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Objectives: peptic ulcer is characterized by its recurrent nature, which necessitates maintenance treatment in most patients. But this natural history can be changed in patients with peptic ulcer associated to Helicobacter pylori, as shown by the low rates of recurrence and decreased hemorrhagic recidivism associated with this infection. Whether CagA or VacA strains are associated with a greater risk of peptic ulcer is controversial. This study was designed to examine endoscopic findings and their relation with H. pylori phenotype (CagA or VacA)., Methods: 106 selected dyspeptic patients underwent upper gastrointestinal tract endoscopic examination between September 1996 and May 1997 [69 with H. pylori (Hp) and 37 without this infection]. Endoscopic findings were classified as gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), duodenitis (Du), chronic gastritis (CG) and normal mucosa (NM). Hp phenotype was analyzed with a western blot test., Results: 75% of H. pylori strains were CagA-positive and 54.2% were VacA-positive. 82.4% of the cases of DU were associated with a CagA+ phenotype, but the association was not statistically significant. Otherwise 100% of gastric ulcers were associated with CagA+ strains (p < 0.005). VacA phenotype was not associated with any particular endoscopic finding. Peptic ulcer (DU or GU) was also associated with the CagA+ phenotype (p < 0.05)., Conclusions: the CagA+ H. pylori phenotype seems to be a peptic lesion marker, but was more frequently related with GU than with DU in our sample of Spanish patients.

Aim: To evaluate the histopathological characteristics of colonic polyps, found during colonoscopy examination and endoscopic polypectomy, and their relation to age, tumor location, sex, histological type and degree of epithelial dysplasia., Material and Methods: Between 1996 and 1997, 2,465 total colonoscopies were performed at the Gastroenterology Department of the Virgin Macarena University Hospital in Seville. Different size polyps were found in 318 patients who had been referred because of several symptoms/by several centers. The mean age was 59.2 years in men and 61.5 years in women., Results: 446 polyps were removed by endoscopic polypectomy, 32 (7.2%) were hyperplastic polyps, 402 were adenomas (90.2%) and 12 (2.6%) were adenomas with adenocarcinoma. Seventy-five percent of adenomas were located in the left colon and rectum and 25% in right colon. Hyperplastic polyps were found in left colon. Of the polyps removed, 55.1% were smaller than 1 cm, 26.5% were between 1 and 2 cm and 18.4% were between 2 and 7 cm. Histopathologic study of adenomas revealed that 17% were villous adenoma, 80% were tubular adenomas and 3% were tubulovillous adenomas. Adenocarcinomas were found in 12 (2.8%) adenomas. Of the adenomatous polyps, 87.4% had low-grade dysplasia and 12.6% high-grade dysplasia. Statistical analysis showed a strong correlation between size of adenoma and degree of dysplasia (p < 0.05). Similar significant relation was found between histological type and size (p < 0.05) but there were no statistically significant differences between location, sex or age, and degree of dysplasia (p < 0.05)., Conclusions: Size of colonic polyps is related to epithelial dysplasia and histological type (p < 0.05). No correlation was found between location, sex or age and degree of dysplasia.

Unlabelled: A relevant percentage of patients with malignant biliary obstruction are not candidates for surgery when the diagnosis is made. Endoscopically placed biliary stents have shown their efficacy in the palliative management of these patients although they do not seem to increase their survival. We report on a retrospective analysis of 37 patients with malignant biliary obstruction treated with endoscopic biliary stents. The distal third (62%) of the main life duct was the most frequent common location for the obstruction, and pancreatic cancer was the most frequent cause of obstruction (64%). Twenty three plastic (13-7F and 10-10F) and 14 metallic stents were placed initially. Forty four percent of the plastic stents (all of them 7F, none 10F) were removed after 39 days against 30% of the metallic stents after a mean period of 60 days. Global survival was 153 days (110 in the plastic stents' group versus 195 in the metallic one, p: NS). We could only make a complete follow up in 52% of the patients., Conclusions: endoprotheses are a good palliative treatment for malignant biliary obstruction. When plastic stents are used they should have a wide calibre (10F or greater). Metallic stents result in an increase of survival time without statistical significance.

