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Endoscopic pancreatic sphincterotomy (EPS) has fallen into disuse for some time because of the risk of severe complications. More recently, EPS has been advocated as an effective treatment modality for several pancreatic disorders, including severe chronic pancreatitis, pancreatic pseudocyst, ampulloma, pancreas divisum, and pancreatic sphincter dysfunction. Favorable outcomes in patients undergoing EPS to facilitate further interventions, in whom long-term follow-up was available, was 70%; complications occurred in 14% and reintervention was required in 23%. The results were as good as those of surgery after long-term follow-up. Patients who underwent some form of pancreatic drainage after sphincterotomy had fewer complications (p = 0.03). Approximately 75% of patients with pancreas divisum who presented with idiopathic acute recurrent pancreatitis improved after endoscopic therapy, but only 25% of patients experienced pain reduction of at least 50%. The National Institutes of Health Consensus recommends EPS in patients with type I sphincter of Oddi dysfunction (SOD). In patients with type II SOD, prior manometry should be performed. In our series of 17 patients, we obtained results similar to those of other studies, although the number of patients was small. EPS appears to be a safe and effective technique, but further, well-designed, multicenter, prospective and long-term studies are required to evaluate these results and settle current controversies.

Gastroenterology education has changed in recent years and the quality criteria are now the aim of it. Adult education is not intuited, it is to be learned. In our days post graduated education needs longer periods of training, because of the everyday development of new techniques and also because the e-learning /e-teaching has appeared in the arena.

Background: Gastric Antral Vascular Ectasia or Watermelon stomach is a rare cause of chronic gastrointestinal bleeding, often presenting as a chronic iron deficiency anemia. This condition can be associated with some other diseases such as cirrhosis, autoimmune diseases and others. We report two patients treated with Argon Plasma Coagulation, a 68 years old male with an ethanol related cirrhosis and a 72 years old female with an idiopathic Gastric Antral Vascular Ectasia. The characteristic endoscopic features were mistaken for many years as gastritis. Both patients presented with severe anemia requiring multiple transfusions as treatment. Due to the poor operative risk, both patients were treated with Argon Plasma Coagulation with good results (Rev Med Chile 2001; 129: 547-51)

TO THE EDITOR: Barrett's esophagus is a well-known premalignant condition that could be associated with the development of dysplasia and adenocarcinoma. However, the risk of developing adenocarcinoma is variable according to the studied population. Then, the ablative treatment with argon plasma coagulator (APC) appears a valid alternative to avoid the progression from metaplasia to dysplasia and cancer.

Inverted Colonic Diverticulum: An Infrequent and Dangerous Endoscopic Finding R. Merino, T. Kinney, R. Santander, R. Yazigi, C. Navarrete, M. Saenz, R. Saenz Background: Inverted Colonic Diverticula (ICD) can be misinterpreted as elevated polypoid lesions, and biopsy or endoscopic resection of these lesions can lead to severe complications. These important lesions are rarely reported in the medical literature and marginally mentioned in classic texts. The aim of this study is to describe the endoscopic characteristics of ICD to avoid misdiagnosis and to report the frequency of these lesions in a large endoscopic series. Materials and Methods: A retrospective analysis was performed of all patients undergoing colonoscopy at our institution between July 2001 and July 2004 using Medicaps 2.0 InfoCYS endoscopic database and selecting patients diagnosed with ICD. Patient characteristics as well as lesion characteristics were recorded, including location, endoscopic characteristics, and the presence of synchronous polypoid lesions.The following endoscopic characteristics were considered in diagnosing ICD: 1) elevated sessile appearance with fine concentric folds surrounding the lesion, 2) mucosal pattern on lesion is similar to surrounding mucosa, 3) umbilicated appearance, 4) found in an area of diverticula, 5) surrounding fine concentric folds enhance with Methylene Blue, and 6) lesion reverts to typical diverticular appearance with direct water infusion, air insufflation, or gentle pressure with biopsy forceps. Results: Among 4508 colonoscopies performed in the selected period, 33 (0.7%) were diagnosed with ICD according to the endoscopic criteria above. Mean patient age was 62.3 years, with 7/9 male/female ratio. 89% of ICD were in an area of multiple colonic diverticula, and 75% were located in the sigmoid colon. One had active bleeding from the inverted diverticulum and was treated with injection therapy. 2 cases required gentle pressure with the biopsy forceps for diagnosis and the remaining were diagnosed according to the other referred endoscopic criteria. No biopsies or resections were performed. There were no complications in this series. Conclusion: ICD is a rare endoscopic finding (0.7%) that is occasionally complicated by local bleeding. Misdiagnosis could be dangerous as these lesions appear similar to sessile polyps, and biopsy or endoscopic resection could lead to serious complications. The endoscopic criteria described should be considered to avoid complications.