These results show that polypectomy of large pedunculated polyps is associated with a higher incidence of bleeding. Particularly in polyps larger than 2 cm, preventive measures can significantly reduce bleeding complications after polypectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.

Early precut is associated with lower pancreatitis rate, suggesting that pancreatitis develops as a consequence of the attempts to cannulate the papilla and pancreatic injection, and not precutting.

In patients with bile duct stones who were treated with biliary plastic stents, the best stent management to avoid cholangitis was stent changing at defined intervals (every 3 months in the current study). The data confirmed that plastic biliary stenting may decrease stone size with a high percentage of subsequent total stone clearance.

No abstract

Sphincterotomy does not seem to be necessary for placement of 10F-PS in patients with malignant common bile duct obstruction.

No abstract

Several theories explain the development of hiatal hernia (HH). Since inguinal hernia (IH) is due to abdominal wall herniation, we hypothesized that if HH is caused by an excessive "push" from increased intraabdominal pressure, there would be a greater than chance association between HH and IH. The aim of this prospective case-control study was to determine the relationship between HH, identified at endoscopy, and IH, found on clinical examination. Outpatients, who were referred for elective upper GI endoscopy at the Endoscopic Unit, from January 1999 to December 1999, were evaluated. Data were collected regarding gender, age, BMI, presence or absence of HH, length of HH, and presence of IH on detailed abdominal examination of each subject. Five hundred fifty-nine outpatients were enrolled in this study. Of these, 128 (23%) had HH, whereas 431 (77%) patients did not. The average length of the HH was 2.7 +/- 0.9 cm (range, 1.5-6 cm). The overall risk of IH in patients with HH is 2.5-fold compared to those without HH (OR = 2.59). Obesity (BM, >25) was an additional risk factor for IH in patients with HH compared with normal weight (BMI, 21-25) (P < 0.05). Males with HH were more likely to have IH than females (OR = 2.86; 95% CI = 1.35-6.08). Inguinal and hiatal hernias occur together more often than expected by chance alone. Male gender and obesity increase the risk of association. These results suggest that a common etiology may exist for both IH and HH, at least in some patients, and support the hypothesis that "push" factors may contribute to the etiology of HH.

Increasing attention has been given to hereditary nonpolyposis colorectal cancer (HNPCC). This report provides medical genetic/pathologic findings on an HNPCC kindred from southern Italy that shows criteria consistent with Lynch syndrome II. An international collaborative effort led to extension of this kindred with disclosure of a potentially new spectrum of phenotypic findings: an excess of gastric carcinoma; complete intestinal metaplasia and chronic atrophic gastritis restricted to the antrum; an apparent excess of colonic mucosal macrophagia, which by special stain appeared to be positive for mucin, with a constant content of both sialo and sulfomucin, a lack of iron, and an inconstant positivity for lysozyme obtained by immunoperoxidase technique; and findings of crypt atrophy of the colonic mucosa. During the relatively short period of investigation of this family, an intensive educational and surveillance program has been mounted in the interest of improving cancer control through direct application of knowledge of natural history and the risk factor evidence through pedigree assessment.