Endosonographic radial tumor thickness after neoadjuvant chemoradiation therapy to predict response and survival in patients with locally advanced esophageal cancer: a prospective multicenter phase ll study by the Swiss Group for Clinical Cancer Research (SAKK 75/02).

Background: EUS response assessment in patients with locally advanced esophageal cancer undergoing neoadjuvant chemoradiation therapy (CRT) is limited by disintegration of the involved anatomic structures.

Objective: Predictive and prognostic values of a prospectively defined maximum tumor thickness (MTT).

Design: Prospective open-label phase ll study (SAKK 75/02).

Endoscopic ultrasound-guided drainage of abdominal abscesses and infected necrosis.

Traditionally abdominal abscesses have been treated with either surgical or radiologically guided percutaneous drainage. Surgical drainage procedures may be associated with considerable morbidity and mortality, and serious complications may also arise from percutaneous drainage. Endoscopic ultrasound (EUS)-guided drainage of well-demarcated abdominal abscesses, with adjunctive endoscopic debridement in the presence of solid necrotic debris, has been shown to be feasible and safe.

Detection and endoscopic therapy of early esophageal adenocarcinoma.

Purpose Of Review: This review summarizes recent progress on endoscopic diagnosis and treatment of esophageal high-grade intraepithelial neoplasia and early adenocarcinoma and critically analyzes the literature in the context of preexisting scientific data.

Recent Findings: Narrow band imaging and computed virtual chromoendoscopy enhanced visualization of the mucosal morphology. The type of mucosal and capillary patterns seen on narrow band imaging predicted the presence of specialized intestinal metaplasia, high-grade intraepithelial neoplasia and early adenocarcinoma.

Application of bleeding prophylactic criteria (NICE) in patients with acute gastrointestinal bleeding. A Swiss prospective study.

Multiple treatment guidelines for nonsteroidal anti-inflammatory drugs (NSAIDs) suggest that patients with one or more risk factors for NSAID-related ulcer complications should be prescribed preventive strategies such as acid-suppressive drugs, misoprostol or COX-2-specific inhibitors to reduce their risk of serious ulcer complications. However data are lacking as to how many patients have been on preventive measures in accordance to the National Institute for Clinical Excellence (NICE) criteria in our population. We therefore evaluated the extent to which patients with acute gastrointestinal bleeding have been under ulcer-preventive strategies at the time of hospital entry.

[Epidemiology of gastrointestinal bleeding in the elderly].

The epidemiological pattern of gastrointestinal bleed in western countries has been steadily changing over the last few years given the rising prevalence of an elderly population. In a one year prospective study at a referral hospital in Zurich, Switzerland, hospitalised patients were investigated with regards to the epidemiology of gastrointestinal (GI) bleeding. Of 7406 hospitalisations, a total number of 224 GI bleeds were registered (53% women, mean age 71 +/- 16, 63% with relevant co morbidities).

Recurrent acute and chronic pancreatitis in two brothers with familial chylomicronemia syndrome.

The chylomicronemia syndrome is well recognized as a rare etiologic factor of acute pancreatitis; however, whether hypertriglyceridemia can cause chronic pancreatitis (CP) remains unclear. We describe the long-time course of 2 brothers with the familial chylomicronemia syndrome caused by identical compound heterozygous mutations in the lipoprotein lipase (LPL) gene with markedly reduced LPL activity. Other etiologic factors were excluded, including mutations in the PRSS1, SPINK1, and CFTR gene.

Unusual mass in the hepatic portal of an 86-year-old woman.

Varicose veins in the hepatoduodenal ligament and hepatic portal are normally due to cavernous transformation of the portal vein. We present an unusual case of varices of the common bile duct in an asymptomatic 86-year-old woman who was referred to our hospital for evaluation of a suspected cholangiocarcinoma. A cholangiocarcinoma could be excluded, however, and the diagnosis of intramural varicosis of the common bile duct was made with transabdominal colour Doppler sonography.

[The "buried bumper syndrome"--a rare complication of percutaneous endoscopic gastrostomy].

The buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy (PEG). Hereby the PEG bumper is overgrown by hypertrophic gastric mucosa and embedded into the gastric wall. This is probably a consequence of enforced tightening of the PEG tube causing an ulcer in the gastric mucosa.

[Ticlopidine-induced cholestasis].

Unlabelled: We report a case of ticlopidine-induced cholestatic hepatitis.

Case Summary: An 82-year-old man suffered a myocardial infarction in February 1998. Because of persistent angina pectoris a coronary stent was implanted in May 1998.

[Incidence of benign prostatic hyperplasia and hepatic cirrhosis].

We studied the incidence of benign hyperplasia of the prostate and hepatic cirrhosis in an ambulatory cohort. Undisturbed androgen production is one of the prerequisites for the development of benign prostatic hyperplasia. The disturbed metabolic activity of the cirrhotic liver causes often hypoandrogenism.

[Autoimmune hepatitis in Switzerland].

The incidence and course of autoimmune hepatitis in Switzerland are unknown. In an attempt to obtain an overview of all patients at present under treatment in Switzerland for autoimmune hepatitis, we circulated a questionnaire to all Swiss gastroenterologists. Eighteen patients were identified and their symptoms, course and treatment were evaluated.

[Prevention and therapy of NSAID-induced ulcers: fact versus myth].

Non-steroidal antiinflammatory drugs (NSAIDs) are responsible for dyspeptic symptoms in more than 50% of patients. Symptomatic ulcers and ulcer complications occur in less than 5%. In order to avoid these complications during prolonged treatment, the lowest possible NSAID dose should be chosen.

