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BACKGROUND: Endoscopic retrograde cholangiopancreatography is a widely used therapeutic modality for the pancreaticobiliary tree. However, it is responsible for the highest rates of complications among the endoscopic procedures, especially post-endoscopic retrograde cholangiopancreatography pancreatitis. The preventive methods include mechanical and pharmacological approaches, such as the use of non-steroidal anti-inflammatory drugs. OBJECTIVE: To compare the efficacy of two different strategies using non-steroidal anti-inflammatory drugs for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis, and to clarify the uncertainty about the route of administration of non-steroidal anti-inflammatory drugs in the prevention of this complication. METHODS: This was a prospective trial. Two therapeutic groups were compared with a control group that was composed of patients who underwent endoscopic retrograde cholangiopancreatography, performed in the same service and by the same team in the period preceding the study (historical series), without the administration of any type of prophylaxis. The first group received 100 mg rectal diclofenac. The second group received 100 mg intravenous ketoprofen. Both groups were compared, separately and jointly, with the control group. RESULTS: Post-endoscopic retrograde cholangiopancreatography pancreatitis occurred in 4.39% (12/273) of the participants. In the group without prophylaxis, the incidence was 6.89% (10/145). Among those who received intravenous ketoprofen, the incidence was 2.56% (2/78). No cases of acute post-procedural pancreatitis were observed in the group that received rectal diclofenac (0/52). Although there was no statistical difference between the therapeutic groups when they were separately analyzed, a statistical difference in the prevention of post-procedural pancreatitis was observed when they were analyzed together (P=0.037). CONCLUSION: This study provides evidence for the efficacy of non-steroidal anti-inflammatory drugs in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. RESUMO CONTEXTO: A colangiopancreatografia retrógrada endoscópica (CPRE) é uma modalidade terapêutica amplamente utilizada para vias biliopancreáticas, responsável pelas taxas mais elevadas de complicações entre os procedimentos endoscópicos, especialmente a pancreatite pós-CPRE (PPC). Os métodos preventivos incluem abordagens mecânicas e farmacológicas, entre elas, a utilização de antinflamatórios não esteroidais (AINEs). OBJETIVO: Comparar a eficácia de duas estratégias diferentes utilizando AINEs para a prevenção de PPC. Elucidar o cenário incerto sobre a via de administração do AINEs na prevenção da PPC. MÉTODOS - Ensaio clínico prospectivo. Duas estratégias terapêuticas foram comparadas a um grupo controle, composto por pacientes submetidos a CPRE no mesmo serviço e com a mesma equipe no período anterior ao estudo (série histórica), que não recebeu qualquer tipo de profilaxia. O primeiro grupo experimental recebeu 100 mg de diclofenaco via retal, o segundo grupo recebeu 100 mg de cetoprofeno endovenoso. Ambos os grupos foram comparados separadamente e em associação com o grupo de controle. RESULTADOS: A PPC ocorreu em 4,39% (12/273) dos participantes. No grupo sem profilaxia, esta incidência foi de 6,89% (10/145); entre os que receberam cetoprofeno endovenoso foi de 2,56% (2/78). Não houve casos de pancreatite aguda após o procedimento no grupo que recebeu diclofenaco via retal (0/52). Apesar de não haver diferença estatística entre estes grupos analisados separadamente, quando os dois grupos terapêuticos são analisados em conjunto estes apresentam diferenças estatísticas na prevenção da PPC (P=0,037). CONCLUSÃO: Este estudo foi capaz de corroborar a eficácia da utilização de AINEs para a profilaxia de pancreatite pós-CPRE.

