[Endoscopic argon plasma coagulation of Barrett mucosa]. / Endoskopische Argon-Beamer-Koagulation der Barrett-Mukosa.

BACKGROUND: Up to 10% of patients with Barrett's esophagus develop adenocarcinoma of the distal esophagus. Endoscopic surveillance is recommended. We studied the potential of Argon plasma coagulation (APC) for eradication of Barrett's esophagus. METHODS: Indication for APC was the histologic evidence of columnar epithelium with a length of > or = 2 cm, located proximal of the cardia and with the presence of goblet cells. Endoscopic therapy was performed using an Argonbeamer (Beamer 2, Erbe Company, Tübingen, Germany) under i.v. sedation and repeated in intervals of 2-3 weeks with the aim of complete eradication of Barrett's epithelium. One month after macroscopic Barrett eradication, superficial and deep biopsies were obtained every 2 cm in 4 quadrant technique to confirm the endoscopic aspect of complete eradication. RESULTS: We report our results (follow-up median: 12 mths., 3-25) in the first 12 patients (8m/4f, median age 57 yrs., 42-69) in which treatment was completed. In one case there was evidence of moderate dysplasia. A mean of 5 (4-11) sessions were required for complete Barrett eradication in 11 patients (median size of Barrett-segment: 4 cm, range 2-11), in one patient partial regression of 50% was observed treatment was discontinued after 17 sessions while only. Deep biopsies showed subepithelial columnar epithelium islands in one case, recurrence of Barrett occurred in 2 cases after 3 and 6 months. Under APC-treatment, 11/12 patients complained about retrosternal pain and odynophagia. No other complications were observed. CONCLUSION: Our preliminary results indicate that APC is safe and effective to eradicate Barrett's epithelium. Follow-up in a larger number of patients is necessary to assess longterm results (Barrett recurrence, decrease in the incidence of the adenocarcinoma), before APC may generally be recommended.

Metabolic long-term follow-up of the ileal neobladder.

In recent years urinary diversion using long gut segments has become increasingly popular. Accordingly, beside the development of metabolic acidosis, some concern has been raised as to the development of malabsorption syndromes. Until now no detailed study has been published on a long-term follow-up of this problem. Therefore this study was performed to investigate various absorption parameters of different metabolic systems in 30 patients with an ileal neobladder. The resulting data revealed no major or severe changes in the absorptive parameters, therefore orthotopic urinary diversion with the ileal neobladder seems to be a safe procedure with regard to the development of malabsorption syndromes.

[The functional, augmented rectal bladder. Initial clinical experience with 10 patients]. / Die funktionelle, augmentierte Rektumblase. Erste klinische Erfahrungen an 10 Patienten.

From August 1988 until March 1990, 10 female patients received an augmented, functional rectal bladder, according to the technique first described by Kock. Indications were a radical cystectomy in 8 and a rediversion from a previously wet stoma in 2 patients. There was no perioperative mortality. Postoperative complications were obstructive pyelonephritis (1 case, treated with a temporary nephrostomy), obstruction at the ileal intussusception (1 case; operative revision) and slipping at the sigmoid nipple (1; no treatment). Intravenous pyelography 2-3 months postoperatively showed 13 normal and 5 slightly dilated renal units. All patients are completely continent by day, 7 are continent by night, 2 wear sanitary pads during sleep due to occasional spotting. Preliminary experience with this new technique is encouraging and warrants further clinical application in patients in whom the external urethral sphincter is not available to provide the continence mechanism.

Functional, augmented rectal bladder: early clinical experience.

From August 1988 until March 1990, 10 female patients received an augmented, functional rectal bladder according to the technique first described by Kock. Indications were radical cystectomy in 8 and undiversion from a previously wet stoma in 2 patients. There was no perioperative mortality. Postoperative complications were: one obstructive pyelonephritis (treated with a temporary nephrostomy); one obstruction at the ileal intussusception (operative revision), and one slipping at the sigma nippel (no treatment). Intravenous pyelographies taken 2-3 months postoperatively, showed 13 normal and 5 slightly dilated renal units. All patients are completely continent by day, 7 are continent at night, 2 wear sanitary pads during the night due to occasional spotting. The preliminary experience with this new technique is encouraging and warrants further clinical application in patients in whom the external urethral sphincter is not available as continence organ.

The functional rectal bladder--prevention of hyperchloremic acidosis following vesico-sigmoidostomy in dogs.

Urinary diversion by a vesico-sigmoidostomy was performed in fourteen dogs. The animals were randomly divided into two groups. Group 1 had an isoperistaltic intussusception of the sigma proximal to the vesico-sigmoidostomy. Group 2 was used as control without intussusception. In the postoperative course, serum creatinine, chloride, pH, bicarbonate, base-excess were controlled over a period of four months twice weekly. Additionally, IVPs were taken in all dogs and rectograms performed in the intussuscepted group. While IVPs and creatinine values demonstrated normal postoperative kidney function in all dogs of both groups, acidbase parameters including chloride were significantly (p less than 0.001, Wilcoxon test) better in group 1. Intussusception of the sigmoid colon is a reliable operative way to significantly reduce hyperchloremic acidosis in the course of urinary diversion into the sigmoid colon, while the fecal stream remains undisturbed.