[Opaque enema as the first test: is it always the right choice?]. / Clisma opaco come primo esame: è sempre una scelta giusta?

Dual contrast barium enema is the first investigation which is performed in a patient with symptoms of colic pathology. According to the results the doctor will decide whether to continue with further tests. The authors have carried out a retrospective study of the consequences of this diagnostic iter in an attempt to establish whether barium enema can be used as grounds to identify patients requiring further tests, also taking into account the costs of this diagnostic procedure. The medical records were examined for all patients admitted to hospital with colic symptoms and subjected to barium enema and then total colonoscopy in our unit from January 1990 to April 1992. A total of 131 patients were included in the study, of which 71 were males and 60 females, with a mean age of 62.4 years (range 22-89). Patients with rectorrhagia (59) routinely underwent barium enema and, irrespective of radiological results, colonoscopy. Patients with other forms of colic symptoms (72), with the exception of rectorrhagia, only underwent colonoscopy if barium enema was positive. Radiological findings were divided into positive, negative and radiological images of uncertain interpretation, were controlled using colonoscopy. Colonoscopy was total in 115 cases (87.5%), partial due to the presence of insuperable stenoses in 10 cases (7.4%), and incomplete due to technical difficulties in 6 cases (5.1%). In 24 cases endoscopy showed false negative (18.3%), false positives in 20 cases (15.2%) and uncertain radiological findings in 15 cases (11.4%) with no pathological endoscopic finding. In one case (0.7%), barium enema failed to make the entire colon opaque.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic approach to patients with portal hypertension: a complex diagnosis. A retrospective study based on 10 years' experience.

We analyzed the endoscopic findings in 788 patients with esophageal and gastric varices who underwent upper gastrointestinal endoscopy between 1 January 1979 and 31 December 1988. Of these, 154 patients (19.6%) had gastric varices associated in various patterns with esophageal varices. Congestive gastropathy, occurring with esophageal and gastric varices (43.4%), was the most frequent pathology detected in our patients. Esophagitis was present in 15.8% of patients, but did not correlate with variceal bleeding. Endoscopy performed at 1 day to 1 week post-hemorrhage in 313 patients accurately identified the source of bleeding in only 57.2% of patients. This figure increased to 98.2% when we performed the examination within the first 24 h of hemorrhage. In this group varices were the source of hemorrhage in 72.3% of patients while the hemorrhage came from other sources, such as erosive gastritis, duodenal and gastric ulcer in 27.6% of patients.

Is ERCP manometry useful in the choice of treatment of stones of the common bile duct?

To verify the appropriateness of sphincterotomy as the treatment of choice of choledocholithiasis, since 1980 we have been using endoscopic retrograde cholangiopancreatographic (ERCP) manometry of the sphincter of Oddi (SO). This method allows direct investigation of SO motor activity and provides useful information regarding the presence of benign papillary stenosis (BPS). Thirty-four patients were investigated because the radiological examination indicated BPS might be present. Of these, 20 had common bile duct (CBD) stones, while the remaining 14 presented with biliarylike pain and one or more of the following: CBD dilation (larger than 12 mm); emptying of the ERCP contrast medium took longer than 45 min; abnormal liver function tests. Moreover, 8 healthy volunteers served as controls. Our results show that the incidence of SO motor anomalies is very low in the presence of choledocholithiasis, while it is substantial in patients with suspected SO dysfunction. These observations would suggest that, unlike the traditional view, BPS is rarely secondary to biliary lithiasis. Therefore, most of the sphincterotomies performed that are based on the assumption of underlying SO pathology should be considered unnecessary. Under these circumstances, the physiological role of a functioning SO has induced us to advocate sphincterotomy, surgical or endoscopic, in selected cases only.