Os avanços significativos ocorridos desde o III Consenso Brasileiro sobre H. pylori realizado em 2012, em Bento Gonçalves, justificam este quarto consenso. O evento foi organizado pelo Núcleo Brasileiro para Estudo do Helicobacter e Microbiota, associação vinculada à Federação Brasileira de Gastroenterologia, tendo sido realizado novamente em Bento Gonçalves, RS, nos dias 25 a 27 de agosto de 2017. Participaram 26 delegados provenientes das cinco regiões brasileiras incluindo gastroenterologistas, endoscopistas e patologistas, além de um convidado internacional (EUA). Os participantes foram convidados pelo conhecimento e contribuição ao estudo da infecção por H. pylori. O encontro buscou rever diferentes aspectos relacionados ao tratamento da infecção, suas inter-relações com a dispepsia, microbiota e outras afecções, com ênfase especial ao câncer gástrico, além de promover uma reavaliação dos aspectos epidemiológicos e diagnósticos desta infecção. Os participantes foram alocados em quatro grupos, a saber: 1) Epidemiologia e diagnóstico, 2) Dispepsia, microbiota e outras afecções, 3) Neoplasias gástricas, e 4) Tratamento. Previamente à reunião do Consenso, os participantes receberam um tema a ser discutido e elaboraram texto com uma revisão recente da literatura, contendo uma assertiva de sua revisão. Todas as assertivas foram avaliadas em dois turnos de votação. Inicialmente, cada participante apresentava sua compilação e assertiva ao seu grupo, para eventuais modificações e votação. Posteriormente, em uma segunda votação, agora em sessão plenária, as assertivas eram novamente votadas e eventualmente modificadas. As votações obedeceram a cinco alternativas: 1) concorda fortemente; 2) concorda com reservas; 3) indeciso; 4) discorda e; 5) discorda fortemente. O índice de consenso adotado para cada afirmativa foi de 80% dos votantes respondendo que concorda fortemente ou concorda com reservas. As recomendações aqui apresentadas foram baseadas nas evidências científicas mais relevantes para o manuseio da infecção por H. pylori na população adulta no Brasil. Significant progress has been obtained since the III Brazilian Consensus Conference on H. pylori infection held in 2012, in Bento Gonçalves, Brazil, and justify a fourth meeting to establish updated guidelines on the current management of H. pylori infection. Therefore, the Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM), association linked to Brazilian Federation of Gastroenterology (FBG) held its fourth meeting again in Bento Gonçalves, RS, Brazil, on August 25-27, 2017. Twenty-six delegates, including gastroenterologists, endoscopists, and pathologists from the five regions of Brazil as well as one international guest from the United States, participated in the meeting. The participants were invited based on their knowledge and contribution to the study of H. pylori infection. The meeting sought to review different aspects of treatment for infection; establish a correlation between infection, dyspepsia, intestinal microbiota changes, and other disorders with a special emphasis on gastric cancer; and reassess the epidemiological and diagnostic aspects of H. pylori infection. Participants were allocated into four groups as follows: 1) Epidemiology and Diagnosis, 2) Dyspepsia, intestinal microbiota and other afections, 3) Gastric Cancer, and, 4) Treatment. Before the consensus meeting, participants received a topic to be discussed and prepared a document containing a recent literature review and statements that should be discussed and eventually modified during the face-to-face meeting. All statements were evaluated in two rounds of voting. Initially, each participant discussed the document and statements with his group for possible modifications and voting. Subsequently, during a second voting in a plenary session in the presence of all participants, the statements were voted upon and eventually modified. The participants could vote using five alternatives: 1) strongly agree; 2) partially agree; 3) undecided; 4) disagree; and 5) strongly disagree. The adopted consensus index was that 80% of the participants responded that they strongly or partially agreed with each statement. The recommendations reported are intended to provide the most current and relevant evidences to management of H. pylori infection in adult population in Brazil. ASSUMPÇÃO, P. P. Universidade Federal do Pará

Background & Aims International consensus guidelines, aimed at predicting malignancy, are available for surgical resection of mucinous cysts but not for other cystic lesions of the pancreas. We sought to determine whether the consensus guidelines can be applied to all cystic lesions of the pancreas. Methods We identified all patients who underwent surgical resection of pancreatic cysts from 2001–2007. Pathology analyses of surgical specimens served as the reference standard. Surgical resection criteria proposed by the Sendai Guidelines and 5 modifications of these criteria were tested to determine their accuracy for diagnosis of malignant cysts. Results Patients with cystic lesions of the pancreas (n = 154; mean age, 59.8 years; 64% women) underwent resection and met prespecified study criteria. Twenty-one patients had a malignancy. The classification cyst size ≥3 cm had an accuracy of 56%, negative predictive value of 84%, and identified only 57% of the malignant cysts. The classification cyst size ≥3 cm or cyst with main pancreatic duct ≥10 mm had an accuracy of 55%, negative predictive value of 86%, and identified 66% of malignant cysts. The modified criterion of cyst size ≥3 cm or cyst with main pancreatic duct >3 mm had an accuracy of 48%, negative predictive value of 94%, and identified 91% (19/21) of the malignancies. Cyst size (odds ratio, 1.05) and pancreatic duct dilation >3 mm (odds ratio, 10.5) were strong and independent predictors of malignancy. Conclusions When applied to all cystic lesions of the pancreas, the international consensus criteria cause some malignant cysts to be missed. Modified criteria could identify most malignant cysts, although overall accuracy remains low.

