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AIM: To determine the diagnostic accuracy of colon capsule endoscopy for colorectal cancer screening. METHODS: Studies that compared the diagnostic performance of colonoscopy and second-generation colon capsule endoscopy (CCE-2) for screening of asymptomatic patients aged 50-75 years were included. The primary outcomes were sensitivity, specificity, and positive and negative likelihood ratios for polyps and adenomas measuring at least 6 mm or 10 mm. RESULTS: Eight full-text studies that evaluated 1602 patients were included for systematic review. Of these, 840 (52.43%) patients participated in an opportunistic screening program. The pooled outcomes of CCE-2 for polyps at least 6 mm / 10 mm were (CI = confidence interval): sensitivity: 88% (95% CI: 0.84-0.91) / 88% (95% CI: 0.82-0.93), specificity: 94% (95% CI: 0.92-0.95) / 95.5% (95% CI: 0.94-0.97); positive likelihood ratio: 11.86 (95% CI: 5.53-25.46) / 23.07 (95% CI: 6.163-86.36); negative likelihood ratio: 0.14 (95% CI: 0.1-0.21) / 0.14 (95% CI: 0.09-0.21). The area under the summary receiver operating characteristic curve for polyps at least 6 and 10 mm was 96.3% and 96.7%, respectively. The only cancer missed by complete CCE-2 was shown at multiple frames in the unblinded review. In total, 125 (7.8%) patients presented mild adverse events mostly related to bowel preparation. CONCLUSION: CCE-2 is demonstrated to be an effective and safe alternative method for colorectal cancer screening. Diagnostic performance of CCE-2 for polyps of at least 6 and 10 mm was similar. Completion rates still need to be improved.

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BACKGROUND: Many studies evaluated magnification endoscopy (ME) to correlate changes on the gastric mucosal surface with Helicobacter pylori (H. pylori) infection. However, few studies validated these concepts with high-definition endoscopy without ME. AIM: To access the association between mucosal surface pattern under near focus technology and H. pylori infection status in a western population. METHODS: Cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard high definition (S-HD) followed by near focus (NF-HD) examination. Presence of erythema, erosion, atrophy, and nodularity were recorded during S-HD, and surface mucosal pattern was classified using NF-HD in the gastric body. Biopsies were taken for rapid urease test and histology. RESULTS: One hundred and eighty-seven patients were analyzed from August to November 2019. Of those, 47 (25.1%) were H. pylori+, and 42 (22.5%) had a previous H. pylori treatment. In the examination with S-HD, erythema had the best sensitivity for H. pylori detection (80.9%). Exudate (99.3%), nodularity (97.1%), and atrophy (95.7%) demonstrated better specificity values, but with low sensitivity (6.4%-19.1%). On the other hand, the absence of erythema was strongly associated with H. pylori- (negative predictive value = 92%). With NF-HD, 56.2% of patients presented type 1 pattern (regular arrangement of collecting venules, RAC), and only 5.7% of RAC+ patients were H. pylori+. The loss of RAC presented 87.2% sensitivity for H. pylori detection, 70.7% specificity, 50% positive predictive value, and 94.3% negative predictive value, indicating that loss of RAC was suboptimal to confirm H. pylori infection, but when RAC was seen, H. pylori infection was unlikely. CONCLUSION: The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H. pylori negative status. On the other hand, the loss of RAC had a suboptimal correlation with the presence of H. pylori.

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Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have significantly evolved in the last couple of decades. They mechanically act by decreasing the volume of the stomach and its reservoir capacity, delaying gastric emptying, and increasing satiety leading to a subsequent weight loss. Despite the low rates of complications and mortality associated with IGBs, adverse events and complications still occur and can range from mild to fatal. This review aims to provide an update on the current scientific evidence in regard to complications and adverse effects of the use of the IGB and its treatment. This is the first comprehensive narrative review in the literature dedicated to this subject.

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BACKGROUND: Endoscopic aspect of fundoplication anatomy: Normal aspect of Nissen fundoplication. Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. AIM: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. METHOD: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). RESULTS: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). CONCLUSION: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.

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ABSTRACT Background: Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. Aim: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. Method: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). Results: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). Conclusion: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.

