Hospital Virgen de la Luz

<h3>Background and Importance</h3> Oral antineoplastic agents have transformed the management of haematological malignancies, increasing patient autonomy and convenience. However, adherence remains a major challenge as patients assume greater responsibility for their own treatment. While there is some evidence on interventions to improve adherence, findings for haematological cancer populations are limited and heterogeneous. <h3>Aim and Objectives</h3> The objective of this systematic review is to analyse current scientific evidence on strategies to improve adherence to oral antineoplastic therapy in patients diagnosed with chronic lymphocytic leukaemia, chronic myeloid leukaemia, or multiple myeloma. <h3>Material and Methods</h3> A systematic review was conducted in June 2025 according to PRISMA criteria. The search was carried out in PubMed, Scopus, Web of Science and EMBASE. Studies were included if they were original publications (controlled clinical trials, cohort studies, case-control, or prospectively/retrospectively designed) in English or Spanish published in the last 10 years, focused on adult patients with haematological malignancies receiving oral antineoplastic therapy, that evaluated interventions to improve adherence. Risk of bias was evaluated using RoB-2, ROBINS-I, NOS, and CHEERS tools. <h3>Results</h3> Of 215 records identified (98 published in the last 5 years), after screening, six studies met inclusion criteria, investigating the impact of: educational programmes, pharmacist-led follow-up, medication diaries, blister pack use, and smart pill bottle technologies. All interventions demonstrated improvements in adherence versus control. Statistically significant results were observed for pharmacist-managed follow-up among patients with medication possession rates below 90% (p&lt;0.0446). Multidisciplinary interventions increased adherence by 1.5% (p=0.04). The combined use of smart dosing systems and pharmacist involvement achieved median adherence of 100% (p=0.001). Medication diaries enabled adherence rates exceeding 95% in intervention groups, with significant differences compared to control(p=0.001). Blister packaging and multidisciplinary programmes likewise enhanced adherence and proved cost-effective in some settings. Quality appraisal revealed five studies had high or serious risk of bias, largely due to issues with participant selection and confounding variables. Although interventions consistently improved adherence, current evidence is constrained by methodological limitations. <h3>Conclusion and Relevance</h3> Educational and technological strategies, especially pharmacist-led multidisciplinary programmes, appear effective in improving adherence to oral antineoplastic agents among haematological patients. Higher-quality randomised trials are needed to clarify effects on adherence and related clinical and economic outcomes. <h3>Conflict of Interest</h3> No conflict of interest

<h3>Background and Importance</h3> Endoscopic retrograde cholangiopancreatography (ERCP) is a key diagnostic and therapeutic technique in biliary and pancreatic pathologies, whose most prevalent complication is cholangitis, with high morbidity and mortality. Proper antibiotic prophylaxis reduces the risk of infection. <h3>Aim and Objectives</h3> To analyse the criteria for prescribing antibiotic prophylaxis in patients undergoing ERCP and the degree of compliance with clinical recommendations. <h3>Material and Methods</h3> Retrospective observational study conducted in a secondary-level hospital (January/2024-July/2025), including 67 hospitalised patients. The clinical variables (age, sex, reason for admission, ALT/AST values), type and duration of the antibiotic were collected from the Mambrino electronic medical records. Transaminase values were classified as normal, mild(&lt;5USN), moderate(5-15USN) and severe(&gt;15USN). The statistical analysis was carried out using the SPSS program, including descriptive statistics for qualitative and quantitative variables, chi-square test for associations between antibiotic and clinical variables (choledocholithiasis, cholangitis and ALT/AST transaminase levels), logistic regression models to identify predictors of cholangitis and choledocolitiasis. <h3>Results</h3> The mean age was 76±14 years, with a predominance of females (53.7%). The most commonly used antibiotics were ciprofloxacin (CIP,47.8%), Piperacillin/Tazobactam (PTZ,20.9%), PTZ+Amoxicillin/Clavulanic Acid in de-escalation (PTZ+AMC,16.4%) and PTZ+CIP in de-escalation (4.5%). CIP was administered mainly to patients with choledocholithiasis (68.7%) without cholangitis, with normal transaminases (65.6%). Average duration: 4.3 days. PTZ was prescribed mainly in cholangitis (57.1%), with mild elevation of transaminases (64.3%). Average duration: 9.6 days. PTZ+AMC were mainly used in cholangitis (72.7%), with a higher proportion of normal ALT/AST (72.7%). Average duration: 12.1 days. PTZ+CIP was administered predominantly in choledocholithiasis with recent history of cholangitis (&lt;1 month) and mild elevation of transaminases (66.7%). Mean duration: 16.5 days. Significant associations were found between the prescribed antibiotic and the presence of cholangitis (p&lt;0.001). There was no relationship between the prescribed antibiotic and previous hospitalisation (p=0.924), previous biliary prosthesis (p=0.945), AST elevation (p=0.514) or ALT (p=0.954). Logistic regression identified AST elevation as predictor of cholangitis (OR=38.6;p=0.017), without significant predictors for choledocholithiasis (χ2=9.87;p=0.196). <h3>Conclusion and Relevance</h3> CIP is suitable for mild choledocholithiasis, while PTZ or combinations such as PTZ+CIP are reserved for cholangitis or at-risk patients. The duration of treatment increases significantly in the presence of cholangitis, consistent with clinical guidelines and the individualisation of antibiotic management according to risk and severity. <h3>Conflict of Interest</h3> No conflict of interest