Desde 1960 houve grande avanço tecnológico na observação do aparelho digestivo com o advento dos endoscópios flexíveis, usados inicialmente para o trato digestivo superior e posteriormente também para o inferior, permitindo diagnósticos mais precisos e realização do tratamento em alguns casos. Mesmo em situações de urgência a colonoscopia pode ser utilizada como primeira escolha podendo ser diagnóstica e terapêutica. OBJETIVO: O presente estudo teve por objetivo avaliar quais foram os resultados principais das colonoscopias realizadas no Setor de Endoscopia Digestiva do Hospital Regional de Mato Grosso do Sul. MATERIAIS E MÉTODOS: Foram estudados 290 pacientes submetidos à colonoscopia no Serviço de Endoscopia Digestiva do Hospital Regional do Mato Grosso do Sul, no período de novembro de 2006 a agosto de 2007. Foram analisadas as seguintes variáveis: sexo, idade, caráter de indicação do exame (urgência e eletiva) e diagnóstico. RESULTADOS: A idade média foi de 52 anos, variando de 15 a 92 anos. A maioria dos pacientes era do sexo feminino (56,5%). Dos 290 exames realizados no período foram constatados 48,5% (n=141) de colonoscopias com diagnóstico normal. Dentre os anormais houve uma prevalência de doença diverticular dos colos (n=56), seguido de pólipos (n=37), doenças inflamatórias (n=31), neoplasias (n=18) e angiodisplasia (n=7). Os pólipos apresentaram uma maior concentração em colo sigmóide (n=18) seguido pelo colo descendente e reto. As doenças inflamatórias apresentaram como diagnóstico colonoscópio, colite actínica (n=11) seguida por retite actínica (n=7) e retite inespecífica (n=7). Houve um maior número de procedimentos oriundos do ambulatório (73%) em contraste com internados (20%) e provenientes do Pronto Socorro (7%). CONCLUSÃO: A doença diverticular e os pólipos foram os diagnósticos preponderantes, pois a maior indicação foi a hemorragia digestiva. Uma alta incidência de pólipos em sigmóide demonstrou a importância da retosigmóidoscopia, é um procedimento relativamente seguro e mais barato que a colonoscopia. A baixa incidência de angiodisplasia, resultado discordante da literatura pode ser explicada por uma idade média relativamente baixa, existe mais angiodisplasia no delgado. Since 1960 it there was a great technological breakthrough, including the observation of the digestive system with the advent of flexible endoscopy. Initially used to the upper digestive tract and subsequently to the colon, allowing more accurate diagnoses and, in some cases, the complete treatment. Even in urgency situations, colonoscopy can be used as first choice and work as a diagnostic tool or eve the therapeutic procedure. AIM: This study analyzed the results of colonoscopy held in the Digestive Endoscopy unit at the Hospital Regional Rosa Pedrossian in Mato Grosso do Sul. MATERIALS AND METHODS: It was performed a colonoscopy in 290 patients at the unit of Digestive Endoscopy in the Hospital Regional of Mato Grosso do Sul, in during november 2006 until august 2007. The results were analyzed and verified the following variables: sex, age, solicitation as elective or emergency and diagnosis. RESULTS: The age of the patients ranged from 15 to 92 years old and the mean age was 52 years. Most of the patients were female (56.5%). The colonoscopy tests showed that 48.5% (n=141) were normal. Among the abnormal there were a prevalence of colon diverticulum (n = 56), followed by polyps (n = 37), inflammatory diseases (n = 31), cancer (n = 18) and angiodisplasy (n = 7). Polyps most usual place were in colorectal sigmoid (n = 18) followed by colorectal downward and rectum. The inflammatory diseases were shown as actinic colitis (n = 11) followed by actinic proctitte (n = 7) and nonspecific proctite (n = 7). There was a higher prevalence of procedures from the ambulatory 73%, interns 20% and from the emergency room 7%. CONCLUSION: The predominant diagnosis was diverticulum disease, followed by polyps. Digestive hemorrhage was the main signal noticed by the doctors who asked for the exam. With a high incidence of polyps, and mostly in sigmoid, just evidenced the how important the retosigmoidoscopy is. It is a relatively safe and cheaper procedure in comparison to the colonoscopy and can be performed during the simple consultation. The low incidence of angiodisplasia could be explained by a relatively low average age, differing from literature.