RESUMO Racional: A endoscopia digestiva alta é importante ferramenta para a avaliação de pacientes submetidos à fundoplicatura, principalmente para elucidar os sintomas pós-operatórios. Entretanto, a avaliação endoscópica da sua anatomia e complicações é atualmente pouco padronizada entre os endoscopistas, o que leva à disparidade de laudos e condutas. Objetivo: Avaliar a frequência de anormalidades pós-operatórias da fundoplicatura através de uma classificação endoscópica e correlacionar os achados endoscópicos com os sintomas clínicos. Método: Este é estudo observacional prospectivo, realizado em um único centro. Os pacientes foram submetidos a um questionário para coleta de dados. A avaliação endoscópica da fundoplicatura foi realizada de acordo com a classificação em estudo, que considerou quatro parâmetros anatômicos, incluindo a posição da junção gastroesofágica em vista frontal (acima ou no nível da zona de pressão); posição da válvula na visão retroflexa (intra-abdominal ou migrada); conformação valvar (total, parcial, desgarrada ou torcida) e hérnia paraesofágica (presente ou ausente). Resultados: Foram avaliados 100 pacientes submetidos à fundoplicatura, 51% homens (idade média: 55,6 anos). Quarenta e três por cento relataram sintomas pós-operatórios. Anormalidades endoscópicas da anatomia da fundoplicatura foram relatadas em 46% dos pacientes. Junção gastroesofágica acima da zona de pressão (fundoplicatura deslizada) e fundoplicatura migrada foram significativamente correlacionadas com a ocorrência de sintomas pós-operatórios. Não houve correlação entre sintomas e conformação da fundoplicatura (total, parcial ou torcida). Conclusão: Essa classificação endoscópica modificada proposta para avaliar a anatomia da fundoplicatura é reprodutível e parece correlacionar-se com a sintomatologia. As anormalidades mais frequentes observadas foram fundoplicaturas migradas e deslizadas, e ambas se correlacionaram com a presença de sintomas.

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INTRODUCTION: Laparoscopic sleeve gastrectomy is becoming the most commonly performed bariatric surgery. Despite clinical efficacy, adverse events have gradually increase due to its rapid adoption. Sleeve stenosis is the second most common adverse event, occurring in 0.7 to 4% of patients undergoing laparoscopic sleeve gastrectomy (LSG). Endoscopic management with pneumatic balloon dilation (PBD) or stent placement is commonly performed, with a success rate of up to 88%. Recently, Moura et al. (VideoGIE 4(2):68-71, 2018) described a new technique, named as endoscopic tunneled stricturotomy. In this video, we demonstrated the evolution of this technique including full-thickness dissection with staple line disruption. METHODS: A 28-year-old woman with a BMI of 35.3 kg/m2 who underwent LSG, presented with dysphagia to solid food. An upper GI series showed a stenosis at the level of the incisura angularis. The patient was then referred for endoscopic evaluation. RESULTS: She underwent three endoscopic PBD in an attempt to treat the stenosis. Unfortunately, her symptoms did not improve. After failed PBD treatment, an endoscopic tunneled stricturotomy with full-thickness dissection was performed. The procedure is performed in 6 steps: (1) identification of the stenosis, (2) submucosal injection 3-5 cm before the stenosis, (3) incision, (4) submucosal tunneling, (5) stricturotomy with full-thickness dissection, and (6) mucosal closure. During follow-up, the patient maintained a 1200-cal diet, without recurrence of symptoms. CONCLUSION: Endoscopic tunneled stricturotomy with full-thickness dissection is feasible and appears to be safe and effective in the management of stenosis after sleeve gastrectomy. This procedure may be an option after conventional treatment failure or may be considered as a primary alternative.