ABSTRACTBackgroundLimited data are available on the management and outcomes of postoperative Crohn's disease (CD) in older patients. We aimed to describe the management of CD in the postoperative setting and assess surgical postoperative recurrence (POR) in this population.MethodsThis was a case‐control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo‐colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).ResultsA total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo‐colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.ConclusionsAlthough postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.

BACKGROUNDPost-polypectomy syndrome (PPS) is a rare but relevant complication of endoscopic colorectal polyp removal. Although its course is usually benign, it may conceal more severe conditions. This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARYWe report the case of a 67-year-old man who presented with asthenia and abdominal discomfort after a scheduled polypectomy. The patient was initially diagnosed with PPS and managed conservatively. However, progressive clinical deterioration led to hospital admission. Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation. The initial polyp was identified as a subepithelial lipoma. The patient underwent successful percutaneous drainage, antibiotic therapy, and recovered without the need for surgical intervention.CONCLUSIONThis case highlights the importance of accurate endoscopic diagnosis and technique selection. PPS should not preclude the consideration of concurrent complications. Early identification and a tailored therapeutic approach can prevent major surgical procedures and improve patient outcomes.

The treatment of locally advanced rectal cancer (LARC) has evolved significantly over the past century, driven by a deeper understanding of tumor biology, technological advancements, and multidisciplinary approaches. This article reviews the historical progression of LARC management, emphasizing the latest breakthroughs that are reshaping treatment paradigms. Key developments include the watch and wait strategy for patients achieving a complete clinical response after neoadjuvant therapy, the emergence of total neoadjuvant therapy as a standard approach, and the adoption of minimally invasive surgical techniques, such as transanal endoscopic microsurgery. Watch and wait may reduce treatment-related morbidity and help preserve anorectal function, but it requires rigorous patient selection and close long-term surveillance to ensure oncologic safety. Additionally, the role of targeted therapies and immunotherapy is gaining prominence, offering new opportunities for personalized treatment. These innovations aim to improve oncological outcomes while minimizing morbidity and preserving organ function, ultimately enhancing patients’ quality of life. Despite these advancements, challenges remain in optimizing patient selection, refining treatment strategies, and ensuring long-term safety and efficacy. A multidisciplinary approach involving surgeons, oncologists, and radiation specialists is crucial to tailoring therapies to individual patient profiles. As research continues, integrating novel therapeutic strategies will be key to further improving survival rates and reducing treatment-related morbidity in LARC patients.

BACKGROUNDAcute pancreatitis (AP) is commonly encountered in gastroenterology, with biliary and alcohol-related causes being predominant. Among less frequent etiologies, metabolic and drug-induced origin are the most prevalent. As an exception, non-pancreatobiliary malignancies may trigger AP, representing less than 1% of cases. We present a case of AP secondary to an uncommon oncologic etiology.CASE SUMMARYWe describe the case of a 50-year-old male recently diagnosed with small-cell lung cancer (SCLC). The patient was admitted to the emergency department with acute abdominal pain and subsequently diagnosed with AP. He was hospitalized under the care of the gastroenterology service. During the etiological workup, metastatic pancreatic lesions were identified on imaging, which had not been observed on the initial cancer staging. Following resolution of the initial episode, oral intake was introduced, but the patient experienced recurrent abdominal pain and laboratory abnormalities consistent with new episodes of AP. This pattern repeated over the following days. After several episodes, and with suspicion of a metastatic origin, the case was discussed in multidisciplinary meeting. In agreement with the patient and given the need to initiate treatment for the primary tumor as well, chemotherapy was started. This treatment successfully alleviated symptoms, allowing dietary progression without complications and discharge from the hospital.CONCLUSIONOncologic treatment can be considered as part of the therapeutic approach in AP secondary to SCLC metastasis, especially chemotherapy.