Background & Aims Practice guidelines recommend that endoscopists spend at least 7 minutes examining the colonic mucosa during colonoscopy withdrawal to optimize polyp yield. The aim of this study was to determine if the implementation of an institution-wide policy of colonoscopy withdrawal time ≥7 minutes was associated with an increase in colon polyp detection. Methods All 42 endoscopists at our institute were asked to attain a colonoscopy withdrawal time of at least 7 minutes. Compliance with 7-minute withdrawal time was recorded for all nontherapeutic colonoscopies. Polyp detection ratio (number of polyps detected divided by number of colonoscopies performed) was computed. Regression models were used to assess the association between compliance with 7-minute withdrawal time and polyp detection. Results During the study period, 23,910 colonoscopies were performed. The average age of patients was 56.8 years, and 54% were female. Colon cancer screening or surveillance was the indication for 42.5% of colonoscopies. At the beginning of the study, the polyp detection ratio was 0.48. Compliance with 7-minute withdrawal time for nontherapeutic procedures increased from 65% at the beginning of the initiative to almost 100%. However, no increase in polyp detection ratio was noted over the same period for all polyps (slope, 0.0006; P = .45) or for polyps 1–5 mm (slope, 0.001; P = .26), 6–9 mm (slope, 0.002; P = .43), or ≥10 mm (slope, 0.006; P = .13). No association was detected when only colonoscopies performed for screening or surveillance were analyzed. Conclusions An institution-wide policy of colonoscopy withdrawal time ≥7 minutes had no effect on colon polyp detection.

RACIONAL: Ainda que se reconheça a eficiência da ecoendoscopia para o diagnóstico e até mesmo para o tratamento de várias doenças do aparelho digestivo, a sua inclusão nos algoritmos de decisão clínica em gastroenterologia tem sofrido restrições. Este fato é comprovado indiretamente através da existência de vários estudos que se preocuparam em demonstrar o impacto do exame ecoendoscópio na mudança de condutas e na redução de custos. Outra evidência, esta direta e identificável em nosso meio, é a disponibilidade bastante limitada da ecoendoscopia no Brasil. Neste sentido, quiseram-se identificar as situações clínicas em que o exame ecoendoscópico é eficiente, através de revisões sistemáticas, graduando-se o grau da evidência e a força da recomendação, realizadas pelo grupo envolvido com o método em nosso país, apresentadas e votadas na forma de consenso. MÉTODO: O grupo de médicos que realiza ecoendoscopia foi formado a partir de informações obtidas junto às sociedades de especialidades e aos fabricantes de equipamentos. A lista de tópicos e perguntas relevantes foi formulada por dois membros do consenso (FMF, CMD), discutida com e distribuída aos consensualistas 5 meses antes da reunião de consenso. Foi solicitado que se realizassem, na medida do possível, revisões sistemáticas e que as respostas fossem apresentadas para a votação com o grau de evidência e a força da recomendação. Nos 2 dias da reunião de consenso, as respostas foram apresentadas, debatidas e votadas. Quando, no mínimo, 70% dos votantes concordaram com o texto da resposta, houve consenso. O relatório final foi submetido a apreciação e aprovado por todos os consensualistas. RESULTADOS: Setenta e nove questões foram debatidas na pré-reunião do consenso, resultando 85 questões que foram então distribuídas. Nos 2 dias da reunião do consenso, 22 participantes debateram e votaram as 85 respostas. O impacto causado pelo exame ecoendoscópico foi comprovado por evidências do nível 1, gerando recomendações grau A e consenso entre os participantes nas seguintes situações: diagnóstico diferencial da lesão subepitelial do tubo digestivo e do espessamento de pregas gástricas, estádio e identificação de lesão irressecável no câncer do esôfago, sinais indiretos de carcinomatose peritonial no câncer gástrico avançado, estádio de linfoma gástrico tipo Malt e estádio do câncer de reto, diagnóstico da litíase da vesícula biliar e do colédoco, diagnóstico da pancreatite crônica, diagnóstico diferencial do nódulo sólido da pancreatite crônica, diagnóstico diferencial do cisto pancreático, resultados do tratamento endoscópico das varizes esofágicas, diagnóstico e estádio do câncer de pulmão não-pequenas células. CONCLUSÃO: Já há evidências do melhor nível na literatura médica justificando a utilização do exame ecoendoscópico em várias doenças do sistema digestório e, até mesmo, no câncer do pulmão. BACKGROUND: In the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. This fact is an indirect evidence of the difficulty of popularization of the method. On other hand, the limited availability of endoscopic ultrasonography in Brazil is a direct evidence of this limitation. This was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. It was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology. METHODS: A panel of experts on endoscopic ultrasonography was selected based on the files of the Gastroenterology and Endoscopy Societies and on the registries of endoscope manufacturers. Two members of the meeting selected the relevant topics that were transformed into questions. The topics and the questions were debated among the experts five months before the consensus meeting. The experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. During the two days of the meeting the answers were presented, debated and voted. Consensus was reached when a minimum of 70% of the voters were in agreement. The final consensus report was submitted to the experts' evaluation and approval. RESULTS: Seventy nine questions were debated by the experts at the pre-Consensus meeting. As the result of this debate 85 questions came out and were assigned to the members of the panel. During the Consensus meeting 22 experts debated and voted 85 answers. Consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer, indirect signs of peritoneal involvement of gastric cancer, MALT gastric lymphoma and rectal cancer staging, diagnosis of common bile duct and gallbladder stones, diagnosis of chronic pancreatitis and differential diagnosis of a solid mass in chronic pancreatitis, differential diagnosis of the pancreatic cyst, prediction of the results of the endoscopic treatment of esophageal varices and diagnosis and staging of non-small cell lung cancer. CONCLUSIONS: There are the highest levels of evidences that support the indication of endoscopic ultrasonography for several digestive diseases and even for non-small cell lung cancer.

