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The authors report a patient with obstructive jaundice as the first clinical manifestation of a primary malignant melanoma metastatic in the ampulla of Vater. After the histologic diagnosis of the metastases was made, the primary tumor was located in the skin of the back. Obstruction jaundice secondary to ampullary obstruction due to metastatic melanoma has only been reported twice, and in neither case was jaundice the first symptom of the disease.

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Endoscopic polypectomy was one of the first therapeutic procedures, as it was done even before the appearance of colonoscopy through rigid endoscopies. Immediately after the use of monopolar current in endoscopy, polyp resection in the digestive tract has been a elective treatment, and is reserved only for surgeries which are very extensive, or those which cannot be surrounded with a wire loop. The impact of the polypectomy in colonic adenomas has been notable because of the possibility of the diagnosis of the entire surgical piece, and for the treatment of lesions with premalignant potential. The success of the complete resection of a colonic polyp is directly proportional to its size and shape, given that pendicular polyps guarantee the complete extirpation of the tumor, in that sessile polyps require additional techniques to elevate the lesion. Among the precautions in prepolypectomy are found the following: Anti-inflammatory non-steroidal (AINS) suspension; anticoagulant suspension, and adequate intestinal preparation. Hemorrhage and perforation occur in 0.1% of each. Postcoagulation syndrome is a secondary effect which only requires vigilance. The inherent complications in the use of secondary current are minimal when its technical principles are known. The success of endoscopic polypectomy depends on the refinement of the procedure, which is achieved through experience.

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Helicobacter pylori (Hp) has been associated to gastritis, peptic ulcer, gastric cancer, and other gastrointestinal disorders. The 14C-urea breath test (UBT) has been proposed as a simple and noninvasive method for its detection, and has recently been implemented in our institution. To optimize our resources, we performed a sensitivity analysis to determine the minimal sampling and duration of testing required, and to establish objective criteria for its interpretation. With this purpose, endoscopy, antral biopsy and UBT were performed in 104 dyspeptic patients. For the UBT, a basal breath sample was taken before the administration of 10 microCi of 14C-urea and followed by sequential breath sampling at 5, 15, 30 and 60 minutes. Considering histologic findings as the gold standard, receiver operating characteristic (ROC) curves were constructed for the following three 14CO2 excretion strategies: excretion by sample, maximum excretion, and cumulative excretion. Hp was detected in 74 (71%) of the patients, and its presence coincided with significantly higher 14CO2 excretion than in the Hp negative (p < 0.001). The three excretion strategies were comparable in terms of diagnostic accuracy, but the most efficient results were given by the 15 minute sample. With a cut-off point of > or = 1.7%, the sensitivity and specificity of this sample was > or = 83%, the positive and negative predictive values were 93% and 68%, and the accuracy was 84%. We conclude that UBT can be completed with a single breath sampling at 15 min, and its results objectively interpreted as positive if the 14CO2 excretion is > or = 1.7%.

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Non-neoplastic colon polyps are benign lesions with normal histology components, we present our experience with colonoscopy polypectomy in 10 years. We resected 187 polyps in 96 patients (50 males) with medium age of 49.3 years and range 2-82. Most common indication was hemorrhage (37%) taking out the hyperplastic polyps who were found in asymptomatic patients with the highest frequency (41%). Juvenile polyps follows with 25%. 71% polyps were unique but hamaetomatous polyps of Peutz-Jeghers syndrome were multiple (39%). Juvenile (retention) polyps were found among the youngest patients (average 13.2 years) and frequently had hemorrhage (21-25). Lipomas were found in elder patients (range 52.5 years). We had no major complications with hemorrhage or mortality, minor complications were found in 3.09%.

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This study was undertaken to evaluate the usefulness of the urea test (UT) in the detection of Helicobacter pylori (HP) in dyspeptic patients. The UT was done in 105 patients with dyspepsia who underwent endoscopy and biopsy. Hematoxylin-eosin and Warthin Starry tissue stains were performed for HP detection, and the resulting microscopic findings were considered as the gold standard. The sensitivity, specificity, and positive and negative predictive values of the UT were of 95%, 63%, 85% and 83% when compared to the hematoxylin-eosin stain-related findings, and 99%, 79%, 93% and 96% when compared to those related to the Warthin Starry stain. We conclude that the UT is a simple, non-invasive and useful diagnostic alternative to detect HP in patients with dyspepsia.

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We report all patients with neoplastic polyps endoscopically excised during 10 years, performed in different hospitals in Mexico City. All ages, both sexes and socio-economic levels were seen in several endoscopy services both, public and private. We find 190 patients (100 females) with 268 polyps and a mean age of 54.5 (range 18-86). Tubulo-villous adenomas have the less frequency (8%). Villous adenomas were the largest and had a 11% frequency, almost all were confined to recto-sigmoid region its mean age was 6 years. Villous adenomas were the most frequent (69%) distributed in all colonic segments, its mean age was 54.5 years with the widest range (18-80 years); they have highest dysplasia rate (8.1%). Carcinomas arising in polyps were all located in recto-sigmoid region, with female predominance (2.3:1) and oldest mean age of presentation (66.3 years). Neoplastic polyps in Mexico City general population has a low frequency; endoscopic polypectomy is safe and had a low morbi-mortality rate.

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In 52 patients we performed endoscopic sclerotherapy during active bleeding with good results in stopping hemorrhage in 93%. Most patients were Child "C" (66%) and postnecrotic cirrhosis was the commonest etiology (50%). Major complications were pleural effusion (2%) and mediastinal inflammation (2%), no mortality was found directly by this method. Conclusions are that endoscopic sclerosis of variceal hemorrhage have a special role in stopping bleeding but has no effect in one year survival.

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A multicenter open study aimed at evaluating the effect of famotidine in the treatment of duodenal ulcer was performed in several institutions located in 15 different cities of Mexico. One-hundred-and-fourteen patients with duodenal ulcer demonstrated by endoscopy were given 40 mg. of famotidine daily, administered as a single dose at night. After 4 and 6 weeks of treatment, healing of the ulcer was observed in 81.6% and 95.6% of patients, respectively. Side-effects were very unusual. In only one patient, who experienced vertigo during the treatment, administration of the drug had to be stopped.

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A multicentric open study designed to evaluate the effect of famotidine in the treatment of gastric ulcer was performed in several institutions located in 15 different cities of Mexico. 54 patients with gastric ulcer demonstrated by endoscopy were given 40 mg of famotidine daily, administered as a single dose at night. After 6 and 8 weeks of treatment, healing of the ulcer was observed in 63% and 88.9%, respectively. Side-effects were very unusual.

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