[Endoscopic polypectomy--sense and nonsense]. / Die endoskopische Polypektomie--Sinn und Unsinn.

The vast majority of gastrointestinal polyps are hyperplastic polyps or adenomas, their identification is possible bioptically. Adenomas are precancerous lesions, smaller ones with a diameter minor than 1 cm show invasive carcinoma in nearly 1%, in major polyps the percentage of invasive carcinoma will be 10% and more. Adenomas should therefore be removed with electrocautery snare (endoscopic polypectomy). Hamartomatous polyps (Peutz-Jeghers and juvenile polyps) are much less frequent, and mainly met with the Peutz-Jeghers syndrome (PJS) and familial juvenile polyposis (FJP). Hamartomas may bleed or induce obstruction or invagination. Adenomatous and malignant structures may be found within hamartomas, endoscopic polypectomy of these polyps is therefore mandatory. Mesenchymal (submucosal) polyps--leiomyoma, neurinoma--may only be identified by button-hole biopsy or after polypectomy; smaller submucosal polyps (up to 2 cm diameter) can be removed endoscopically, if strangulation is possible; the others should be removed during operation. Carcinoid tumors are rare within the upper and lower gastrointestinal tract, those with a diameter up to 1 cm should be removed by endoscopic polypectomy, larger ones have to be operated on.

[Microbiologic findings in protracted and chronic enterocolitis]. / Mikrobiologische Befunde bei protrahiert verlaufenden und chronischen Enterokolitiden.

Novel diagnostic methods (immunoblotting, immunofluorescence test) have been proved to be very sensitive and specific for detecting enteropathogenic bacilli. 28 patients with chronic enterocolitis were investigated. In 50% (14/28) of these patients Yersinia enterocolitica could be visualized in biopsies by immunofluorescence. The serum of 8 patients also contained IgA-antibodies against plasmid encoded released proteins of Y. enterocolitica. This paper reports evidence for persistence of Yersinia bacilli in a group of patients with chronic enterocolitis. Further studies must show, if these results may have therapeutic implications.

[Fasting blood gastrin levels in colon adenomas and colorectal carcinomas]. / Serum-Nüchtern-Gastrin-Werte bei Kolonadenomen und kolorektalen Karzinomen.

The trophic effect of gastrin in the intestine has been shown. Fasting gastrin levels of patients with adenomatous polyps or adenocarcinoma and in control subjects were determined (n = 141). The mean value of fasting gastrin of control subjects (n = 75) was 47.1 pg/ml +/- 17.8, of patients with adenomatous polyps (n = 49) 49.8 pg/ml +/- 20.7, of patients with carcinoma (n = 17) 50.1 pg/ml +/- 23.3. Neither in the group of patients with adenomatous polyps nor in the group of patients with carcinoma, fasting gastrin levels were elevated compared to control subjects. Our study indicates that there is no significant difference in fasting gastrin between either group (control subjects, colon polyps and carcinoma).

[Brief lavage in preparation for colposcopy]. / "Short-Lavage" zur Koloskopievorbereitung.

In order to reduce the amount of fluid, necessary for whole-gut irrigation, 140 consecutive patients were pretreated with Bisacodyl before they got 2 liters of mannitol solution 5%. The cleansing effect was comparable to standard whole-gut irrigation (5-6 liters of mannite 5%), patients suffered less, duration of irrigation was reduced and there were no side effects related to Bisacodyl.

[Endoscopic biopsy study for staging of reflux esophagitis]. / Endoskopisch-bioptische Studie zur Stadieneinteilung der Refluxösophagitis.

Endoscopy reveals that the lesions of reflux esophagitis are red and white spots and streaks. The red lesions are thought to reflect local inflammatory alterations with or without partial necrosis of the squamous epithelium, while white lesions represent complete necroses of the squamous epithelium with fibrin deposits. Fifty-nine patients with reflux esophagitis and red lesions (n = 23) or white lesions (n = 36) underwent endoscopically controlled biopsy of selected particles. Histologic analysis confirmed the hypothesis that white lesions are nearly always necroses involving all layers of the squamous epithelium with fibrin deposits (and rarely epithelial hyperplasia), while red lesions are caused by local granulocytic inflammation or granulation tissue with partial reepithelialization. These results suggest that reflux esophagitis Savary Stages I and II can be rationally subclassified into reflux esophagitis with red spots (Stage Ia), white spots (Stage Ib), red streaks (Stage IIa), and white streaks (Stage IIb).

[Percutaneous transhepatic cholangioscopy as a single-step technique]. / Percutan-transhepatische Cholangioskopie in Einschritt-Technik.

The PTCS is a method for diagnostic and therapeutic purpose in patients with common bile duct diseases not suitable for transpapillary approach. The present paper describes a technique which shortens the usual time of treatment and reduces injury. Lithotripsy of common bile duct stones, endoscopic controlled biopsy, introduction and removal of bile duct endoprosthesis as well as percutaneous papillotomy is possible.

[Definition of the Barrett esophagus--results of an endoscopic study with biopsy]. / Zur definition des Barrett-Osophagus--Ergebnisse einer endoskopisch-bioptischen Studie.

There are two different definitions of Barrett's esophagus, a precancerous condition. The first requires circumferentially lining of the lower esophagus with columnar epithelium, the second adds tongue-like projections extending up into the squamous epithelium more than 2 cm. Carcinomas, which develop in a Barrett's esophagus almost ever are associated with metaplasia of the specialized columnar type. Endoscopic-bioptical examinations of columnar lined projections were done with 26 patients altogether. Histologically 8 patients showed metaplasia of the specialized columnar type. These results show that columnar lined projections of the specialized type are part of Barrett's esophagus.

[Peroral and transhepatic cholangioscopy]. / Perorale und transhepatische Cholangioskopie.

Cholangioscopy is possible via the peroral or the transhepatic route. Cholangioscopy is of diagnostic value in tumour strictures and stenoses of the common bile duct. More important than diagnostic cholangioscopy is therapeutic cholangioscopy: with the technique of intracorporeal shockwave lithotripsy nearly all difficult CBD-stones may be successfully treated. 17 patients with 40 CBD-stones were managed in mother-babytechnique in applicating intraductal shockwaves under direct visual control (electrohydraulic principle). Mechanical lithotripsy during ERCP had formerly failed in all patients. In 6 patients transhepatic cholangioscopy with intracorporeal shockwave lithotripsy was successfully performed. Patients had an operated stomach, so conventional ERCP with lithotripsy was not possible. 18 stones could be treated. As a total 23 patients with 58 CBD-Stones underwent cholangioscopy (median stone diameter 20 mm) with intracorporeal shockwave lithotripsy. Complete stone clearance was achieved in all cases, no serious complication occurred.