-Background -Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. Aim -To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. Methods -Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. Results -Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. Conclusion -Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea. HEADINGS -Acquired immunodeficiency syndrome. Colitis. Cytomegalovirus infections. Diarrhea. Colonoscopy.

Although the interobserver reproducibility of the colonic pit pattern is good for experienced endoscopists, MC must not be used to replace the histopathological analysis, since it does not differentiate with the necessary safety neoplastic from nonneoplastic lesions.

Fig. 1 A 2.0 cm-lesion (0-IIa + Is) at the transverse colon (narrow-band imaging). ▶ Fig. 2 Underwater endoscopic mucosal resection (EMR) technique. ▶ Fig. 3 Bleeding and perforation after underwater endoscopic mucosal resection (EMR). ▶ Fig. 4 Endoscopic appearance after hemostasis, through-the-scope clip closure, and endoscopic tattoo. ▶ Fig. 5 Follow-up after 6 months. Paccos José Luiz et al. Perforation and bleeding during an underwater EMR of a large colonic lesion … Endoscopy |

To avoid bleeding after colonoscopic polypectomy, several procedures are being used. We describe a new method that consists of a homemade nylon loop that is applied and tied to the stalk of the pedunculated polyp and after which a conventional polypectomy is done. We have used this method in 15 patients and no complication was observed. The procedure is simple; the loop may be opened to large diameters to make it easier to use for large polyps. It has a low cost and seems to be safe and effective to prevent bleeding after endoscopic polypectomy.

We can conclude that we must be careful to apply high resolution colonoscopy and chromoscopy because adenomatous lesions can be misdiagnosed as non-neoplastic.