Obscure gastrointestinal bleeding: a complication of radiation enteritis diagnosed by wireless capsule endoscopy.

Obscure gastrointestinal bleeding is a common disorder and may account for as many as 5% of all gastrointestinal hemorrhages. It is often caused by lesions in the small intestine, which were very complicated to examine prior to the advent of wireless capsule endoscopy. Here we present the case of a 31-year-old woman with obscure gastrointestinal bleeding as a complication of radiation enteritis, which was diagnosed only after she underwent an examination with wireless capsule endoscopy. This technique has proven to be far superior to other radiographic and endoscopic methods in diagnosing obscure gastrointestinal bleeding and pathologies of the small intestine in general.

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients.

BACKGROUND: Endoscopic sphincterotomy without cholecystectomy is a therapeutic option in selected patients after acute biliary pancreatitis. We conducted a prospective evaluation of the long-term effects of sphincterotomy in terms of the need for of subsequent cholecystectomy and the recurrence of gallstone pancreatitis. METHODS: We studied 88 patients with acute biliary pancreatitis and an intact gallbladder who, underwent endoscopic sphincterotomy either because they were high-risk candidates for surgery or because they had refused of cholecystectomy. The median follow-up was 51 months (range, 5-86). RESULTS: Only two patients (2.2%) experienced recurrent pancreatitis. Subsequent cholecystectomy was performed in 10 patients because of acute cholecystitis in eight cases and biliary colic in two cases. Sixty-six patients (75%) remained asymptomatic. CONCLUSIONS: Endoscopic sphincterotomy is a safe and acceptable alternative to cholecystectomy for the prevention of recurring attacks of gallstone pancreatitis. As a result of this procedure, 75% of patients remained free of symptoms in the long term.

Treatment of achalasia with the Witzel dilator: a prospective randomized study of two methods.

BACKGROUND AND STUDY AIMS: Several studies have shown that the use of the Witzel dilator is an effective and safe treatment for achalasia. However, the optimal values for pressure, number of dilations, and duration of application have not yet been established. The aim of this study was to determine these three parameters. PATIENTS AND METHODS: 43 patients with a diagnosis of achalasia (based on clinical, radiological, manometric and endoscopic evaluation) were randomly allocated to one of two treatment groups. Patients in group A (n=21) underwent three consecutive 1-minute dilations per session at 1-minute intervals, at 200 mmHg for the first dilation and 300 mmHg for the second and third. In group B patients (n=22) only one dilation was done, at 200 mmHg for 2 minutes. Before and after treatment, the clinical score, the maximum esophageal diameter (obtained using barium contrast studies) and the basal pressure of the lower esophageal sphincter were evaluated in each patient. The need for further treatment and the presence of complications were also determined. RESULTS: Both methods led to clinical, radiological, and manometric benefits. No differences were observed between the methods (satisfactory results in 86%; one perforation in each group). Six patients underwent operation; five for an incomplete response and one for a perforation. CONCLUSIONS: There were no differences between the two groups investigated, suggesting that only one 2-minute dilation at 200 mmHg is sufficient.