Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies.

Background And Study Aims: Data on process quality and complications of colonoscopies are sparse, especially for the screening setting. We describe process quality in routine care, estimate the incidence of acute complications, and identify risk indicators for substandard care and complications.

Patients And Methods: We analyzed data from 236 087 compulsory health insurance (CHI) members who underwent colonoscopies in 2006.

Characteristics of metachronous colorectal adenomas found during long-term follow-up: analysis of four subsequent generations of adenoma recurrence.

Objective: Because of the high recurrence rates of colorectal adenomas, regular surveillance by colonoscopy has been recommended, but there is still a dearth of information on the long-term results of follow-up colonoscopy after polypectomy. The aims of this study were to determine the differences between initial adenomas and metachronous lesions, to evaluate the effect of long-term surveillance and to describe the hypothetical origin of the colorectal adenoma-carcinoma sequence.

Material And Methods: Between 1978 and 2003 a total of 1091 patients undergoing periodic surveillance examinations were prospectively documented at the Erlangen Registry of Colorectal Polyps.

Risk of advanced metachronous colorectal adenoma during long-term follow-up.

Background: According to the adenoma-carcinoma concept, all colorectal adenomas are to be removed and all patients have to undergo regular surveillance examinations. But there is still shortage on information on the long-term results of follow-up colonoscopy after polypectomy.

Methods: Between 1978 and 2003, more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps.

Benefit-risk analysis of different risk-related surveillance schedules following colorectal polypectomy.

Background/aims: For colorectal screening patients a gain of life time was previously calculated to be about 30-50 days. Different recommendations for recognizing at-risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published. However, no benefit-risk analysis regarding specific long-term effects of follow-up patients has been reported to date.

Follow-up after colorectal polypectomy: a benefit-risk analysis of German surveillance recommendations.

Objective: For colorectal screening patients a mean gain of life time was previously calculated of about 30-50 days. Different recommendations for recognising at-risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published. However, no benefit-risk analysis regarding to specific long-term effects of follow-up has been reported to date.

[Recurrent bouts of fever accompanied by abdominal pain and emesis].

A 34 year-old Turkish patient was admitted to hospital several times with the same symptoms of abdominal pain, fever up to 39.2 degrees C and vomiting. The diagnosis always was an acute attack of chronic pancreatitis.

Low-molecular-weight heparin does not prevent acute post-ERCP pancreatitis.

Background: Studies suggest that heparin has anti-inflammatory effects that could prevent acute post-ERCP pancreatitis. The aim of this investigator-initiated, prospective, randomized, double-blind, multicenter study was to determine whether low-molecular-weight heparin can prevent acute post-ERCP pancreatitis.

Methods: Patients at increased risk for acute post-ERCP pancreatitis based on assessment of known risk factors were randomized to receive low-molecular-weight heparin (Certoparin 3000 IU subcutaneously) or placebo (saline solution 0.

Endoscopic placement of nasojejunal tubes: a randomized, controlled, prospective trial comparing suitability and technical success for two different tubes.

Background: Jejunal feeding is an attractive means for delivering nutrients to critically ill patients. Nasojejunal tubes may have different advantages and disadvantages that may have important clinical implications.

Methods: To compare the suitability of 2 different nasojejunal feeding tubes (Tube A, Dobbhoff; Tube B, Freka-Trelumina) for use by endoscopists and nursing staff, a randomized, controlled, prospective trial was performed in 60 patients.

Risk related surveillance following colorectal polypectomy.

Background: Patients who have had a colorectal adenoma are likely to develop a metachronous adenoma and therefore need to be kept under surveillance. It is essential to avoid unnecessary examinations by tailoring the frequency of follow up examinations to individual risk.

Methods: A total of 3134 patients undergoing endoscopic removal of colorectal adenomas were prospectively recorded on the Erlangen Registry of Colorectal Polyps between 1978 and 1996.

Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP?

Background: An exploratory analysis of a prospective study of risk factors for acute pancreatitis after ERCP combined with endoscopic sphincterotomy showed that the frequency of acute pancreatitis was lower in patients who received heparin compared with patients not treated with heparin. The study was continued to further analyze the effect of heparin on the frequency of acute pancreatitis.

Methods: Potential risk factors for acute pancreatitis and outcomes were evaluated prospectively for all ERCP procedures with endoscopic sphincterotomy performed between September 1994 and December 1998.

Abdominal actinomycosis: complication of endoscopic stenting in chronic pancreatitis?

Pancreatic endotherapy is frequently performed in patients with chronic pancreatitis and stenoses of the main pancreatic duct. In a patient with long-standing chronic pancreatitis and treatment with pancreatic stents, metastatic pancreatic head carcinoma was suspected because of infiltration of the neighboring organs and hepatic lesions. Ultrasound-guided aspiration of one liver lesion revealed grains typical for actinomycosis.

Right-sided shift found in metachronous colorectal adenomas.