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Background and study aims The combination of endoscopy with laparoscopy for full-thickness gastric resection has received much attention. The advantage in using it is removak of the target lesion without resection of excessive normal tissue. The technique could prevent deformed scars, particularly at the cardia and in the prepyloric area. The aim of this protocol was to evaluate a new combined operation for full-thickness resection of the gastric wall. Materials and methods Gastric subepithelial lesions in multiple topographic locations of the stomach were simulated in seven live pigs. Full-thickness gastric resection was undertaken and after assessment of the outcome, the animals were euthanized. The primary endpoint was accomplishment of the procedure following all steps in the new technique, in various gastric locations. The secondary endpoints were duration of the procedure, quality of specimen margins, and complications. Results Resections were successful, complete, and complication-free, ensuring a safe surgical margin of healthy tissue. The procedure was completed in 50 minutes. No mucosal perforation or gas escape occurred. Conclusions The combined technique was safe, effective and minimally invasive. No expensive materials were used. Lesion exposure, gastric content leakage, incomplete resection, and excessive normal tissue elimination were avoided. Human trials of this technique may be warranted.

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INTRODUCTION: Obesity is a pandemic associated with significant comorbidities such as type 2 diabetes (T2DM). RYGB is an effective treatment modality for obesity and T2DM. However, bariatric surgery is currently limited to a relatively small population of patients. The duodenal-jejunal bypass sleeve (DJBS) has recently emerged as a promising therapy for obesity and T2DM by providing similar physiological effects to RYGB. We describe a case of a patient with a previously placed DJBS presenting with abdominal pain from anchor erosion managed with an endoscopic approach. METHODS: A 58-year-old man with obesity and T2DM who had failed prior medical therapy for obesity was referred for DJBS placement. This was placed without complications. At 8 weeks follow-up, he developed abdominal pain and vomiting prompting immediate endoscopic evaluation. RESULTS: EGD revealed an anchor erosion resulting in mild stenosis of the pylorus. Additionally, hyperplastic tissue was found to be adhered to the device in the duodenal bulb. Endoscopic removal with balloon dilation was unsuccessful, and a stent was placed in a "stent-in-stent" fashion through the sleeve to compress the area of tissue ingrowth encouraging local tissue necrosis and device extraction. At 15 days follow-up, the stent was removed; however, the DJBS remained adhered and immobile. Next, the ingrowing hyperplastic tissue was resected in a piecemeal fashion. This resulted in mobilization of the sleeve anchors in the duodenal bulb and successful removal of the DJBS. CONCLUSIONS: DJBS endoscopic removal is safe and effective even in challenging cases, thus preventing the need for surgical intervention.

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Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05-0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was -0.02 (with a 95% CI between -0.04 and -0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.

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BACKGROUND: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia. OBJECTIVE: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy. MATERIALS AND METHODS: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy. RESULTS: Average procedure time was 27 minutes (21-54 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature. CONCLUSION: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.

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ABSTRACT Background Endoscopic treatment of superficial gastrointestinal tumors is routinely performed, however the advantages and shortcomings of submucosal pressure-jet dissection is still debated. Objective - Aiming to compare this technique with conventional submucosal dissection, a study was designed in pigs. Methods - Areas of the antral mucosa of the stomach with a diameter of 2 cm2 (6 per animal) were marked, and resected by means of the hybrid-knife (experimental technique), and Flush-knife or IT-knife (controls). An ERBE ICC 300 electrosurgical unit was adopted. End-points were procedural time, complications, and quality of the resected specimen. Results - A total of 27 interventions were conducted in five animals. Time spent with the two options was quite short, and similar: 9.5±3.1 vs 8.0±3.0 minutes (P=0.21). Complications didn't differ (three per group, not significant), and removed specimen looked adequate in both circumstances. Conclusion - The hybrid-knife technique is an acceptable alternative to submucosal dissection, showing no difference compared to the standard technique taking into consideration the procedure, the presence of complications and the quality of the resected specimen.

