Background and Study AimsTo obtain an adequate view of the whole small intestine during capsule endoscopy (CE) a clear liquid diet and overnight fasting is recommended. However, intestinal content can hamper vision in spite of these measures. Our aim was to evaluate tolerance and degree of intestinal cleanliness during CE following three types of bowel preparation.

Introduction: Colon capsule endoscopy (CCE) is an alternative approach for the examination of the colon in patients who refuse colonoscopy or after incomplete colonoscopy (IC). We conducted a study to determine the frequency of complete colonoscopy after IC, the diagnostic yield of CCE, the therapeutic impact of lesions found in CCE, the level of colon cleanliness and the safety of the procedure.Methods: We performed a prospective, multicenter study involving ten Spanish hospitals. Consecutive outpatients aged ≥ 18 years with previous IC were invited to participate. The latest version of the CCE device, PillCam™ COLON 2 (CCE-2), was administered to all patients according to the protocol.Results: The study population comprised 96 patients. The most frequent cause of IC was the inability to move past a loop using standard maneuvers (75/96 patients, 78%). Complete visualization of the colon was obtained with CCE-2 in 69 patients (71.9%). Of the 27 patients in whom the CCE-2 did not reach the hemorrhoidal plexus, it passed the colonic segment explored with the previous colonoscopy in 20 cases; therefore, it could be inferred that a combined approach (CCE-2 plus colonoscopy) enabled complete visualization of the colonic mucosa in 92.7% of patients. CCE-2 revealed new lesions in 58 patients (60.4%). Polyps were the most frequent finding (41 patients; 42.7% of the total number of patients). In 43 of the 58 patients (44.8% of the total number of patients), the new lesions observed led to modification of therapy, which included a new colonoscopy for polyp resection or surgery in patients with colonic neoplasm.Conclusions: CCE-2 is a suitable diagnostic procedure that can lead to more frequent diagnosis of significant colonic lesions after IC.

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure for diagnosis and treatment of biliary and pancreatic diseases. Even in the best hands, complications may occur. Clinically significant hemorrhagic complications associated usually to previous papillotomy are uncommon. Subcapsular hepatic hematoma is excepcional, with only twenty cases described. We present a case of a 52-year-old man who developed a large subcapsular liver hematoma following a therapeutic ERCP. Due to serious anemization and hemodynamic instability, arterial embolization and finally urgent surgical evacuation of the hematoma were performed. In the postoperative period the patient presented infection of the collection, which indicated colocation of percutaneous drainage and broad-spectrum intravenous antibiotics, and gradually recovered.

Metastatic choriocarcinoma is a rare nonseminomatous germcell tumor with a characteristic hemorrhagic tendency due to its trophoblastic origin. Gastrointestinal tube involvement is present in less than 5% of cases, and location or therapy of these lesions can be achieved by endoscopy, angiography or surgery. Despite its being a highly curable malignant disease, the ocurrence of gastrointestinal bleeding worsens prognosis. We report a case of metastatic choriocarcinoma which manifested as melaena and was diagnosed by the presence of metastatic lesions in the stomach and right bowel on endoscopy.

End-stage liver disease related to hepatitis C virus (HCV) Viremia and genotype are implicated in a rapid course of is an indication for transplantation in 15% to 41% of liver posttransplant hepatitis C virus (HCV) infection recurrence, transplant recipients. Recurrence of viral disease after orbut the role played by host immune reactions has not yet thotopic liver transplantation (OLT) is becoming the most been evaluated. We correlated the degree of liver injury with important management issue for transplant hepatologists. the intrahepatic expression of molecules involved in immuneCurrent data demonstrate that the recurrence of HCV viremia response. The study included 32 biopsies of 30 liver transafter OLT is almost universal. 1,2 Despite the differences replant recipients. Recurrence of viremia was detected by Amported regarding liver damage and severity of histological plicor assay. Genotype was tested by Inno-Lipa. Cryostat secoutcome after HCV-infection recurrence, the fact that the tions were assessed by immunohistochemistry, using a wide development of chronic hepatitis is more rapid in liver transpanel of monoclonal antibodies. Correlations between histoplant recipients than in immunocompetent patients has been logical-immunohistochemical semiquantitative evaluation and well established. 3 The reasons for these findings are not elucilevels of viremia were performed. In severe hepatic inflammadated at present. After OLT, many different viral factors exist tion, high numbers of activated cytotoxic T cells were found, that could play a role in the course of HCV-infection recuralong with marked hepatocellular expression of beta 2-microrence, such as higher levels of viremia. 4 Nevertheless, in these globulin (b 2-MG) and intercellular adhesion molecules. Likepatients no clear correlation between the quantity of circulatwise, a strong vascular adhesion molecule expression was ing HCV-RNA and the degree of hepatic injury has been observed mainly in those areas that were more inflamed. A found. 5,6 Speculations could arise regarding the existence of striking endoglin reactivity was detected in enlarged portal superinfections or a greater complexity of HCV quasispecies tracts, and the presence of neoformed microvessels was also after OLT, but such theories have recently been rejected. 2,7 noteworthy. By contrast, in mild hepatic inflammation only Moreover, host factors could be implicated in the different a few activated T cells were detected, together with a weaker HCV-infection course after OLT. Donor-recipient match is reactivity for all molecules studied. The level of viremia did not clearly related with a higher rate of histological hepatitis not correlate with the degree of liver damage. The severe recurrence. 8,9 Possibly, immunosuppression could be the forms of post-transplant HCV infection recurrence are associmost important factor responsible for clinical course variaated with a marked and aberrant intrahepatic expression of tions. Evidence of its potential implication is a more aggresmolecules involve...

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