Instant evaluation of contrast enhanced endoscopic ultrasound helps to differentiate various solid pancreatic lesions in daily routine.

Background: Contrast enhanced harmonic endoscopic ultrasound (CEH-EUS) is a spreading technique; some studies have shown its value in the diagnosis of pancreatic adenocarcinoma using quantitative analysis.

Aim: To examine the value of CEH-EUS for differentiating various pancreatic lesions in everyday routine with qualitative and quantitative analysis.

Methods: Data of 55 patients with pancreatic lesions who underwent CEH-EUS were analysed retrospectively.

Contrast-enhanced harmonic endoscopic ultrasound is able to discriminate benign submucosal lesions from gastrointestinal stromal tumors.

Background: Although endoscopic ultrasound (EUS) has improved the diagnostic of potential malignancies, gastric lesions with suspicion of gastrointestinal stromal tumors (GIST) or benign lesions like lipoma or leiomyoma can often not be accurately differentiated by EUS, therefore, requiring tissue sampling with the risk of bleeding complications especially in GIST. As with the newest generation of EUS machines, contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) has become a new option to determine perfusion characteristics. The aim of this analysis was to evaluate whether CEH-EUS may help to discriminate various submucosal lesions.

Follow-up endoscopy in gastroenterology: when is it helpful?

Background: The indications for follow-up endoscopy have not been established in all diseases that can be diagnosed by endoscopy.

Methods: Selective review of the literature and a survey of national guidelines.

Results: In confirmed erosive or non-erosive reflux disease, follow-up endoscopy is indicated only in the presence of complications or Barrett's esophagus.

Hyperamylasaemia and/or hyperlipasaemia: incidence and underlying causes in hospitalized patients with non-pancreatic diseases.

Objective: There are no recommendations on how to proceed in patients with increased pancreatic enzyme activities but non-pancreatic diseases. The objective of this study was to investigate prospectively in a general medical hospital the incidence, causes and clinical impact of hyperamylasaemia and/or hyperlipasaemia in these patients.

Material And Methods: During a 4-month period in 2004, amylase and lipase activities were measured in all patients (n, 1765) admitted to the Department of Internal Medicine of the Municipal Clinic of Lüneburg, Germany.

[Chronic pancreatitis--rational diagnosis and therapy. Which procedures are relevant for general practice?].

Chronic pancreatitis is characterized clinically by recurrent or persistent abdominal pain, as well as exocrine, and possibly also endocrine, pancreatic insufficiency. The diagnosis is established with the aid of imaging procedures and the investigation of pancreatic function. Treatment comprises pain amelioration, possibly also applying endoscopic and surgical measures, and the treatment of exocrine and endocrine insufficiency.

[Diagnosis and therapy of chronic pancreatitis].

Chronic pancreatitis is characterized by recurrent or persisting pain. As the exocrine pancreatic insufficiency occurs early in the progression of the disease, the endocrine function may persist intact. Imaging procedures and pancreatic function tests are used to make a diagnosis.

[Acute pancreatitis].

While interstitial acute pancreatitis usually takes a benign course, necrotizing acute pancreatitis takes a severe course, mainly because of severe local and systemic complications. After a quick diagnosis it is necessary to rapidly assess a degree of severity of the disease and thus the prognosis. The clinical picture and the result of imaging procedures do not always correspond.

Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal.

Objective: A study was designed to reevaluate hemoconcentration as an early marker of severe and/or necrotizing pancreatitis and compare it against contrast-enhanced CT, the gold standard to diagnose acute necrotizing pancreatitis.

Methods: This prospective study covers the years 1988-1999 for 316 patients (202 male, 114 female) with a first attack of acute pancreatitis. The role of the hematocrit as an early marker of severe and/or necrotizing pancreatitis has been retrospectively evaluated against the prospectively obtained data.

Does gastroscopy induce myocardial ischemia in patients with coronary heart disease?

