[Catheter-free pH-metry using the Bravo capsule versus standard pH-metry in patients with non-erosive reflux disease (NERD)]. / Katheterfreie pH-Metrie mittels Bravo-Kapsel versus Standard-pH-Metrie bei Patienten mit nicht erosiver Refluxkrankheit (NERD).

BACKGROUND: pH-monitoring is considered the gold standard for the detection of acid reflux in patients with non-erosive reflux disease (NERD). Preliminary pH studies performed over periods longer than 24 hours have shown that in up to one-third of subjects abnormal pH exposure is detected only on the second day of monitoring. Therefore, pH-monitoring during 48 hours may yield more information about pathological acid reflux in patients being investigated for NERD. AIM: The aim of this study was to compare conventional 24-hour pH-monitoring with the new wireless 48-hour Bravo pH-monitoring in patients with NERD. PATIENTS AND METHODS: Patients with typical reflux symptoms, a positive reflux disease questionnaire and negative endoscopy (NERD) and without any form of acid suppressive therapy were included in this prospective study. The patients were divided into two groups: group A for conventional 24-hour pH-monitoring and group B for wireless 48-h Bravo pH-monitoring. RESULTS: 76 patients with a diagnosis of NERD based on a positive RDQ questionnaire and negative endoscopy were included. (47 woman, 29 men, median age: 49 years). 54 underwent conventional pH-monitoring and 22 underwent 48-h pH-monitoring with the new wireless BRAVO system. The overall incidence of acid reflux was 55 % in patients with NERD. Acid reflux was detected less frequently when using Bravo as compared to conventional pH-monitoring. In addition, the Bravo pH-metry showed a large day-to-day variability. CONCLUSIONS: Prolonged pH-monitoring over a period longer than 24 hours did not improve the detection of acid reflux in patients with NERD. Thus, it appears that the Bravo pH-metry does not offer an advantage over standard pH-metry in the daily clinical practice.

[Standards and innovations in the diagnosis of gastroesophageal reflux disease]. / Standards und Innovationen in der Diagnostik der gastroösophagealen Refluxkrankheit.

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world. This article gives an overview about diagnostic procedures for GERD. Standard procedures such as pH-metry, Bilitec and manometry and also new diagnostic tools such as combined multichannel intraluminal impedance (MII) and pH-metry and Bravo Capsule are described in detail. Established endoscopy criteria as well as innovative techniques such as magnification, narrow band imaging and computed virtual chromoendoscopy are also presented. Not all of these procedures need to be used in every patient. Therefore, it is important to know the technical aspects, indications, advantages and disadvantages of each method in order to appropriately use any of these tests. The final goal is to characterise GERD and provide the patient with an appropriate therapy.

[Early gastric cancer--diagnosis and therapy]. / Magenfriihkarzinom--Diagnostik und Therapie.

Early gastric cancer (EGC) is defined as an invasive mucosal or submucosal neoplasia of the intestinal type tumor. Endoscopic mucosal tumor resection (EMR) is a new minimal invasive procedure for local tumor resection with excellent outcome in a well selected subset of patients.

Diagnostic and therapeutic impact of double-balloon enteroscopy.

BACKGROUND AND STUDY AIMS: Double-balloon enteroscopy (DBE) is a new endoscopic method for examining the small intestine. Most reports of DBE have been from Japan, and very few data on this new technique have been reported by centers outside Japan. The aim of the present study was to determine the diagnostic yield of DBE, measure the frequency of management changes made on the basis of the results, and evaluate the clinical outcome for patients undergoing the procedure. PATIENTS AND METHODS: All patients undergoing DBE using a Fujinon enteroscope (length 200 cm, diameter 8 mm) during a 11-month period were studied. All of the patients had previously undergone esophagogastroduodenoscopy and colonoscopy. They underwent small-bowel cleansing on the day before the procedure using a standard colon lavage solution. RESULTS: Seventy DBE procedures were carried out in 53 patients (34 men, 19 women; mean age 60 years, range 24 - 80) by the oral route in 46 cases and the anal route in 24. The indications for the examination were gastrointestinal bleeding (n = 29), suspected Crohn's disease (n = 6), abdominal pain (n = 4), polyp removal or evaluation in polyposis syndromes (n = 6), chronic diarrhea (n = 4), and surveillance or tumor search (n = 4). The mean duration of the procedure was 72 min (range 25 min - 3 h). The mean radiation exposure was 441 dGy/cm (range 70 - 1462), and the mean depth of small-bowel insertion was 150 cm (range 1 - 470 cm). It was possible to evaluate the entire small bowel in four patients (8 %). A new diagnosis was obtained in 26 of the 53 patients (49 %). The findings in the 70 procedures were angiodysplasia (n = 13), ulcerations or erosions (n = 5), jejunitis or ileitis (n = 5), tumors (n = 5), stenosis (n = 4), polyps (n = 5), lymphangiectasias (n = 4), Crohn's disease (n = 4), and normal (n = 17). DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfusions) in 57 % of the patients (30 of 53). The only complication (1.4 %) observed was one case of intraprocedural postpolypectomy bleeding, which resolved with injection of epinephrine. CONCLUSION: In almost two-thirds of the patients examined, DBE was clinically useful for obtaining a new diagnosis and starting new treatments, changing existing treatments, carrying out surgical intervention, or providing therapeutic endoscopy. DBE is a useful and safe method of obtaining tissue for diagnosis, providing hemostasis, and carrying out polypectomy.

Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis.

AIM: This prospective study aimed to compare the accuracy of echo enhanced ultrasound with spiral computed tomography (CT) in assessing acute pancreatitis and to explore the correlation between ultrasound findings and clinical outcome. METHODS: Thirty one patients (24 men and 7 women, median age 39 years, range 19-67 years) with acute pancreatitis were investigated by contrast enhanced CT and echo enhanced ultrasound within 72 hours after admission. Echo enhanced ultrasound (with intravenous injection of 2.4 ml SonoVue, pulse inversion technique, mechanical index 0.1 to 0.2, Siemens Elegra) was performed following conventional ultrasound. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI). Correlations between CTSI and USSI and between USSI and clinical parameters were tested by Spearman's rank correlation coefficient. RESULTS: A strong correlation was demonstrated between CTSI and USSI (r = 0.807, p<0.01). Ultrasound correlated with the following: the Ranson score (r = 0.401, p<0.05), C-reactive protein levels 48 hours after admission (r = 0.536, p<0.01), duration of hospitalisation (r = 0.422, p<0.05), and clinical outcome regarding morbidity, including local and systemic complications (r = 0.363, p<0.05). Based on CT findings as the gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detecting severe acute pancreatitis based on imaging criteria (Balthazar score D or E and/or presence of hypoperfusion compatible with necrosis and/or SI>/=3) were, respectively, 82% (95% CI 61 to 93), 89% (95% CI 57 to 98), 95% (95% CI 75 to 99), and 67% (95% CI 39 to 86). CONCLUSION: Echo enhanced ultrasound produces excellent results in the staging of acute pancreatitis severity. The procedure is cheaper and has fewer contraindications than CT. Further multicentre studies need to be performed before including the method in the diagnostic algorithm of patients with acute pancreatitis.