Racional — Atualmente existem dúvidas quanto ao método ideal de rastreio e vigilância para o câncer colorretal. A retossigmoidoscopia é preconizada, já que é barata, eficaz e causa pouco desconforto, mas não pode diagnosticar tumores do cólon proximal. Objetivo - Avaliar quantas lesões encontradas no cólon proximal seriam perdidas caso a colonoscopia só fosse empregada em pacientes com lesões detectadas durante sigmoidoscopia. Casuística e Método - Foram revistas as colonoscopias consecutivas com achado de pólipos ou neoplasia, realizadas no Setor de Endoscopia da Disciplina de Gastroenterologia da Universidade Federal de São Paulo, excluindo pacientes repetidos, operados ou com doença inflamatória intestinal. Resultados - Cento e um exames foram elegíveis, sendo 45 pacientes do sexo masculino. A idade média foi 62 anos (DP ± 13,7 anos). Cento e oito fragmentos foram enviados separadamente para exame anatomopatológico, sendo 38 com suspeita de neoplasia e 70 pólipos. Ao se considerarem apenas os achados no cólon proximal, observou-se o total de 45 lesões, sendo 23 adenomas, 10 adenocarcinomas, 1 linfoma e 11 lesões benignas. Destas lesões, 28 eram isoladas, sendo 16 adenomas, 7 adenocarcinomas. Conclusão — Observaram-se que 23 pacientes (22,77%) tinham adenoma ou adenocarcinoma apenas no cólon direito, que não seriam diagnosticados se sigmoidoscopia flexível fosse usada isoladamente.

This is the first Brazilian Consensus on inflammatory bowel disease, carried out by the Brazilian Study Group of Inflammatory Bowel Disease, and discusses the treatment of Crohn's disease and ulcerative colitis in acute and remission phases. The first part of the text, brings out a review on the main drugs used in the treatment of inflammatory bowel disease, as well as their mechanisms of action and cautions during their use. In the second part, the committee's opinions about the most recommended medical and surgical approaches for both diseases are presented on the basis of disease activity, location and behaviour status. The recommendations here presented were widely discussed in several scientific meetings with active participation of all members of the group and were highly based on scientific evidence covered by the literature.

A 48-year-old female with severe ulcerative colitis refractory to conventional therapy was referred to our facility for management. The patient showed extensive ulcerative colitis since the age of 20 years and had failed therapy with 5-aminosalicylic acid agents and azathioprine. The disease remained active despite treatment with steroids and cyclosporine. The clinical and endoscopic parameters were consistent with severe disease. Infectious precipitants were ruled out. Given the severity of the disease and in order to avoid a colectomy, we started the patient on infliximab therapy. A dramatic clinical and endoscopic response was observed and she remained in remission at the end of a 1-year follow-up period. We discuss findings in the literature regarding the use of infliximab therapy in patients with ulcerative colitis who have failed steroids and cyclosporine.

