In patients with obscure gastrointestinal bleeding, capsule endoscopy provides a high degree of diagnostic aid. The best candidates for this procedure are patients with obscure-overt bleeding who have required blood transfusions. Capsule endoscopy has a positive influence on an important proportion of patients, whether oriented towards new diagnostic techniques or towards a definitive treatment.

y tratamiento endoscópico de la hemorragia digestiva por lesión de Dieulafoy. Rev Esp Enferm Dig 2007; 99: 505-510. RESUMENObjetivo: conocer la incidencia, forma de presentación, localización y resultados del tratamiento endoscópico en la hemorragia digestiva causada por lesión de Dieulafoy.Material y métodos: se revisaron de forma retrospectiva todos los casos de hemorragia digestiva por lesión de Dieulafoy entre los años 2000 y 2006. Se recogieron los principales datos clí-nicos y endoscópicos, tipo de tratamiento empleado, eficacia del mismo, recidiva, complicaciones y mortalidad durante el ingreso.Resultados: se encontraron 41 pacientes, 26 varones y 15 mujeres, con edad media de 71,19 años. La lesión de Dieulafoy fue la causa del 1,55% de los casos de hemorragia digestiva aguda en el periodo estudiado. La incidencia de hemorragia digestiva por lesión de Dieulafoy fue de 2,2 casos por cada 100.000 habitantes y año. La mayoría de los pacientes presentaban hemorragia activa en el momento de la endoscopia (85,36%) y comorbilidad (92,68%). La localización más frecuente fue el estómago (60,97%), seguida del duodeno (29,26%). El tratamiento endoscópico logró la hemostasia inicial en el 100% de los casos. Tres pacientes (7,31%) presentaron recidiva hemorrágica, todos ellos habían sido tratados inicialmente con esclerosis con adrenalina y respondieron adecuadamente a un segundo tratamiento endoscó-pico. Ningún paciente precisó cirugía. La mortalidad durante el ingreso fue del 4,87%.Conclusiones: la lesión de Dieulafoy es una causa poco frecuente, pero potencialmente grave, de hemorragia digestiva y puede aparecer en cualquier punto del tracto gastrointestinal. El tratamiento endoscópico es eficaz y presenta pocas complicaciones. La esclerosis única con adrenalina se asocia a un mayor riesgo de recidiva hemorrágica.Palabras clave: Dieulafoy. Hemorragia digestiva. Tratamiento endoscópico. ABSTRACTObjective: the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion.Material and methods: all consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and efectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization.Results: we found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic t...

A minor proportion of patients with achalasia eventually have a neoplasm and, as a consequence, pseudoachalasia is diagnosed. A neoplasm may either involve gastrointestinal junction or present a paraneoplastic effect. Over the global diagnoses of achalasia issued in 5 years of experience in our motility unit, we have found 13% (3/23 cases) of pseudoachalasia (2-4% in previous series, probably due to the fact that the population assisted was mainly composed of elderly patients). The origin of the neoplasm was bladder, prostate and metastases from epidermoid carcinoma of vocal chord. Treatment of primary neoplasm, besides classical approach (with dilatation of botulinum injection) may help in the resolution of this clinical disorder.

Percutaneous endoscopic gastrostomy is a widely used technique for long-term enteral nutrition. Buried bumper syndrome is one of the long-term complications of percutaneous endoscopic gastrostomy, and occurs when the internal retention bolster ulcerates the gastric mucosa, migrates into the deeper gastric wall and becomes covered by gastric mucosa. Clinically, this migration is revealed by a gradual increase of resistance at feeding administration and during catheter cleaning. It can also cause the infection of the site, leading to inflammatory changes and even sepsis. We show an endoscopic solution with argon beam local gastric destruction plus Savary dilatator introduction in the gastric camera. Endoscopic ultrasonography previous visualization of the gastric wall let's to realize this endoscopic solution.

A 76-year-old woman presented with a 1-year history of back pain and sudden onset of plantar keratoderma. Her serum carbohydrate antigen (CA 19.9) levels were elevated. Endoscopic radial sonographic examination led to the diagnosis of pancreatic adenocarcinoma, in a stage not detectable with helical CT yet amenable to surgical therapy. Cutaneous lesions disappeared after distal pancreatectomy.