Background And Study Aims: Patients who have had a colorectal adenoma are likely to develop a metachronous adenoma, and therefore need to be kept under surveillance. The question is whether metachronous adenomas will be found at the same anatomical site as the preceding adenomas, thus prompting us to focus surveillance examinations on this region, using flexible sigmoidoscopy or total colonoscopy.

Patients And Methods: Between 1978 and 1996 a long-term follow up of 1091 patients was prospectively documented at the Erlangen Registry of Colorectal Polyps.

[Ileocecal manifestation of Schoenlein-Henoch purpura as a rare differential Crohn disease diagnosis].

In the case of a 21-year-old patient gastroscopy and coloscopy were performed because of recurrent abdominal pain with diarrhea and vomiting. Colonoscopy showed moderate signs of inflammation of the rectum and aphthoid ulcerations in the terminal ileum. Since the macroscopic and clinical presentation was compatible with Crohn's disease, therapy with sulfasalacine was started.

Microsatellite instability in colorectal adenomas: relevance and clinical importance.

A number of investigations have recently been published on the role of microsatellite instability (MSI) in the process of colorectal carcinogenesis. The data concerning colorectal adenomas are difficult to compare (due to differences in the tumor collection, selection and number of analyzed loci, definition of high and low instability and histological types), and this review therefore examines the significance of the results of these publications. We then discuss the extent to which MSI and its effects on the integrity of the genome are early or late events in the malignant transformation, and which clinicopathological features are presented by MSI-positive adenomas.

In vivo efficacy of heated and non-heated humidifiers during nasal continuous positive airway pressure (nCPAP)-therapy for obstructive sleep apnoea.

Upper airway dryness is a frequent side-effect of nasal continuous positive airway pressure therapy (nCPAP) in obstructive sleep apnoea (OSA). In this situation, heated or non-heated passover humidifiers are often added to the nCPAP-therapy. The efficacy of these two modes in terms of increasing the absolute humidity of the inspired air in vivo has so far not been established.

Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study.

Background: Anthranoid laxatives are the most commonly used purgatives in the therapy of acute and chronic constipation. Recent experimental data and a prospective cohort study provide evidence of a possible risk of anthranoid use for the development of colorectal neoplasms.

Materials And Methods: We performed a prospective case control study at the University of Erlangen to investigate the risk of anthranoid laxative use for the development of colorectal adenomas or carcinomas.

K-RAS-2 gene mutations as predictors of metachronous colorectal adenomas.

Background: Mutations of K-RAS-2 gene and tumour suppressor genes have been found in both colorectal adenomas and carcinomas. The aim of this study was to investigate the prognostic value of K-RAS-2 gene mutations found in initial colorectal adenomas for predicting the risk of metachronous adenomas.

Methods: Genomic DNA was extracted from formalin-fixed and paraffin-embedded adenomas larger than 5 mm in diameter removed at the initial total colonoscopy between 1980 and 1982.

Invasive carcinoma in colorectal adenomas: multivariate analysis of patient and adenoma characteristics.

Background And Study Aims: The risk of invasive carcinoma developing in colorectal adenomas is influenced by a number of characteristics, relating both to the patients and to the adenomas, and by the composition of the sample analyzed. The aim of the present study was use a multivariate analysis to investigate the risk of invasive carcinoma in endoscopically and surgically removed adenomas.

Patients And Methods: Between 1978 and 1993, more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps.

Differences between colorectal adenomas removed endoscopically and surgically.

Background/aims: To date, risk factors for severe dysplasia in colorectal adenomas have been studied mainly in endoscopically removed material. The aim of this study was to determine whether there are any differences between adenomas removed endoscopically and surgically in terms of patient and polyp characteristics.

Methodology: Between 1978 and 1993, 5092 consecutive patients with 9874 colorectal adenomas attending the Medical and Surgical Departments of the University of Erlangen were prospectively documented in the Erlangen Registry of Colorectal Polyps, and statistically examined using regression analysis.

Melanosis coli--a harmless pigmentation or a precancerous condition?

Unlabelled: Melanosis coli has long been considered as a harmless pigmentation of the colorectum associated with the use of laxatives containing anthraquinone. Recent experimental and clinical studies, however, have provided some evidence of a possible association between melanosis coli/laxative use and colorectal cancer.

Methods: In 2.

Risk of invasive carcinoma in colorectal adenomas assessed by size and site.

Background: The risk of invasive carcinoma developing in colorectal adenomas is influenced by a number of characteristics of both patients and adenomas, and the composition of the sample analysed.

Patients And Methods: Between 1978 and 1993 more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps, and analysed statistically by logistic regression.

Results: The size of the adenomas proved to be the most important factor for adenomas equal to or larger than 15 mm as compared with smaller lesions.

[Abscess development caused by ingrown nitinol spiral as a fatal complication of a partially deteriorated MEMOSOND-PEG].

Percutaneous endoscopic gastrostomy (PEG) is a safe method with a low complication rate for providing enteral nutrition. While the "pull" method is the standard technique for PEG placement, alternatively "push" methods were developed in order to minimize peristomal wound infections caused by micro-organisms from the oropharyngeal cavity. Intragastral fixation of the "push" type PEG tube has always been a problem.