RESUMO Contexto O tratamento endoscópico de tumores gastrointestinais superficiais é realizado rotineiramente, no entanto as vantagens e deficiências da dissecção submucosa com jato de pressão ainda é debatido. Objetivo - Visando comparar esta técnica com dissecção submucosa convencional, um estudo foi realizado em suínos. Métodos - Áreas da mucosa antral do estômago com um diâmetro de 2 cm2 (um total de 6 por animal) foram marcadas, e a ressecção através do hybrid-knife (técnica experimental), e do Flush-knife ou IT-knife (controles). Uma unidade eletro cirúrgica ERBE ICC 300 foi adotada. Os desfechos foram: tempo do procedimento, complicações e qualidade da amostra ressecada. Resultados - Um total de 27 intervenções foram realizadas em cinco animais. O tempo gasto com as duas técnicas foi curto e semelhante: 9,5±3,1 vs 8,0±3,0 minutos (P=0,21). As complicações não diferiram (três por grupo, não significativas), e amostras retiradas foram adequadas em ambas as circunstâncias. Conclusão - A técnica de hybrid-knife é uma alternativa aceitável para dissecção submucosa, demonstrando não haver diferença em comparação à técnica convencional levando em consideração o tempo de procedimento, a presença de complicações e a qualidade da amostra ressecada.

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BACKGROUND: Endoscopic treatment of superficial gastrointestinal tumors is routinely performed, however the advantages and shortcomings of submucosal pressure-jet dissection is still debated. OBJECTIVE: - Aiming to compare this technique with conventional submucosal dissection, a study was designed in pigs. METHODS: - Areas of the antral mucosa of the stomach with a diameter of 2 cm2 (6 per animal) were marked, and resected by means of the hybrid-knife (experimental technique), and Flush-knife or IT-knife (controls). An ERBE ICC 300 electrosurgical unit was adopted. End-points were procedural time, complications, and quality of the resected specimen. RESULTS: - A total of 27 interventions were conducted in five animals. Time spent with the two options was quite short, and similar: 9.5±3.1 vs 8.0±3.0 minutes (P=0.21). Complications didn't differ (three per group, not significant), and removed specimen looked adequate in both circumstances. CONCLUSION: - The hybrid-knife technique is an acceptable alternative to submucosal dissection, showing no difference compared to the standard technique taking into consideration the procedure, the presence of complications and the quality of the resected specimen.

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Double pylorus and gastroduodenal fistula are rare conditions and can be either congenital or acquired. We report a case of a 58-year-old man with epigastric pain and dyspepsia in which the upper gastrointestinal endoscopy revealed an acquired double pylorus, probably caused by a gastric ulcer.

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Double pylorus and gastroduodenal fistula are rare conditions and can be either congenital or acquired. We report a case of a 58-year-old man with epigastric pain and dyspepsia in which the upper gastrointestinal endoscopy revealed an acquired double pylorus, probably caused by a gastric ulcer.

El doble píloro y la fístula gastroduodenal son condiciones raras y pueden ser congénitas o adquiridas. Se reporta un caso de un varón de 58 años con dolor epigástrico y dispepsia en quien la endoscopía digestiva alta mostró un doble píloro adquirido, probablemente causado por una úlcera gástrica.

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BACKGROUND AND STUDY AIMS: Bleeding is not uncommon following endoscopic sphincterotomy. Supra-papillary puncture (SPP) might be safer than standard cannulation (SC) techniques in patients with coagulopathy. The aim of the study was to compare the safety and effectiveness of SPP and SC. PATIENT AND METHODS: This was a prospective case control intervention study. Decompensated cirrhotic patients with coagulopathy and choledocolithiasis underwent SC and SPP methods for biliary access. RESULTS: One hundred five patients (56 [53.3%] men, mean [SD] age 56 [15.8]) underwent ERCP. SC and SPP were performed in 63 and 42 patients, respectively. Biliary access was achieved in 56/63 (89%) and 40/42 (95%) of patients undergoing SC and SPP, respectively (P = 0.13; 95% CI [-0.16; 0.03]). Complications occurred in 10/63 (15.8%) patients undergoing SC and 5/42 (11.9%) SPP (P = 0.28; 95% CI [-0.17, 0.16]). Five (7.9%) and two (3.2%) episodes of post-sphincterotomy bleeding was seen in the SC and SPP groups, respectively (P = 0.36; 95% CI [-0.16, 0.05]). In contrast, three (4.8%) episodes of pancreatitis were seen in the SC and none in the SPP group (P = 0.05; 95% CI [0.001; 0.004]). A cost-effectiveness analysis demonstrated that SPP is an acceptable alternative at an ICER of US$ 5,974.92 per additional successful procedure. CONCLUSION: SPP is a safe and effective technique for the management of common bile duct stones in decompensated cirrhotic patients. Conditional to the willingness-to-pay and to the local ERCP-related costs, SPP is also a cost-effective alternative to the SC methods. SPP is associated with a lower rate of complications but larger studies to validate these findings are necessary.

