Transpapillary placement of an endoprosthesis with the aid of the Frimberger Varioguide.

The guide wire, an important requisite for the placement of endoscopic transpapillary biliary prostheses, should combine two, normally incompatible, properties: a high degree of flexibility for atraumatic passage through irregular or "bent" stenoses, and a high degree of stiffness, to prevent sidewise deviation during advancement of the prosthesis. These opposing, formerly incompatible, properties are combined in a new type of guide wire, known as the Varioguide. With the aid of a tension controller, the stiffness of the Varioguide can be varied steplessly. In 88.2% of 68 patients with stenosis of the bile duct we succeeded in placing a transpapillary endoprosthesis with the Varioguide. In 13 cases in which a previous attempt with the conventional guide wire was unsuccessful, placement of the endoprosthesis was successfully accomplished with the Varioguide; the reverse was true in only a single patient. In the case of very narrow, rigid high stenoses, in which placement of a transpapillary endoprosthesis is especially difficult, the Varioguide has proved highly suitable (stenoses of the bile duct bifurcation).

Effect of thioloxidant diazene dicarboxylic acid bis-(N'-methylpiperazide) (DIP) on 45Ca2+ net uptake into rat pancreatic islets.

The effect of DIP (an oxidant of glutathione) on 45Ca2+ net uptake induced by a variety of stimulators of insulin secretion was studied in rat pancreatic islets. In addition the effect of exogenous glutathione (GSH) on 45Ca2+ net uptake in response to glucose was tested. DIP (0.1 mM) inhibited the increase of 45Ca2+ net uptake in the presence of glucose (16.7 mM) and glyceraldehyde (10 mM). A similar inhibitory effect could be demonstrated, when 45Ca2+ net uptake was enhanced by tolbutamide (100 micrograms/ml), glibenclamide (0.5 micrograms/ml), b-BCH (20 mM), 2-ketoisocaproate (20 mM), arginine (20 mM) in the presence of 3 mM glucose or by high extracellular potassium (20 mM). The increase of 45Ca2+ net uptake stimulated by leucine (20 mM) plus glucose (3 mM) was further augmented by DIP. Exogenous GSH did not affect 45Ca2+ net uptake in the presence of (5.6-16.7 mM) glucose. It is suggested that 45Ca2+ net uptake of pancreatic islets depends on the redox state of islet thiols regardless of whether uptake is promoted via inhibition of potassium efflux (nutrients, sulfonylureas) or by high potassium and arginine. The voltage sensitive calcium-channel is the site of action of critical thiols. It is possible that these thiols are localized at the inner side of the plasma membrane.

[Uses of endoscopic high frequency diathermy: polypectomy--sphincterotomy (papillotomy)]. / Endoskopische Hochfrequenz-Diathermie-Anwendungen: Polypektomie--Sphinkterotomie (Papillotomie).

Several complications may arise as a consequence of monopolar high frequency diathermy applied for control of hemorrhage, polypectomy and papillotomy because of the specific conditions of current flow. Such complications can be burns, thermic organ damage or dysfunction of implanted cardiac pacemakers. Results and experience obtained during the last decade however show, that this endoscopic method of surgery is efficient and of low risk, if appropriate precautions are taken.

Angiodysplasia in the colon and rectum. Endoscopic morphology, localisation and frequency.

In a prospective study, the occurrence of angiodysplasia was investigated by total colonoscopy in 1938 patients. Angiodysplasia was found in 59 patients, i.e. 3%. 12 out of 59 patients were admitted for acute or chronic peranal hemorrhage or anemia. 47 out of 59 patients were asymptomatic. The site of the lesions was as follows: cecum 37%, ascending colon 17%, transverse colon 7%, descending colon 7%, sigmoid colon 18% and rectum 14%. Histological confirmation was obtained in 15 out of 37 biopsies. The endoscopic appearance was variable, most of the vascular dilatations being smaller than 5 mm (n = 47), with a homogeneous (n = 35) or inhomogeneous (n = 24) structure and a regular (n = 34) or irregular (n = 25) border. The lesions were single (n = 34) as well as multiple (n = 25), they were usually flat (n = 54), seldom slightly prominent (n = 5). Concomitant pathological findings in the bowel were diagnosed in 33 out of 59 patients: diverticula in 32%, adenomas in 24% and carcinomas in 8.5%. Right hemicolectomy for bleeding angiodysplasia is indicated only if endoscopic therapy has failed and other colorectal sources of bleeding, and especially angiodysplasia in the left colon and rectum have been excluded by endoscopy or angiography.

[Colorectal angiodysplasias (vascular ectasias). Endoscopic morphology, localization and incidence]. / Kolorektale Angiodysplasien (vaskuläre Ektasien). Endoskopische Morphologie, Lokalisation und Häufigkeit.