Background Pancreatic-cyst fluid carcinoembryonic antigen (CEA) levels and molecular analysis are useful diagnostic tests in differentiating mucinous from nonmucinous cysts. Objective To assess agreement between CEA and molecular analysis for differentiating mucinous from nonmucinous cysts. Design Retrospective analysis. Setting Academic medical center. Methods Patients who underwent EUS-guided FNA for evaluation of pancreatic cysts were identified. The following information was used to designate a cyst mucinous: the CEA criterion was CEA level ≥192 ng/mL and the molecular analysis criteria were DNA quantity ≥40 ng/μL and/or k-ras 2-point mutation and/or ≥2 allelic imbalance mutations. Pathologic analysis of cysts served as the criterion standard. Results From 2006 to 2007, 100 patients met the study criteria. The average age of the patients was 63 years, 65% were women, and 30% were symptomatic. The mean diameter of pancreatic cysts was 2.5 cm. The median CEA value was 83 ng/mL (range 1-50,000 ng/mL), the mean DNA content was 16 ng/μL (range 1-212 ng/μL), 11% had K- ras mutations, and 43% had ≥2 allelic imbalance mutations. When using prespecified criteria, there was poor agreement between CEA and molecular analysis for the classification of mucinous cysts (kappa = 0.2). Poor agreement existed between CEA and DNA quantity (Spearman correlation=0.2; P = .1), K- ras mutation (kappa = 0.3), and ≥2 allelic imbalance mutations (kappa = 0.1). Of the 19 patients for whom a final pathologic diagnosis was available, CEA had a sensitivity of 82% compared with 77% for molecular analysis. When CEA and molecular analysis were combined, 100% sensitivity was achieved. Limitations Retrospective analysis and small sample size. Conclusion There was poor agreement between CEA levels and molecular analysis for diagnosis of mucinous cysts. Diagnostic sensitivity was improved when results of CEA levels and molecular analysis were combined.

Pancreatic cancer and cholangiocarcinoma are the main causes of malignant biliary stricture. Both types of cancers have dismal survival rates, and treatment has little or no effect on prolonging the patients lives. Prognostic definition at initial endoscopic retrograde cholangiopancreatography is important to choose the most suitable management.To analyse endoscopic brushing and bilirubinemia importance in determination of the survival of patients with malignant biliary stricture.Patients with biliary strictures diagnosed during endoscopic retrograde cholangiopancreatography were submitted to double brushing cytology. Serum samples were taken from all patients for bilirubinemia assay. Patients were followed to determine the final diagnosis and survival rates.A total of 50 patients with biliary stricture underwent endoscopic retrograde cholangiopancreatography (40 ultimately found to have a final diagnosis of malignant disease). Hyperbilirubinemia or cytology brushing positive for malignancy was related to a shorter survival rate.This research data demonstrate the possibility of determining the prognosis of patients with malignant biliary stricture using endoscopic brushing results and bilirubinemia levels.

RACIONAL: As principais causas de estenose biliar maligna são câncer de pâncreas e colangiocarcinoma. A definição do prognóstico dos pacientes no momento da pancreatocolangiografia retrógrada endoscópica é importante na escolha da conduta mais adequada. OBJETIVO: Avaliar a importância do escovado endoscópico e da bilirrubinemia na determinação da sobrevida dos pacientes com estenose biliar maligna. MÉTODOS: Os pacientes com estenose biliar diagnosticados durante pancreatocolangiografia retrógrada endoscópica foram submetidos a duplo escovado. Amostras de sangue de todos eles foram obtidas para dosagem das bilirrubinas. Os pacientes foram acompanhados para determinar o diagnóstico final e a sobrevida. RESULTADOS: Diagnóstico final de doença maligna foi obtido em 40 pacientes de um total de 50 casos de estenose biliar. Os níveis séricos elevados das bilirrubinas ou a citologia por escovado positiva para malignidade estava relacionada a menor sobrevida. CONCLUSÃO: Os dados desta pesquisa demonstram a possibilidade de determinar o prognóstico em casos de estenoses biliares malignas através do resultado do escovado endoscópico ou da bilirrubinemia. BACKGROUND: Pancreatic cancer and cholangiocarcinoma are the main causes of malignant biliary stricture. Both types of cancers have dismal survival rates, and treatment has little or no effect on prolonging the patients lives. Prognostic definition at initial endoscopic retrograde cholangiopancreatography is important to choose the most suitable management. AIM: To analyse endoscopic brushing and bilirubinemia importance in determination of the survival of patients with malignant biliary stricture. METHODS: Patients with biliary strictures diagnosed during endoscopic retrograde cholangiopancreatography were submitted to double brushing cytology. Serum samples were taken from all patients for bilirubinemia assay. Patients were followed to determine the final diagnosis and survival rates. RESULTS: A total of 50 patients with biliary stricture underwent endoscopic retrograde cholangiopancreatography (40 ultimately found to have a final diagnosis of malignant disease). Hyperbilirubinemia or cytology brushing positive for malignancy was related to a shorter survival rate. CONCLUSION: This research data demonstrate the possibility of determining the prognosis of patients with malignant biliary stricture using endoscopic brushing results and bilirubinemia levels.

