Weekly cisplatin may reverse liver dysfunction and jaundice caused by diffuse liver metastases of solid tumors.

Few data are available on patient management in jaundice caused by liver metastases of solid tumors (nonbreast and noncolon origin). We report the first patient series consecutively treated with cisplatin weekly in patients with severe jaundice and liver failure due to underlying metastatic neoplasms. In 4 out of 8 cases, liver function tests were reversed and jaundice disappeared, permitting subsequent standard chemotherapy. The other 4 patients died 3 to 5 weeks after admission, illustrating the extent and severity of the underlying neoplasm.

Endoscopic dilatation and papillotomy of the accessory papilla and internal drainage in pancreas divisum.

In the case of pancreas divisum the minute orifice of the minor papilla has offered a special challenge to endoscopic diagnosis and therapy. Here we describe a method for easy cannulation of the minor papilla and drainage of the pancreatic duct. By means of a flexible guide wire and a dilator, the tiny papilla can be simply dilated, enabling papillotomy to be successfully accomplished. This method has been used in six cases without any major complications, and should pave the way for diagnosis and therapy of pancreas divisum.

Endoscopic obliteration of large esophagogastric varices with bucrylate.

We report on three patients with severe recurrent bleeding from large esophagogastric varices which could not be controlled by conservative treatment or sclerotherapy. In these cases the bleeding was successfully arrested by intravascular injection of Bucrylate.

Morphological alterations of the esophagus after endoscopic sclerotherapy of varices.

With the combined peri- and intravascular sclerosing technique esophageal varices can be completely eliminated in an average of three treatment sessions. In order to check the success of the procedure, endoscopic and histological findings at the various stages of treatment after sclerosing with 1% Polidocanol were compared. Clinical and autopsy findings are in agreement. After sclerosing, necroses of the mucosa and intramural inflammations occur regularly in the first week. The varices are thrombosed. Later, the inner wall of the esophagus is cicatricially changed. Histologically the fibroses extend transmurally and in some parts even reach the musculature.

[Hepatosplenic granulomatosis with portal hypertension]. / Hepatolienale Granulomatose mit portaler Hypertension.

A 40-year-old female patient was admitted with bleeding from esophageal varices. The histology of liver and spleen showed granulomatous infiltrations that had developed without symptoms so far. The portal hypertension and a thrombopenic bleeding diathesis gave rise to the establishment of a splenorenal shunt with exstirpation of the spleen. By this the patient could be cured symptomatically, as three years after the acute episode liver functions are still normal. In the light of this case, pathogenesis, the variety of etiologies and the clinical courses of granulomatous liver diseases are discussed in detail with regard to the differential diagnosis.

[Experiences with fiber endoscopy sclerosing of esophageal varices with polidocanol]. / Erfahrungen über die fiberendoskopische Osophagusvarizenverödung mit Polidocanol.

Endoscopic sclerosing of oesophageal varices is only a palliative measure, which should be performed when the bleeding came to a standstill. The aim of treatment is to sclerose all visible varices in the oesophagus. This can be done with intervals in 4 to 5 weeks. Anaesthesia is not necessary. We observed perforations in 1%, stenosis of the oesophagus in 10% (n = 414 cases), treated in the last 4 years. The results obtained until now confirm our impression that, at present, injection sclerotherapy is the method of choice.

[Endoscopic injection for haemostasis in the gastrointestinal tract]. / Endoskopische Injektionsmethode zur Blutstillung im Verdauungstrakt.

Haemostasis by endoscopic injection was attempted in 169 patients with acute gastrointestinal haemorrhage between 1976 and 1982. Despite various caused initial haemostasis in the upper and lower digestive tract was achieved in 95%. Recurrences were seen in 10%. Definitive haemostasis thus was 85%. Best results were obtained in Mallory-Weiss syndrome, angiodysplasia and post-polypectomy haemorrhage. The success rate for gastroduodenal ulcers was around 75 to 80%. Until now no complications have been observed. Apart from effectiveness, the injection method has the advantage of simplicity and little technical needs over other procedures.

Early post-operative endoscopy after biliary tract surgery.

Immediate post-operative complications such as obstructive jaundice, biliary fistulae or gastrointestinal hemorrhage, occurring after biliary tract surgery can be diagnosed endoscopically. The causes of bile flow obstruction and leakage from the common bile duct can be identified using ERC. In many cases the diagnosis can be followed by endoscopic treatment, therefore obviating re-laparotomy. Between 1972 and 1979 we carried out early post-operative ERC or esophago-gastro-duodenoscopy in a total of 94 patients after biliary tract surgery. In 75 patients with residual gallstones and 4 cases with overlooked stenoses of the papilla, successful papillotomies were carried out. The procedure was unsuccessful in one case with an extremely narrow papilla. Complete removal of stones was achieved in 72 cases. In two other patients with gastroduodenal stress ulcers, bleeding was stopped by submucosal infiltration.

[Fiberscopic obliteration of esophageal varices (author's transl)]. / Fiberendoskopische Verödung von Oesophagusvaricen.

We are reporting our 2 years experience in the fiberscopic sclerotherapy of esophageal varices. 170 patients from 15-83 years of age were treated (61 females and 109 males), the majority being around 50 years of age. In 162 cases, the cause of the portal hypertension was cirrhosis of the liver and in 8 cases thrombosis of the splenic or portal vein. 47 patients were treated during acute bleeding, 101 in the interval, and 22 prophylactically. Using the modified intravascular technique, most varices could be sclerosed after a maximum of three treatments. In 83%, acute hemorrhages were stopped. The hospital mortality amounted to 30%, while in the interval group only it was 5%. None of the prophylactically treated patients died during their stay in hospital. The mortality after an average of 11.2 months amounted to 11.8%: The main cause was liver failure. Bleeding reoccurred in 11.2% and resulted in death in every fifth case. The most common complication, namely stenosis, arose in 16 cases and 4 of these necessitated dilation therapy. Esophagothoracic fistulae occurred in 2 cases and could be cured by siphon drainage. The rate of complication amounted to 10.6%, without any lethal outcome.