Colonoscope with a sub-distal hyper-flaccid segment for improved insertion at colonoscopy: a randomized study.

BACKGROUND: In sharp bends, particularly in the colonic flexures, the axial pushing force conveyed to the distal actively bending tip of the endoscope may cause impaction rather than progression. It is hypothesized that colonoscopes with a very flaccid segment immediately proximal to the distal bending tip might reduce this problem. MATERIAL AND METHODS: Two prototype colonoscopes with a flaccid passively bending segment (either progressively graded or ungraded flaccidity) positioned immediately proximal to the distal actively bending tip was evaluated in a single-blinded randomized study. The primary end-point was patients' evaluation of pain. RESULTS: Altogether, 400 patients were randomized 1:1 to examination with a prototype (60 patients to endoscope with graded flaccidity; 141 to the endoscope with ungraded flaccidity) or a standard colonoscope. The groups were similar regarding age, sex and previous abdominal surgery. Severe pain was reported by 7% of patients in the prototype and 18% in the standard group (p = 0.001). There was a trend toward shorter cecal intubation time in the prototype group (mean 14.1 min, 95% CI 12.8-15.3) compared to the standard group (mean 15.5 min, 95% CI 14.3-16.7) (p = 0.12) and similar intubation rates (89% and 85%, respectively). Results for first (ungraded flaccidity) and second (graded flaccidity) generation prototypes collectively were similar to the second generation separately. CONCLUSIONS: The concept of an endoscope with a hyper-flaccid segment may facilitate negotiation of sharp bends and reduce pain without compromising cecal intubation rate or intubation time.

[Gastrointestinal stromal tumors (GIST). Clinical characteristics, diagnosis, and therapy in five cases]. / Gastrointestinale Stromatumoren (GIST) Klinische Charakteristika, Diagnostik und Therapie anhand von fünf Fallberichten.

Gastrointestinal stromal tumors (GIST) are rare causes of gastrointestinal bleeding. In most cases these tumors are localized in the stomach and small intestine, more rarely in the esophagus and colon.Pluripotent mesenchymal cells are the suspected origin of GIST. The pathogenesis is obviously initiated by gene mutations, leading to an overexpression and activation of tyrosine kinase proteins. This activation is followed by uncontrolled proliferation and loss of apoptosis. The immunohistochemical detection of the protein CD 117 (c-kit) is an important diagnostic tool. Activating c-kit mutations are observed in most cases of GIST. Grading of GIST remains a problem. Size and mitotic rate are the most powerful predictive factors associated with malignant behavior. The most common symptoms of GIST are pain and gastrointestinal bleeding. Endoscopy, sonography, scintigraphy or radiology -- enteroclysma, computed tomography (CT) and magnetic resonance imaging (MRI) -- are possible methods to detect a GIST. Surgical resection is the standard therapy of GIST. In cases of metastatic GIST, systemic therapy with imatinib, a tyrosine kinase inhibitor, frequently leads to partial remission and clinical improvement. Only few side effects are described. Five patients with GIST are reported. In all cases gastrointestinal bleeding was the main symptom. All tumors were surgically resected, and no signs of recurrence or metastasis have been observed in any of the patients so far (19-51 months postoperatively).