O teste rápido da urease, método acurado, barato, de resultado prontamente acessível, vem sendo largamente utilizado na pesquisa do Helicobacter pylori. Com qualidade equivalente à dos testes comerciais, o teste rápido da urease não tamponado tem sido preparado para uso diário. Objetivo - Avaliação deste método estocado em geladeira (4 ºC). Material e método - Foram obtidas biopsias endoscópicas da mucosa antral de 104 pacientes consecutivos, nas quais a pesquisa do Helicobacter pylori foi realizada pelo teste rápido da urease, exame anatomopatológico e teste rápido da urease estocado mantido em geladeira por período de 1 a 8 dias e retirado no dia do exame. Resultados - Consideramos presente a infecção quando o teste rápido da urease e anatomopatológico foram concomitantemente positivos, o que ocorreu em 45 pacientes (42%). O teste rápido da urease estocado mostrou especificidade comparável ao teste rápido da urease (93%), com sensibilidade de 88%. Conclusão - Podemos concluir que o teste rápido da urease estocado mantém acurácia adequada, permitindo seu uso rotineiro. Assim, torna-se ainda mais fácil a utilização de testes de urease não tamponados, já que a acurácia diagnóstica fica mantida mesmo com estocagem por até 8 dias. The rapid urease test is an accurate and cheap method, which results are readily available, and broadly used for routine Helicobacter pylori infection diagnosis. Aim - The evaluation of rapid urease test stored in refrigerator at 4 °C (SRUT) compared to regular rapid urease test. Patients and Method - Endoscopic biopsies were obtained from gastric antrum in 104 consecutive patients. Diagnosis of Helicobacter pylori infection was accomplished by rapid urease test, histology and rapid urease test stored (kept in refrigerator by a period ranging from 1 to 8 days). Results - Infection was considered present if both rapid urease test and histology were positive. Helicobacter pylori was present in 45/104 patients (42%). Rapid urease test stored had specificity comparable to rapid urease test (93%), with sensitivity of 88%. Conclusion - We concluded that rapid urease test can be stored in refrigerator for up to 1 week, without loss of clinical applicability, and that can make the test even easier to use for routine Helicobacter pylori tests in a busy endoscopy unit.

Introdução - A presença de uma segunda neoplasia maligna, tendo sítio e histologia diferentes da primeira, define o conceito de neoplasias primárias múltiplas. Com o aumento da sobrevida dos pacientes com câncer, houve um aumento de neoplasias primárias múltiplas. Este estudo objetiva avaliar a freqüência de neoplasias primarias múltiplas em pacientes com diagnóstico de câncer colorretal do Setor de Oncologia da Disciplina de Gastroenterologia da Universidade Federal de São Paulo. Pacientes e Métodos - No período de 1993 a 1998, 145 pacientes com câncer colorretal foram acompanhados no Setor de Oncologia da Disciplina de Gastroenterologia da Universidade Federal de São Paulo. Destes, cinco pacientes (3,4%) tinham neoplasias primárias múltiplas. O segundo tumor foi confirmado por exame histológico, sendo excluídas as possibilidades de metástase. Resultados - A idade média dos doentes com neoplasias primárias múltiplas foi de 60,6 anos, quatro eram do sexo feminino e um do masculino, três apresentaram doença no reto, um no cólon direito e um no cólon esquerdo. Os outros sítios foram mama, útero, útero e vagina, pele e lábio. Um paciente foi a óbito e os outros estão em acompanhamento, sendo que dois, há mais de três anos. Dois pacientes tinham sido submetidos a radioterapia pélvica antes do aparecimento da neoplasia colorretal. Em um paciente o tumor colorretal antecedeu o outro câncer e em quatro apareceu posteriormente ao diagnóstico da outra neoplasia primária. Discussão - A prevalência de neoplasias primárias múltiplas foi de 3,4%, sendo maior no sexo feminino. Câncer de endométrio foi o outro tumor maligno mais freqüente. Quarenta por cento dos nossos pacientes foram submetidos a radioterapia. Acreditamos ser importante o acompanhamento dos pacientes para o diagnóstico precoce de uma nova neoplasia em qualquer paciente que já tenha apresentado um câncer. Introduction - Multiple primary neoplasms are defined as a second malignance having histology and site different from the first. The increase of the life expectation in cancer patients leads to an increase in multiple primary neoplasms incidence. This study analyzes the characteristics of patients with colorectal cancer and another primary neoplasm. Patients and Methods - In the period from 1993 to 1998, 145 patients with colorectal cancer were accompanied in the Oncology Division of Gastroenterology of Federal University of São Paulo, São Paulo, SP, Brazil. Five patients (3.4%) had multiple primary neoplasms. The possibility of metastasis were excluded and the second cancer was confirmed by hystological examination. Results - The medium age was of 60.6 years old, four were female and one male. Three had rectum cancer and two colon cancer, one in the right colon and one in the left colon. The other site of cancer was breast, uterus, uterus and vagina, skin and lip. One patient died and the others were in attendance, two for more than three years. Two patients received pelvic radiotherapy before the rectal cancer. In one patient the tumor colorectal cancer appeared before the other cancer, and in four it appeared later on to the diagnosis of the other primary neoplasia. Discussion - The prevalence of multiple primary neoplasms was of 3,4%, being major in female. Uterus' cancer was the more frequent association. Radiotherapy was performed in 40% of patients. We believe that attendance of cancer patients is very important to precocious diagnosis and treatment of multiple primary neoplasms.