In a prospective study, angiodysplasias were looked for in 824 patients during total coloscopy. Such angiodysplasias were discovered in 30 patients (3.6%). The endoscopic morphology varied, most of the angiodysplasias being smaller than 5 mm (23 patients), with a homogeneous structure in 19, spider-like extensions in only 11 patients. In 13 patients there were multiple angiodysplasias. Two or more segments of the colon were affected in 7 patients. Site of lesions was as follows: in 19 patients in the caecum and/or ascending colon; descending colon, sigmoid and/or rectum in 16; transverse colon in 3 patients. Histological confirmation was obtained in 9 of 20 patients who had a biopsy. Right-sided colectomy for bleeding angiodysplasias (resulting in anaemia) is indicated only if endoscopic coagulation has failed and other colorectal sources of bleeding (neoplasm, diverticulum or polyp) and especially angiodysplasias in the left colon or rectum have been excluded by endoscopy or angiography.

[Endoscopic extraction of gallbladder calculi]. / Endoskopische Extraktion von Gallenblasensteinen.

Endoscopic extraction of gallbladder stones were performed, as far as we know for the first time, in three patients with combined choledochocystolithiasis. Following endoscopic papillotomy (EPT) and subsequent mechanical lithotripsy of multiple choledochal concrements measuring up to 3 cm the gallbladder stones were successfully extracted with a Dormia basket through the cystic duct. The patients have remained free of complications after the endoscopic intervention.

[Esophageal papilloma--potential precursor of squamous cell carcinoma?]. / Papillome der Speiseröhre--potentielle Präkursoren des Plattenepithelkarzinoms?

Endoscopies for various indications revealed a total of 15 papillomas of the oesophagus in 12 patients over a period of 9 months. In most cases they were small whitish prominences in the cervical and thoracic oesophagus. Except for one case only females between 46 and 76 years were affected. Thus papillomas of the oesophagus are more frequent than previously assumed. Virology and histology indicate a potential role of the papilloma as precursor of oesophageal squamous cell carcinoma. Papillomas should thus be excised by loop or forceps.

Short-channel duodenoscope: innovations in selective biliography.

The selective cannulation of the intrahepatic branches of the biliary system is made possible by the use of torsion-stabilized angiographic catheters passed via short-channel duodenoscopes. Other feasible applications are the endoscopic selective positioning of biliary endoprosthesis, and the cannulation of the gall bladder using a cysto-nasal catheter through which a litholytic fluid can be installed directly into the gall bladder.

[Coloscopic small intestinal enema]. / Koloskopischer Dünndarmeinlauf.

Coloscopic small bowel enema, a new diagnostic method, permits small and large intestinal investigation in one session. A coloscope is required equipped with a circular mounted balloon at the distal end. The endoscope is placed into coecum using the conventional technique (coloscopy). After intubation of the ileocoecal valve the balloon is inflated in the terminal ileum. This prevents reflux of the contrast medium and methyl-cellulose solution which are instilled into the small bowel through the endoscope instrumentation bore. Double-contrast investigation of the small bowel is particularly suitable for diagnosis of inflammatory diseases (e.g. Crohn's disease), Meckel's diverticulum and polypoid lesions such as carcinoid tumours.

[Stenosis endoscope. A new instrument for the diagnosis and therapy of stenoses in the gastrointestinal tract]. / Stenosen-Endoskop. Ein neues Instrument zur Diagnostik und Therapie bei Stenosen im Gastrointestinaltrakt.

A new type of endoscope combines the advantages of the narrow-calibre paediatric endoscopes and the stable-shaft regular endoscopes. This is achieved by reduction of the distal diameter from 13 mm to 9,5 mm with a conical transition between both parts. These characteristics make the instrument particularly suitable for the diagnosis of gastrointestinal stenoses (stenosis endoscope). At the same time the stenosis endoscope dilates as well as a metal olive or a rubber bougie. Thus dilatation of gastrointestinal stenoses is now possible beyond the reach of instruments used as bougie or for dilatation until now. The stenosis endoscope opens new possibilities of therapeutic endoscopy.

[Gastric mucosa islands in the cervical esophagus. Their potential pathogenetic significance]. / Magenschleimhaut-Inseln im zervikalen Osophagus. Ihre potentielle pathogenetische Bedeutung.

Islands of gastric mucosa were sought in non-selected in- and out-patients undergoing endoscopy. Mucosal islands were found in 40 patients (out of approximately 1000 oesopho-gastroduodenoscopies), mostly a few centimetres below the mouth of the oesophagus. Histology showed "pure" corpus mucosa in 24 cases, a combination of fundus glands (with zymogenic and parietal cells) and mucoid glands were shown in 9 cases; the rest had only mucoid glands (3 cases) or surface elements of gastric mucosa (two cases). In two cases the islands were missed in the biopsy. In one case the demonstration of HCl secretion from a corpus mucosal island could be achieved by local application of congo red via endoscope after stimulation with pentagastrin. The pathogenetic significance of HCl-producing gastric mucosal islands in the cervical oesophagus is due to their ability to induce peptic lesions with subsequent web or membrane formation.