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-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

Injecting triamcinolone after every dilation session next to or at the borders of the lacerations caused by the dilators, results in a significant improvement or resolution of dysphagia.

NPL showed high prevalence and higher aggressiveness than polypoid lesions, especially the depressed type.

Introduction. To compare the accuracy of digital and real-time chromoendoscopy for the differential diagnosis of diminutive (<5 mm) neoplastic and nonneoplastic colorectal lesions. Materials and Methods. This is a prospective randomized study comparing the Fujinon intelligent color enhancement (FICE) system (65 patients/95 lesions) and indigo carmine (69 patients/120 lesions) in the analysis of capillary meshwork and pit pattern, respectively. All lesions were less than 5 mm in diameter, and magnification was used in both groups. Histopathology was the gold standard examination. Results. Of 215 colorectal lesions, 153 (71.2%) were adenomas, and 62 were hyperplastic polyps (28.8%). Morphological analysis revealed 132 (61.4%) superficial lesions, with 7 (3.3%) depressed lesions, and 83 (38.6%) protruding lesions. Vascular meshwork analysis using FICE and magnification resulted in 91.7% sensitivity, 95.7% specificity, and 92.6% accuracy in differentiating neoplastic from nonneoplastic lesions. Pit pattern analysis with indigo carmine and magnification showed 96.5% sensitivity, 88.2% specificity, and 94.2% accuracy for the same purpose. Conclusion. Both magnifying virtual chromoendoscopy and indigo carmine chromoendoscopy showed high accuracy in the histopathological diagnosis of colorectal lesions less than 5 mm in diameter.

Background Acute pancreatitis is the most common complication after ERCP, occurring in about 4 % of the procedures. Only the placement of pancreatic duct prosthesis and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have shown benefit in the prevention of post-ERCP pancreatitis (PEP). Although the benefit of rectal administration of indomethacin or diclofenac is recommended by some studies and society guidelines especially in a selected group of high-risk patients, there is so far, no standardization of time or route of NSAID administration. The aim of the current study is to investigate the role of an intravenous NSAID administered before the procedure for PEP prevention. Methods In this randomized double-blind clinical trial, all consecutive patients who underwent ERCP were randomized to receive saline infusion with ketoprofen or saline, immediately before the procedure. Results A total of 477 patients were enrolled and completed follow-up. The majority of patients (72.1 %) had bile duct stones, and only 1.5 % had a clinical suspicion of sphincter of Oddi dysfunction. PEP developed in 5 of 253 (2 %) patients in the placebo group and in 5 of 224 (2.2 %) patients in the ketoprofen group (p = 1.). Conclusions Intravenous administration of ketoprofen immediately prior to ERCP did not result in reduction in PEP in a general population of ERCP patients.

RESUMO -Contexto -O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagnóstico in vivo de neoplasias colônicas. Objetivo -Avaliar a exatidão da magnificação associada à cromoendoscopia eletrônica ou com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. INTRODUÇÃONos últimos anos, a magnificação de imagens com ou sem o emprego da cromoscopia, tem ganho grande importância como recurso propedêutico para endoscopia digestiva, em especial, da colonoscopia (6,9,11,16,19,20) . Maior precisão diagnóstica requer detecção de pequenas alterações estruturais ou de coloração (8) , que podem ser diagnosticadas por meio da colonoscopia de alta resolução aliada à magnificação de imagens. Esta tecnologia permite o aumento de uma porção da imagem e sua visualização com grande riqueza de detalhes, seja ela obtida óptica ou digitalmente. A imagem endoscópica depende dos comprimentos de onda da luz que são refletidos pelo tubo digestivo. O sistema FICE ® ("Fuji Intelligent Color Enhancement"), por meio de filtros específicos para diferentes combinações de comprimentos de onda entre o vermelho, o verde e o azul, converte imagens ópticas em imagens espectrais altamente contrastadas. Desta forma, o FICE ® se apresenta como verdadeiro método de cromoscopia virtual, dispensando o emprego de corantes, o que levaria a ganho de tempo, redução dos custos e maior praticidade durante a colonoscopia.Neste estudo, pretende-se comparar a precisão diagnóstica desta nova ferramenta com o método clássico de magnificação de imagens aliada à cromoscopia com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. MÉTODOS

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