A colonoscopia é atualmente o padrão ouro para investigação da mucosa dos cólons, reto e íleo terminal. Para sua realização, há necessidade de uso de soluções para limpeza do cólon que, em geral, são mal toleradas pelos pacientes. Os objetivos do presente estudo foram comparar duas soluções de preparo intestinal para colonoscopia, quanto à efetividade, tolerabilidade, aceitabilidade e segurança em pacientes que se submeteriam a colonoscopia eletivamente, no Centro de Diagnóstico em Gastroenterologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Trata-se de estudo unicêntrico, prospectivo, com alocação aleatória dos pacientes. Cem pacientes pareados por sexo e idade foram randomizados em dois grupos. O grupo I recebeu bisacodil mais 1 litro de Polietilenoglicol (PEG) na véspera e 1 litro no dia do exame. O grupo II recebeu bisacodil na véspera e 1 litro de manitol 10% no dia do exame. A mesma dieta foi orientada nos dois grupos. A qualidade do preparo foi graduada através das escalas de Boston e Ottawa. A tolerabilidade e aceitabilidade foram aferidas por questionários previamente estudados. Quanto à segurança, foram ava liadas: variação de sinais vitais antes e após o preparo e complicações. Noventa e seis pacientes (96%) completaram o estudo. Não se observou diferença na qualidade do preparo entre os grupos(p = 0,059). Quanto à tolerabilidade, o grupo I (PEG) apresentou frequência significativamente menor de náusea, vômito, dor abdominal e distensão abdominal (p < 0,05). A aceitabilidade foi significativamente melhor com o grupo I (PEG) (p < 0,05). Em relação à segurança, o grupo I (PEG) apresentou-se mais seguro. No presente estudo, podemos concluir que ambos os preparos são semelhantes em eficácia (p > 0,05) e a solução de PEG apresentou melhor tolerabilidade, aceitabilidade e segurança em comparação ao preparo com manitol (p < 0,05). Colonoscopy is currently the gold standard to examine the colon, the rectum, and the terminal ileum. To perform a colonoscopy, is necessary to use solutions to clean the colon that are generally poorly tolerated by the patients. The study aims to compare the effectiveness, tolerability, acceptability and safety of two solutions used for intestinal preparation for elective colonoscopy examination in the Diagnosis Center Of Hospital das Clinicas, Faculty of Medicine, University of São Paulo. It is a Prospective study carried out in a single center, with random allocation of the patients. One hundred patients that were paired based on sex and age were randomized into two groups. Group I received bisacodyl plus 1 liter of polyethylene glycol (PEG) the night before and 1 liter on the day of the exam. Group II received bisacodyl the night before and 1 liter of a 10% mannitol solution on the day of the exam. The patients diet was the same for both groups. The quality of the preparation was graded based on the Boston and Ottawa scales. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, as well as any complications. Ninety-six patients (96%) completed the study. No difference was observed in the quality of the preparation between the two preparation methods (p = 0,059). As for tolerability, group II (the mannitol preparation group) presented a significantly higher frequency of nausea, vomiting, abdominal pain and abdominal distension (p < 0,05). Acceptability was significantly better in group I (p < 0,05). The PEG solution was also shown to be safer than mannitol. Based on the present study, the following conclusions can be made: 1) Both methods of preparation had similar efficiencies (p > 0,05); 2) PEG method showed higher tolerability, acceptability and safety compared to the mannitol method (p < 0,05).