[Effect of non-steroidal antirheumatic agents on the gastrointestinal tract: clinical aspects and pathophysiology].

The major gastrointestinal side effects of non-steroidal antiinflammatory drugs (NSAID) mainly occur in the stomach and duodenum. Acute mucosal lesions are almost always seen but only 50% of patients complain of upper abdominal discomfort. NSAIDs elevate the risk of ulcerations of the stomach or duodenum 4 to 5 fold.

[Tumor staging and follow-up care in rectosigmoid carcinoma: colonoscopic endosonography compared to CT, MRI and endorectal MRI].

Background And Study Aims: Endosonography has become the best available method for local staging of primary rectal cancer and diagnosing recurrent local tumor. The aim of this prospective study is to compare the accuracy of endoscopic ultrasound (EUS), using an echo colonoscope (CF-UM 3, CF-UM 20, Olympus optical) to computed tomography (CT), body coil magnetic resonance imaging (MRI) and endorectal coil magnetic resonance imaging (EMRI).

Patients And Methods: From February 1991 to July 1993 90 patients with primary rectosigmoidal tumors (n = 32: 9 women, 23 men, mean age 68 years [range 37 to 84]) or follow-up examinations for recurrent local cancer (patients: n = 58, examinations: n = 93; 41 women, 52 men, mean age 61 years [range 31 to 84]) were investigated.

Anal sphincter defects in fecal incontinence: correlation between endosonography and surgery.

Background And Study Aims: Endoscopic ultrasound provides accurate information about the anatomy of the anal sphincter. The purposes of this study were to evaluate the use of flexible echo endoscopes to examine the anal sphincters, to validate the diagnosis of internal and external sphincter defects obtained using echo endoscopes by comparison with surgical findings, and to assess the outcome after surgical sphincter repair.

Patients And Methods: Twenty-eight patients (13 women, 15 men, median age 50 years, range 30-83) with fecal incontinence--which was of traumatic origin in all but one (childbirth: n = 8; anorectal surgery: n = 17; biopsy of the prostate: n = 2; no trauma: n =1)--were prospectively investigated by endosonography using an echo colonoscope (n = 14) or an echo gastroscope (n = 14) (CF-UM20, GF-UM20, Olympus Optical).

[Abdominal pain].

A 37-year-old female patient was admitted to our outpatient clinic because of abdominal pain and absence of stool for five days. A diagnosis of acute intermittent porphyria was made by determination of porphyrins in the urine and the stool, the absence of skin symptoms and the measurement of urosynthase activity. As triggering event we suspect a viral infection.

[Endosonography in diagnosis of insulinoma].

Aim: In a prospective study endoscopic ultrasonic localisation of clinically suspected insulinomas was compared with the findings of abdominal ultrasound, computed tomography and magnetic resonance imaging.

Method: From Dec. 1990 to Jan.

Endoscopic ultrasound and endorectal magnetic resonance imaging: a prospective, comparative study for preoperative staging and follow-up of rectal cancer.

Background And Study Aims: Endoscopic ultrasound has become the best available method for local staging of primary rectal cancer and diagnosing recurrent local disease. The aim of this study is to compare the value of endoscopic ultrasound (EUS) to magnetic resonance imaging with an endorectal coil (EMRI).

Patients And Methods: Twenty-one patients (11 women, 10 men, mean age 63 years, range 31-79) with primary rectal cancer (n = 6) or follow-up examinations for recurrent local disease (n = 15) were investigated by EUS using an echo colonoscope (CF-UM 20, Olympus Optical) and by endorectal coil MRI on a 1.

[Gastrointestinal hormone profile in medullary thyroid carcinoma].

Medullary thyroid carcinoma (MTC) can be important for gastroenterologists because 20-30% of patients with MTC suffer from chronic diarrhea and the tumor is capable of producing--besides other bioactive substances--a multitude of gastroenteropancreatic hormones. Gastrointestinal hormone profiles of 5 patients with MTC were determined both basally and after intravenous stimulation with secretin and calcium respectively. Diagnosis of MTC was confirmed histologically or cytologically and by demonstration of elevated serum concentration of calcitonin both basally and after calcium stimulation.

[Dilatation of the common bile duct: what does endoscopic sonography contribute?].

In a prospective study 20 patients (14 women, 6 men; mean age 62 [31-81] years) with extrahepatic obstructive jaundice (n = 15) or common bile duct dilatation (CBD) without cholestasis (n = 5) were investigated by endoscopic ultrasound (EUS). All these patients underwent negative transabdominal ultrasonography (US) (n = 20) and computed tomography (CT) (n = 16). Inclusion criterion was a dilatation of the CBD of > 7 mm or > 10 mm in patients with previous cholecystectomy.

Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging.

Purpose: To compare the value of endosonography (endoscopic ultrasound [US]), dynamic computed tomography (CT), and magnetic resonance (MR) imaging in the evaluation of pancreatic tumors.

Materials And Methods: Forty-nine consecutive patients with clinical suspicion of pancreatic tumor underwent endoscopic US (n = 49), CT (n = 46), and MR imaging (n = 25). The final diagnosis of a malignant (n = 22), benign (n = 2), or inflammatory (n = 9) tumor, or no (n = 16) tumor was made at surgery (n = 28) and/or a combination of biopsy (n = 9) and 9-24-month follow-up (n = 12).