background: Chronic esophageal conditions (CEC) are associated with significant disease-related burden, disability, and costs. Health-related quality of life (HRQOL) constructs are intended to capture the physical, mental, social, and emotional aspects of a patient's life and how health status impacts these domains. The Northwestern Esophageal Quality of Life (NEQOL) can be used among esophageal diseases while maintaining sensitivity to specific conditions. We aimed to translate, cross-cultural adapt, and validate the NEQOL into Spanish.Methods: After language and cross-cultural adaptation, the NEQOL was applied to an outpatient clinic-based population in a single tertiary center. We analyzed the internal consistency, construct, criterion validity, and test-retest reliability of the questionnaire. The criterion validity was tested against the SF-12 questionnaire. Key Results: After completing the translation process, no item was considered problematic. A total of 385 patients were included in the validation study. The internal consistency (Cronbach's alpha) for the total NEQOL-S score was 0.89. The NEQOL-S questionnaire showed moderate test-retest reliability (ICC = 0.828; 95% CI 0.755-0.881; p < 0.001). Criterion validity showed good coherence when correlated with the SF-12 survey (R 2 = 0.538; 95% CI 0.491-0.585, p < 0.001). Conclusions and Inferences:The translated and cross-culturally adapted NEQOL-S showed good psychometric properties that allow its use in Spanish-speaking patients suffering from CEC.

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Introduction:The Miami criteria were developed and validated to standardize definitions of dysplasia and cancer during probe-based confocal laser endomicroscopy (pCLE) of Barrett's esophagus. These criteria do not distinguish high-grade dysplasia from low-grade dysplasia (LGD). The aim of our study was to evaluate the accuracy of Miami criteria for LGD in Barrett's esophagus. Methods: We reviewed medical records of all patients undergoing pCLE for Barrett's esophagus from December 2014 to December 2016. An expert pathologist performed blinded review of histology specimens. Patients with LGD on blinded or un-blinded pathology review were included. Patients with nondysplastic Barrett's (NDB) on blinded and un-blinded pathology review were randomly included in a 1:1 ratio as a control group. Two gastroenterologists with expertise in pCLE blindly interpreted all pCLE sequences based solely on Miami criteria and independently assigned a diagnosis as well as degree of confidence. Results: 20 patients with LGD and 20 patients with NDB were included. Patients with LGD had a significantly longer median Barrett's segment than those with NDB (5 cm vs. 2 cm, P=0.003). Inter-observer agreement was poor between blinded and un-blinded pathologists (kappa=0.2), but substantial between the two blinded pCLE reviewers (kappa=0.78). Among the 4 patients with LGD on both blinded and un-blinded pathology review, Miami criteria for LGD were felt to be satisfied in 3 patients by one pCLE reviewer, and 2 patients by the second pCLE reviewer. In the 20 patients with LGD identified by at least one pathologist, accuracy of pCLE Miami criteria were as follows: sensitivity 35-50%, specificity 70-75%, positive predictive value 58-63%, and negative predictive value 54 to 58% (Tables 1 and 2). Among the 20 patients with NDB on blinded and un-blinded pathology review, both pCLE reviewers identified dysplasia in 5 patients. Conclusion:In patients with LGD, Miami pCLE criteria demonstrate substantial inter-observer agreement but correlate poorly with biopsy. As documented in previous studies, there is significant disagreement between pathologists in determining a diagnosis of LGD, which limits the utility of histology as a gold standard for comparison.