Background And Study Aims: Gastroscopy has been reported to be dangerous for unstable patients with coronary heart disease (CHD). The aims of this study were to find out whether endoscopy is equally liable to cause myocardial ischemia in stable CHD patients, and whether this can be predicted prior to endoscopy, and to find out the frequency of abnormal findings in patients for whom a secondary prophylaxis with acetylsalicylic acid (ASA) is indicated.

Patients And Methods: Electrocardiograph recording using a Holter monitor was performed during gastroscopy in 71 patients with stable CHD, to check for silent ischemia.

Gallstone ileus: endoscopic removal of a gallstone obstructing the upper jejunum.

In a 91-year-old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically.

Secretin-pancreozymin test (SPT) and endoscopic retrograde cholangiopancreatography (ERCP): both are necessary for diagnosing or excluding chronic pancreatitis.

Results of the SPT and the ERCP staged for their severity were compared in 202 patients. The correlation between both investigations was significant (p < 0.001); however, ERCP showed significantly more severe changes (p = 0.

Acute abdominal pain in chronic pancreatitis: hemorrhage from a pseudoaneurysm?

An alcoholic, 67-year old retired male nurse complained of abdominal pain, loss of appetite and weight loss of 10 kg within one year. Based on elevated serum enzyme levels, ultrasonography and computed tomography examinations, an acute attack of chronic pancreatitis with several pancreatic pseudocysts was diagnosed. Ultrasonographically, an 1.

Painless acute pancreatitis mimicking pancreatic carcinoma.

Painful acute pancreatitis masking pancreatic carcinoma and painless acute pancreatitis with shock or coma as leading symptoms have been described before. We report a first case of almost-painless pancreatitis mimicking pancreatic carcinoma with spontaneous normalization of symptoms and biochemical as well as imaging procedure findings.

A new fine needle for easier, single handed, ultrasound-guided biopsies, requiring less advancing forces into solid organs.

A fine punch needle with a new bevelled geometry for easy, single-handed, ultrasound-guided biopsies is presented. The needle requires a significantly lower advancing force compared with the commonly used punch needles of the Menghini type. Since, therefore, our needle penetrates the organs to be investigated easier, it enables the puncture of easily movable (stomach, gut) and/or solid organs (kidney) with the yield of sufficiently long punch cylinders.

Chronic nausea as the leading symptom: an indication for double-contrast examination of the upper intestinal tract following normal gastroscopy.

We report a patient with chronic nausea as the leading symptom of a primary carcinoma of the duodenum located at the flexura duodeno-jejunalis. The tumour was not reached at gastroscopy, which was performed twice. Since this area usually cannot be seen upon gastroscopy or upon small bowel enteroclysma according to Sellink, a double-contrast investigation of the upper gastrointestinal tract using a hypotonic agent should be performed when nausea persists although gastroscopy is normal.

Acute pancreatitis: induced by heroin intoxication?

Hyperamylasemia has been reported in heroin addicts and ascribed to an increase of salivary isoamylase. Ours is the first report on acute pancreatitis in a heroin user. All prognostic parameters indicating a severe course of the disease were present, and computed tomography showed an edematous pancreatitis, but the acute pancreatitis took a benign clinical course.

Splenic lesion as a complication of laparoscopy. Case report.

A case of splenic lesion is reported in a 48-year-old female patient who underwent an uneventful diagnostic laparoscopy. Symptoms suggesting massive intraabdominal bleeding occurred 5 hours later. Intraoperatively, a small posterior splenic lesion was found, which could be repaired using fibrin glue.

Prospective study of the incidence of ultrasound-detected hepatic hematomas 2 and 24 hours after percutaneous liver biopsy.

Recently, a high incidence of hepatic hematomas following percutaneous liver biopsy was reported. This induced us to undertake this prospective ultrasound examination before, as well as 2 and 24 h after, percutaneous liver biopsy, using a Menghini needle (O 1.4 mm), in 93 patients for diagnostic purposes.