Unlabelled: Pain in chronic pancreatitis is due to intraglandular neural affection and to pancreatic duct drainage obstruction with an increased intraductal pressure. To achieve pain relief, medical, surgical and endoscopic procedures have been developed., Aim: To evaluate the efficacy of pancreatic duct stenting in patients with narcotic-dependent pain due to chronic pancreatitis., Patients and Method: From May-1994 to May-1996, ten patients (medium age: 47.5 yr) with alcoholic chronic pancreatitis were selected for this procedure. Pancreatography showed single or multiple Wirsung strictures in all cases. Papillotomy and pancreatic duct sphincterotomy were performed before stenting. Strictures were negotiated with a 7F dilating catheter over a guide wire, and intraductal calculi were removed as well. We used 7F plastic stents with variable lengths (5-10 cm), that were exchanged when the patient presented pain recurrence. Stent survival time was defined as the patient's pain-free time., Results: In 6 of the 10 patients stent placement was carried out successfully. A single distal Wirsung stricture was diagnosed in 3 patients while in the remaining 3 there were several strictures associated to ductal lithiasis in two of them. Mean time to achieve pain relief was 3 days and mean stent survival time was 166.5 days. There were no complications due to the procedure., Conclusions: When placed through the stricture, endoscopic pancreatic stent drainage is effective in achieving pain relief. It is a safe procedure with no complications in our short series.

The aim of this study was to obtain pathologic diagnosis by aspiration punction (AP) by real time lineal echoendoscopy in different lesions suspected to be malignant. AP was performed in 6 cases with a Pentax-Hitachi FG 32UA lineal echoendoscopy. Four pancreatic neoplasms, one plastic linitis and one adenopathy of the celiac trunk were observed. Malignancy was confirmed by clinical evolution or surgery. The sensitivity of malignancy diagnosis was 67%, specificity 100% and diagnostic certainly 87%. No complications were observed. In the authors' preliminary experience, aspiration punction with real time lineal echoendoscopy allowed pathological diagnosis to be performed safely and effectively with relative simplicity.

Duodenal varices are uncommon and are frequently diagnosed late. However, they are a potential cause of massive bleeding, with tendency to relapse. We would like to offer as an example a case diagnosed by means of an endoscopy. A patient without oesophageal varices and with obstruction of the splenic-portal axis and venous calcifications is reported. A diminution in the volume of the duodenal varices with inspiratory movements may help in the differential diagnosis during endoscopy. We emphasize the need of avoiding incorrect maneuvers during endoscopy and the value of ultrasonography and CAT scan to confirm the diagnosis. Sclerotherapy appears to be the best therapeutic approach. Percutaneous embolization and surgery are therapeutic alternatives if sclerosis is not effective. However, in some cases with self-limited bleeding and a low tendency to relapse, as with the patient described herein, a conservative attitude should be selected.

In this paper, we show the presence of an anticoagulant factor which induced a prolongation of the partial time of thromboplastin (PTT) in a 23 year old female with Gaucher's disease and premature delivery. We discuss the importance of this factor and the therapeutic efficacy of the total splenectomy in this type of patient when spleen enlargement poses problems for the evolution of pregnancy to the end.

We report a case of a 5-aminosalicylate-induced pancreatitis in a patient with Crohn's disease. These findings suggest that some side effects, traditionally thought to be related to sulphafapyridine, are really due to 5-aminosalicylate. The good prognosis of this rare complication depends on the early withdrawal of the drug. Therefore the degree of the clinical suspicion plays a essential role in the appropriate diagnosis, but a challenge with mesalazine must be carried out in those patients in which other causes of pancreatitis could not be excluded.