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Introdução: A CPRE diagnóstica e terapêutica, em pacientes com gastrectomia à Billroth 11, é mais difícil devido às alterações anatômicas. Acessórios e técnicas têm sido desenvolvidos para minimizar estas adversidades. Objetivo: Nova técnica de acesso biliar em pacientes gastrectomizados à Billroth 11. Pacientes: No período de fevereiro de 2003 a agosto de 2007, foram realizadas 157 CPRE em pacientes gastrectomizados à Billroth 11, por coledocolitíase. Em 37 desses pacientes, não foi possível cateterização pela técnica convencional, sendo submetidos a nova técnica. Métodos: Após fistulopapilotomia para acessar via biliar principal, passava-se fio-guia de 0,035mm, seguido por balão dilatador de 8mm, que se mantinha transpapilar. Pelo canal de trabalho, passava-se o estilete; ao posicionar em frente à papila, procedia-se secção do esfíncter por sobre balão insuflado com contraste até desaparecimento da cintura na radioscopia. Resultados: Dos 37 pacientes submetidos ao novo procedimento, seis foram excluídos. Dezesseis pacientes (51,6%) eram do sexo feminino e quinze (48,4%) do masculino. A idade variou de 29 a 89 anos, com média de 62,3 anos. Todos tinham icterícia clínica e laboratorial. O tempo do procedimento variou de 18 a 48 minutos (30 minutos). O diâmetro da via biliar foi de 4,5 a 12,8mm (7,7mm), apresentando de um a quatro cálculos. Ocorreram seis (19,3%) complicações relacionadas ao procedimento, sendo três (9,7%) pancreatites, duas (6,4%) hemorragias e uma (3,2%) perfuração. Não houve óbitos relacionados ao procedimento. Conclusão: O sucesso desta técnica foi de 83,8% (31 dos 37 casos), sendo 88,6% (31 de 35 casos) se considerarmos apenas a canulação da via biliar, portanto método seguro e eficaz em pacientes com Billroth 11 e papila duodenal difícil.

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Introdução: Tem-se observado mudança demográfica im»portante nas sociedades ocidentais decorrente do aumento da expectativa de vida, com aumento progressivo do número de pacientes idosos. Paralelamente a isso, observou-se incidência aumentada de afecções das vias biliares, particularmente a doen»ça litiásica e as suas complicações nesse grupo populacional. A Baixada Santista atrai a população idosa por ser uma região que detém o segundo melhor índice de desenvolvimento social do Estado de São Paulo (IEME-2002) e o terceiro melhor índice de desenvolvimento humano do Estado, ocupando o quinto lugar no Brasil, segundo o Programa das Nações Unidas para o Desenvolvimento - PNUD. Objetivo: O presente estudo objeti»vou avaliar e discutir o impacto da colangiopancreatografia re»trógrada endoscópica (CPRE) como método diagnóstico e tera»pêutico das afecções biliodigestivas em pacientes idosos na Baixada Santista. Métodos: Foram analisados retrospectivamente dados referentes a 247 pacientes submetidos a CPRE no HAC»Santos, no período de janeiro de 2003 a janeiro de 2006, con»siderando-se como variáveis: sexo, idade, etnia, indicações, diag»nósticos obtidos, procedimentos realizados, complicações relacionadas ao procedimento e mortalidade, enfatizando-se os dados em pacientes idosos (acima de 60 anos de idade). Resul»tados: Considerando-se os idosos, verificou-se que a CPRE foi realizada em 146 (62,9%) do total de pacientes efetivamente estudados (232). As principais indicações para o procedimento foram a suspeita de coledocolitíase em 122/232 (52,7%), icterí»cia obstrutiva em 86/232 (37%) e pancreatite aguda em 24/ 232.

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