PEG placement is an easy and safe procedure, although it is often requested too late. No single variable could predict complications or PEG removal. C-reactive protein was found to be predictive of early mortality and Charlson's index was predictive of late mortality.

Precut papillotomy can be an effective and relatively safe procedure when performed by an average endoscopist skilled in ERCP. Although the complication rate of precutting tended to be higher than standard papilotomy, this was reasonable since it increased the success of selective biliary cannulation in 25% of cases. Complication rates did not improve with experience.

Lithiasis after urinary diversion is an uncommon condition that poses therapeutic challenges. The authors report the case of a patient submitted to cystectomy and ureterosigmoidostomy 35 years ago due to bladder endometriosis. The patient presented with a ureteral stone and was treated by retrograde endoscopic extraction.

INTRODUÇÃOObesidade está descrita como associada ao aumento no risco do câncer colorretal CCR e do adenoma Ad, sendo a prevalência mais nítida no sexo masculino.1,2,3,4,5 Questiona-se no entanto, como fator mais importante, não a obesidade em si, quantificada pelo índice de massa corpórea IMC, mas a presença da obesidade visceral, melhor identificada pela distribuição andróide da gordura, podendo ser indiretamente estudada pela medida da circunferência abdominal ou melhor ainda, pela razão cintura quadril RCQ. 6,7,8,9,10,11,12 O objetivo deste trabalho foi avaliar estas duas variáveis como fator de risco no desenvolvimento do CCR/Ad em nosso meio. PACIENTES E MÉTODODe janeiro a dezembro de 2008 foram realizadas 1287 colonoscopias totais em duas instituições médicas, tendo os pacientes idade mínima de 50 anos e IMC e RCQ calculados. Foram excluídos do estudo, portadores de doença hepática e ou renal crônica, doença inflamatória intestinal, adenomatose familiar FAP, CCR não associado a polipose HNPCC, síndrome de Lynch. Foram considerados obesos os portadores de IMC>30 kg/m(2). O IMC foi avaliado em kg/m(2) e a RCQ medida em centímetros. O Teste t de Student foi usado para estudo da média e desvio padrão e qui-quadrado para comparar números absolutos. A significância estatística foi considerada quando P< 0,05. Todos assinaram consentimento in-

Background and study aims  Performing a percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients can be challenging because of the presence of trismus, pharyngeal obstruction by tumor, and pharyngoesophageal strictures or fistula. Pharyngocutaneous fistula (PCF) is a major postoperative concern in patients submitted to total laryngectomy (TL). In the medical literature to date, the cervical fistula has been used as an access to PEG in only four reports. The aim of this study was to evaluate the safety of cervical fistula for insertion of a PEG tube. Patients and methods  Retrospective study at a single tertiary referral center, regarding the technical feasibility, safety and outcomes of a PEG tube introduced by a cervical fistula in HNC patients with obstructive lesions of the oropharynx. Results  The procedure was technically successful in all 21 patients. A PEG tube was used for a minimum of 1 month and a maximum of 120 months. Twelve patients died while using the PEG tube, 8 had it taken out because it was no longer needed, and only 1 had the tube still in use. Adverse events occurred in 8 patients: granuloma (19 %), dermatitis (9.5 %), accidental late removal of the tube (9.5 %), periprocedural gastric wall hematoma (9.5 %), peristomal wound infection (4.7 %), buried bumper syndrome (4.7 %), and traumatic gastric ulcer (4.7 %). Conclusion  A postoperative cervical fistula can successfully work as a reliable and safe access for a PEG tube procedure in HNC patients, avoiding unnecessary surgery and reducing costs.